Follow-Up: Will my jowls improve after platysmaplasty, chin implant, and neck lipo? (photo)

Question

The pics are before and after. 25 days ago I had platysmaplasty, chin implant(oral) & neck lipo, thread lift and fillers. My jowls have been swollen and hanging down giving my face a square look. Looking at my before pics, would you say that I will achieve a nice jawline later? The canula was inserted just beneath my jowls, not sure if the jowls are just swollen, but going by how i looked before, is that likely to remain, as I did not have a good jawline previously? Anything I could do if so?

Alejandro Nogueira, MD · Answer

I have to disagree, as facial plastic surgeon dealing reagularly with both, facial rejuvenation and chin surgey, with the plan designed for your face and neck.Thread lifts are... only threads... just it... they are a surgical fraud, no real effect overtime.I have to put into serious doubts you really got a platysmaplasty, this is only feasible with extensive approaches and full face-neck lift incisions; additionally you don't show the expectable stigmata of a platysmaplasty at the neck neither your jowls have been addressed (jowls = platysma flaccidity).Your chin, yet swollen, seems to me overcorrected and poorly planned.Maybe in the future you might consider getting a revision procedure with a well experienced specialist in facial plastic surgery, mainly to perform:-complete face-neck platysmaplasty lifting-chin's osseous genioplasty I perform regularly all kinds of genioplasties, not only sliding genioplasties but also one, two and three-dimensional augmentation and/or reduction genioplasties, plus other custom designs; in other words, I know well what I am talking about.
This is an awesome, lifetime lasting, stable and safe procedure, which notwithstanding needs very accurate preoperative antropometric planning, desing, discussion and a brilliant execution, a technique full of creativity and good aesthetic judgement requirements.
Chin implants have many disadvantages:
-visibility, static or with facial gestures / smiliing
-artificialness, fake look, evidence of implant presence
-limited lack of versatility, they do not provice vertical modifications neither reductions
-common infections
-common dislocations
-possible nerve irritation and pain
-short lifetime
So sooner than later they are normally removed, or exchanged by an osseous genioplasty.
Why so popular (chin implants) then? Simple answer: they are technically accessible to all surgeons, little training is required, can be done under local and sometimes office based procedures, they are cheap.
Osseous geniplasties are more expensive and need good skills, true, but when performed they produce lifetime results, safe, stable overtime, very low rate of complications, versatile three-dimensional modifications (augmentation or reduction, vertical, horizontal and depth), low rate of reinterventions, etc.
Feel free to request any additional information from me.

Michael P. Morrissette, DDS, FACS · Answer

First, your surgery was so recent that it is hard to determine your final results just yet. Most of the work that you describe would treat the neck and jawline. It is possible that the threadlift may have been performed in the direction that could help improve the jowls. In general, the best treatment for "jowling" is a SMAS facelift which produces the best results for facial jowling. You should address your concerns with your surgeon. In the case of threadlifts, it can take several months to see the final results.

Vish Banthia, MD · Answer

In general and depending upon the degree of jowling, the optimal ways to improve the jowl area involves a combo of a facelift procedure, gentle jowl liposuction, and potentially the placement of a chin implant that adds volume to the pre-jowl area.  In your case, I would find out what type of chin implant you had placed  - perhaps a chin implant that addresses the prejowl area might help.  Additionally (and assuming that you wanted a more minimally invasive option), one might consider placing a thread lift (or 2) in an appropriate vector and position that might lift the jowls.

Arian Mowlavi, MD, FACS (license on probation) · Answer

Not sure why you did all of those procedures when a straight forward SMAS facelift would have addressed all of your concerns including your jowls. Unfortunately, you will not gain any leverage in jowl improvement until you have a facelift which would have been my first choice for you.

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

Hi, you should discuss your post op concerns with your surgeon.  I have performed many facelifts over the past 30 years.  The Platysmaplasty, neck lipo and chin implant would improve the chin projection and contour of the neck but not affect "jowls".  If you have "jowls” these are sagging facial tissues and an indication for some form of a SMAS facelift.  The SMAS layer 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.
 For over 15 years now, 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 of the cheek, chin and jaw line with every facelift procedure in order to create a naturally, more attractive face.  The thread lift would not be as effective as a SMAS facelift in reducing "jowls" with any lasting results.
Hope this helps.

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