Can I get laser surgery for jowls?

Question

I had laser surgery about 12 years ago on my entire face. I got a staph infection and toxic blood poisoning. I ended up on a respirator for about 3 weeks in the ICU. My lungs kept filling up with fluid. I smoked two and a half packs of cigarettes per day, and I drink beer daily. I am now 47 and starting to get sagging jowls; I'm wondering, what risk would I be in by having laser for jowls only? Is there be a better alternative without surgery?

Richard H. Tholen, MD, FACS · Answer

Angie, you were 35 years old when you had laser resurfacing and ended up with a life-threatening infection, ICU and respirator for 3 weeks, and now at age 47 you use alcohol daily and smoke 2 1/2 packs of cigarettes daily.

	If your health were better, and you weren't a smoker, sagging jowls could be treated by facelift, or perhaps lower facelift. There is no laser that will tighten loose skin, just smooth the surface. Laser treatment would just give you smooth jowls, not wrinkled ones. Seriously. If you have loose skin, you must have a skin-tightening procedure to improve this area. Tightening the SMAS beneath the facial skin can further improve the result and increase the length of improvement.

	But, I would really encourage you to stop alcohol use, stop nicotine use, start exercise and diet if you are not at a proper weight, and use the cigarette and beer money for your plastic surgery!

	Angie, I grew up in Kansas and went to Medical school in Kansas City; Kansas folks are strong and fine people! I am really concerned for your health and encourage you to seek help with your addictions before considering any kind of elective surgery. Best wishes!

Raffy Karamanoukian, MD, FACS · Answer

Morpheus 8 is a non-invasive skin and soft tissue tightening treatment that is consistently amazing in our patients. We use the Morpheus to exact fractional induced RF into the skin or tissue in order to tighten collagen and stimulate contraction of the tissue. For acne scars, it is quite useful to build collagen in patients who have atrophic scars but is not very productive for ice-pick scars which require TCA Cross. For tissue tightening, Morpheus is ideal for the face and neck and we often combine it with CO2 laser or Ultherapy to further enhance results. Chemical peels and skin resurfacing should be done at least 5 to 7 days after, but can be performed earlier, depending on treatment severity. Avoid exfoliating skin treatments before Morpheus and expect a period of 2-4 weeks for skin contraction to set in.

Best,
Dr. Karamanoukian
Realself100 Surgeon

Best, 
Dr. Karamanoukian 
Realself100 Surgeon

Jason Emer, MD · Answer

This is my expertise and a huge portion of my practice. Asymmetry is normal and expected. Buccal fat pad gives slimming not symmetry. Masseter botox will make you slimmer and make the jawline more loose. Fillers help give shaping and contouring. If you want perfect or close to perfect symmetry you need maxillofacial surgery or implants customized. I suggest seeing an expert to go through all options. Most of my younger clients use fillers to give them shaping especially on the cheeks, jawline, and chin which make the face look more slim and tight; and threads such as PDO or Instalift can build collagen and support the facial shaping and skin looseness over time, slowing down the aging process and given the face a more “snatched” look; and morpheus8 or PiXel8 deep microneedling RF can tighten crepe skin especially on the neck and jawline and is great for long term tightening of the full face, neck and chest; its often used to give the face a slimmer more sculpted look because it tightens the skin and gives lift. an early face lift can be performed as well even in younger clients if they want a different facial shape, maxillofacial surgery with bone breaking or shaving can also be done. For facial slimming a combination of treatments are always needed. Options include: 1. Buccal fat pad removal to reduce fat on the lower face 2. Factite or Renuvion/J Plasma to tighten the lower face, jawline, and chin to reduce fat and give the jawline and neck tightening and shaping. 3. Botox to the masseter to reduce the muscular size of the jaw giving the face an illusion of being more slender 4. Fillers to the jawline, chin, cheeks, temples and brow help to shape the face and make it more angled and defined Always use at home derma rolling (see link to Emerageskin x anteageMD roller plus stem cells/hyaluronic acid ampules) and peels like emeragecosmetics enlighten or aerify that can be used to improve skin quality and tighten the skin while improving wrinkles, pigmentation, acne, and Melasma. See an expert who does facial shaping with surgical and non surgical methods to get a comprehensive option. Best, Dr. Emer.

Larry S. Nichter, MD, MS, FACS · Answer

Most likely the biggest risk factor for your prior horrific staph infection is that you were a heavy smoker and also may have used excess alcohol. Because you are continuing to have this unhealthy lifestyle you would be a bad candidate for surgery as the risk to your health is too great. Laser for jowls only will give you little if any improvment. On the otherhand if you can get your life in order and lead a healthy one - stop smoking, more than one drink per day, exercise, normal weight - you would probably be a reasonable candidate for facial rejuvenation.

Vivek Bansal, MD · Answer

Smoking will increase your risks. A surgery is a big risk for you.  Anyone who wants to do your surgery is taking you and them on a very dangerous journey until you can reduce your risk profile.

Stephen Prendiville, MD · Answer

My first observation is as follows: if you are still smoking, don't do anything. A Facelift (properly performed) should significantly improve the contour of your jaw and neckline. There is no laser or laser technique that will significantly improve jowls and I would be careful of any advertising which implies this.

William Ting, MD · Answer

Sagging jowls come from loss of volume along marionette areas along corners of mouth as well as the overall diminised volume along upper 1/2 of the face. Other than surgical facelift, your best bet is to consider combination of localized filler injection along marionette areas and cheek augmentation with Radiesse or Sculptra. Fractional CO2 laser resurfacing can be helpful to tighten the jowl sagging but should be performed in conjunction with judicious filler injection to achieve optimal outcome.

Michael Kulick, MD, DDS · Answer

Hello,
There's laser surgery where a laser is used to treat the surface of the skin and then there is laser surgery where a laser is used to cut - dissect below the skin surface.  Please look at my other laser facelift question responses to help you understand the differences and explore your options.

Peter A. Aldea, MD · Answer

I have never heard of a CO2 Facial laser resurfacing resulting in Sepsis (bacterial blood poisoning) with Pulmonary Edema (lungs being flooded by fluid). Such complications MAY be seen in major surgery and only when the intestine leaks or in severely immunocompromised people (AIDS, cancer etc).

	Your smoking history suggests you have some level of lung disease (COPD) and drinking daily may suggest you have some liver damage as well. A thorough evaluation, probably a treadmill examination, would be wise to evaluate your medical fitness.

	Botox, fillers and lasers are COMPLETELY a waste of your money and time. They are useless with jowling.

	Jowling happens due to facial sagging and emptying and can ONLY be adequately reversed with a Facelift procedure of which there are several.

	Dr. Peter Aldea

Robert Kasten, MD · Answer

Lasers  and fillers can all help with sagging skin if you do not want an operation. Nevertheless, good effects of a medical treatment last longer with a healthy life style.

Can I get laser surgery for jowls?

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