Would you recommend fillers or lower facelift for slight jowling in 44 year old?

Question

Hello. I had laser treatment on my face to help with melasma. As a result, I have lost skin elasticity and fat in my cheeks and now have a pulling down feeling and jowls in my lower face. I have never had fillers before and would like your opinion on what would help correct jowling. I am considering fillers or a lower facelift. Thank you..

Amir Nakhdjevani, MBBS, MRCS, FRCS(Plast) · Answer

Thank you for your question, unfortunately your pictures are not clear to give an option.  People are thinking about having facelift surgery at a young age now.  However, you do not want to have a facelift too young as the difference will be minimal compared to the money spent.  This will result in you being unhappy.  The facelift I perform is under a local anaesthetic which means a significantly reduced downtime.
Most of my patients want a facelift however do not want the downtime associated.  The Concept Facelift and Necklift is the procedure I perform, which combines the latest surgical techniques with the use of local anaesthetic to dramatically reduce the risks associated with traditional facelifts, while significantly reducing the bruising and downtime of your recovery, from months to a matter of days. 
If you have lax facial skin, lost volume and feel that you have jowls and wrinkles on your cheeks and you look tired when you're not then the concept facelift can help improve your appearance. With concept facelift you will look natural and fresh just like the way you feel inside. There are no bandages, drains and hospital stay but with lasting results of traditional facelift techniques it fits with today's age.
This can be combined with resurfacing options such as chemical peels or laser which gives your skin a glow and helps the appearance of acne scarring. 
 Typically recovery period is 7-10 days as you do tend to bruise more with your eyes than facelift and necklift.  You would need to return for a follow up appointment 7 days later to check your healing progress.  This can be combined with lower eyelid surgery which I think will give you a fresher appearance.
What are the benefits of a local anaesthetic facelift?
Minimally invasive as it is a short scar facelift, although has the same effects as the Traditional Facelift as the SMAS muscle is tightened along with the skin.There is minimal bruising and swelling, especially when compared to traditional faceliftsAs the procedure is performed under local anaesthetic, you can go straight home following the procedureFull recovery in a matter of days rather than monthsSignificantly less risk than Facelifts performed under general anaestheticFresh, youthful and long lasting resultsPlease make sure you find a reputable and qualified plastic surgeon

Alejandro J. Quiroz, MD · Answer

Thank you for your question. Provably both procedures will help but they are also very different procedures. I will recommend you to have a in person consultation with a surgeon that offers both procedures and discuses the benefits and what is involved for you can take the best decision.

David Hansen, MD · Answer

Fillers are mostly useless for jowls and jawlines.  You need a little liposuction and Accutite to smooth out and tighten up that jawline and jowls. It is done under local and is so easy to undergo.

Jason Emer, MD · Answer

FaceTite can internally tighten the skin in the lower face and neck. After all the skin has been heated and contracted, we shape the neck with liposuction to give definition and remove stubborn pockets of fat. In one quick treatment, we can tighten skin, remove fat, and contour the lower face, jawline, and jowls with only a weekend of downtime.  Keep in mind that combination approaches will give you a more significant improvement as opposed to a single procedure. I recommend getting a consultation with a board-certified cosmetic dermatologist and facial sculpting expert. Best, Dr. Emer

Brian K. Machida, MD, FACS · Answer

It looks like you might benefit from fillers and not a facelift. It’s best to go for a personal consultation.

Toby Mayer, MD · Answer

Though you can have fillers and a chin implant when people see your face they see “sad,tired and older female”. Therefore, a hairline Browlift with Hairline Lowering using the Irregular Trichophytic Hairline Incilsion which I developed and have done hundreds of will give you a more youthful and alert look. Hair grows thru the incision and the recovery is 6 days.

Michael P. Morrissette, DDS, FACS · Answer

The most striking feature in your photos is not your jowling but lack of chin projection.I think that you would benefit from a chin implant. The implant is placed along the bone and can diminish the area called the pre-jowl sulcus and provide more balance to the lower third of your face. I don't see the need for a facelift at this time. The area of your cheeks could benefit from the placement of fillers.

Evan Ransom, MD, FACS · Answer

Thank you for the question and the photos. At 44 years of age, most patients are not ready for a facelift. This is a great surgery, but it is invasive and has risks. Some patients with premature aging or who have significant skin excess from weight loss may need such a procedure earlier... In your case, starting with some energy-based treatments (e.g., ThermiTight, FaceTite, Genius, etc.) would be my recommendation. This can help with some of the laxity and adipose tissue along the jawline. This can be paired with fillers (e.g., Radiesse or Voluma) to help add jawline definition. Best of luck moving forward!

William Portuese, MD · Answer

The side profile photographs would also be helpful to make a better determination upon what the issues really are. From the limited photographs, it appears that there's a recessive chin profile and a pre-jowl sulcus which can be improved with a chin implant. You're probably too early for a facelift at this point.

Robert Singer, MD · Answer

Facial rejuvenation varies from surgeon to surgeon and means different things to different patients. In general it is the process to try to reverse the facial appearance caused by aging. It may involve improving the skin texture and complexion, diminishing skin discoloration, minimizing fine lines and wrinkles, contouring hollows, or tightening loose tissue that has lost its elasticity. 
 
 There are a variety of procedures, both non-surgical and surgical which can be utilized to achieve these various goals. Fillers, Botox or Dysport, micro-fat grafts, chemical peels, a skin care program, lasers, skin tightening, and surgical lifts are some of the methods that are used to achieve a cosmetic improvement. Each has advantages and disadvantages as well as limitations of what they can achieve. The best technique or combination of procedures depends on patient concern, desired outcome, individual anatomy, underlying medical health, and extent of aging. There is no one approach that is ideal for everyone.
 
 I would suggest you find a plastic surgeon certified by the American Board of Plastic Surgery and ideally a member of the American Society for Aesthetic Plastic Surgery (ASAPS) that you trust and are comfortable with who has all of the modalities of treatment available. You should discuss your concerns with that surgeon in person. 
 
 Facial rejuvenation needs to be individualized. What would be an ideal approach for one patient is not necessarily the same for someone else. Based on the examination and discussion at the consultation, you should have a better understanding of the various options that can achieve the best cosmetic result for you. 
 
 Robert Singer, MD FACS
 
 La Jolla,California