What is best procedure for double chin, sagging jowls and neck? (Photo)

Question

I'm 51 years and would like to get feedback on the best procedure to remove double chin and sagging neck.

Jed H. Horowitz, MD, FACS · Answer

It is best to begin by consulting with a board-certified surgeon in-person. The presence of banding down the front of the #neck, and, amount of excess skin and condition of your skin are among some factors which determine if you are a #candidate for #rejuvenating the neck. Chin deficiency with the neck and jawline are also taken into consideration. A weak #chin implies a lack of chin support for the skin along the neck line. As a stand-alone procedure, chin augmentation can be performed in the office under local #anesthesia. For individuals with signs of aging in the neck, a chin implant added to one of the recommended procedures above, will provide optimal results. 
If deemed a candidate, you may want to learn more about the Lite-lift™. Patients who desire facial rejuvenation that is affordable, quick, and effective should also consider the Lite-lift™. Like the Life-Style™ facelift, this is a modified facelift, individualized for each patient, that can be performed in the office with a local anesthetic and improve signs of aging around the neck, jawbone and lower face. These procedures are not "Thread-lifts" or "String-lifts". We do not use the "barbed" sutures employed in these other lifting operations. The Lite-lift™ uses longer lasting techniques that are discussed below. Because the incisions are limited, there is less bruising, swelling and healing time for most patients. Many patients can be back to work in one to two weeks looking rested and more youthful.
A board certified plastic surgeon should evaluate both your anatomical features and aesthetic goals to suggest which procedure best suits your needs. In some cases there may be more than one option to choose from. If you are not a candidate at the time of your #consultation, your board surgeon can recommend non-surgical alternatives to address your concern.

Michael I. Echavez, MD · Answer

I would say the most improvement you could obtain for the double chin and sagging jowls and neck would be with a facelift.  This would provide the the best result for you and tighten the area of the neck and lower face.

Jason Emer, MD · Answer

I find that VASER liposuction in combination with ThermiRF are best for contouring the chin in those who are candidates and can be combined with a neck lift at the same time, if there is skin laxity. Kybella can be used as an alternative and needs to be combined with thermage/ultherapy/exilis or coolsculpting for good results. I recommend getting a formal evaluation with a facial sculpting expert. Best, Dr. Emer

Chase Lay, MD · Answer

In your case a combination of facelift, fat transfer, possible chin implant among other things would give you the most dramatic change but still look natural. There's 101 less invasive procedures you could have performed with more modest results.  Get several in person consultations with Facial Plastic Surgeons and see what they have to say.  My personal and professional favorites in my area for this type of work would be Davied Lieberman MD and Sachin Parikh MDChase Lay MD

William Portuese, MD · Answer

From the limited photographs presented, a lower face and neck lift would be required.  In our practice, this procedure can accomplish tightening loose facial and neck skin, tightening loose facial and neck muscles, lifting the jowls, and removing the fatty deposits in the neck. For more information and many before-and-after examples, please see the link and the video below

Francis R. Palmer, III, MD (retired) · Answer

Hi, I have performed facelifts for over 30 years and have performed many minimally, invasive SMAS facelifts.  From the photos your cheeks are flat in the front, jowls are present and there is significant excess skin in the neck.  
  "Jowls” are sagging facial tissues and an indication for some form of a SMAS facelift.  The underlying SMAS layer, of the face, must be dissected, lifted, trimmed and re-sutured (not merely folded or suspended with threads or sutures that will not last).  The excess skin is then removed and the facelift incisions closed.
 My most popular facelift is the minimally invasive, short incision facelift that has all the benefits of more invasive facelifts (traditional, mid-face, deep plane, cheek lift and subperiosteal facelifts) but with these added benefits:
very small incisions and no incisions extend or are placed within the hair.
minimal tissue dissection = less bruising and swelling = rapid recovery ( several days instead of weeks or months with the more invasive type facelifts mentioned)
can be performed in 90 minutes or less, with or without general anesthesia
no incisions within the hair = no hair loss
excess fat can be removed from the face and neck
excess skin removed from the face and neck
cheeks, chin and jaw line can be augmented with dermal fillers (I prefer Restylane Lyft) or facial implants
most patients fly back home to parts all over the world in as little as 3 days post-op
  I combine facial shaping with every facelift procedure.  When jowls are present, these should be done in concert and not alone or separately in order to create a naturally, more attractive face.  Following my beauty principles, women look the most feminine, youthful and attractive with heart shaped faces.  Heart shaped faces have cheeks that are full and round in the front.  Cheek augmentation with a dermal filler or using cheek implants for a permanent enhancement will create full, round cheeks that will feminize the entire face.
   Along with the minimally, invasive SMAS facelift described above, some of the excess skin below the chin can be removed using a small, curved incision under the chin.  This along with skin removed in front and behind the ear will tend to reduce the skin excess by around 70% or more.
 If anterior platysmal bands are present or the maximal amount of neck skin is to be removed, a "formal" neck lift can be done.  In this procedure, the face and neck tissues are elevated using a curved incision around the front (explained later) of the ear that continues in the crease behind the ear and then 3 inches into the posterior hairline.  The tissue is dissected from that point all the way across the entire neck to the same position on the other side of the head in a dissection that is as long vertically as the entire neck.  The Platysma muscles are tightened using a curved incision under the chin and each side is pulled upward and back again being tightened at a line behind each ear (under the tissues).  Since the skin flap pull is up and back, this will pick up any tissue laxity along the jaw line or "jowls" which must be dissected and flattened out using a lower facelift (incision around the front of the ears).  If this isn't done, pleats of excess skin will appear below each ear.
This is an extensive surgery taking 4 1/2 to 5 hours with large incisions, possible hair loss and months of recovery.
Hope this helps.

Gerald Wittenberg, MSc, DMD (retired) · Answer

Your skin tissue and underlying muscle can be 'tensioned' with incisions behind the ear. This restores contour to the neck under the chin and along the jawline. Not a difficult procedure to undergo and the results are immediate.

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