Best lower face procedures to correct asymmetric sagging jowls, define jawline and under chin sagging and laxity? (Photo)

Question

Would I be a candidate for these procedures: 1. Chin implant 2. Buccal Fat Removal 3. Lower SMAS facelift 4. Under chin lipo and/or neck lift My goal is for a V-shaped lower face and jawline definition. Improve front and side profile.

Jed H. Horowitz, MD, FACS · Answer

It's best to begin by consulting with a surgeon in-person to discuss your options. 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. During an in-person examination, your chin will also be evaluated along with the neck and jawline. A weak #chin implies a lack of chin support for the skin along the neck line. In younger individuals a chin implant alone is usually all that is needed to improve the appearance of the neck. Subsequently, it will improve the overall #balance of the face and can create the illusion of a smaller nose. 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. #Liposuction is often used during or in place of a neck lift if necessary.
Also, if deemed a candidate, you may want to consider Lite-lift™ which is an affordable, quick, and effective innovative facelift developed by board-certified plastic surgeons Dr. Larry Nichter and myself. The goal is to provide a less invasive natural looking option for both men and women desiring to refresh their appearance with less downtime and risks. The LiteLift® is a “real” facelift, which does address the underlying muscle, tissue and overlying skin.
This is a modified facelift 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. 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.

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

Without an exam your question cannot be answered.  You will need to see an Oral/Maxillofacial surgeon to see if othognathic surgery, genioplasty or using an implant is best for your specific case. It should be noted that patients with severely weak jaws or abnormally functioning jaws may be better treated with other facial surgery (orthognathic surgery), although a chin augmentation may be an option at a later time. These patients should seek the advice of a plastic surgeon to determine which course is right for them. Here is some information to help you make this decision: Candidates for Chin Augmentation - Patients whose chin profiles are weak but have normally functioning jaws are candidates for Chin Augmentation. Many of these candidates have used injectable fillers in the past to strengthen the protrusion of their chins, but are looking for a permanent solution. If you are one of these patients, then you are a likely candidate for chin augmentation
#weakchin #chinimplant

Michael P. Morrissette, DDS, FACS · Answer

I would add necklift to that list and you have presented all the options that are available to you. Jowling is best corrected with liposuction and facelift. Improving the contour of the jawline is easily accomplished with an extended facelift incision behind the ear. Fillers can help but the results are temporary. Schedule a consultation with an experienced cosmetic surgeon.

Catherine Winslow, MD · Answer

Hello! The best way to review options of course is in person with an experienced facial plastic surgeon who is looking at you and reviewing your medical history and expectations. I would agree with everything you say except buccal fat removal- the trend is volumizing the face, not removing volume, as the face naturally loses volume with age. Volume loss makes the face look older, not younger. Contouring is best done through other means. Good luck!

Zoran Potparic, MD · Answer

Based on minimal information from your photos and short of in-person evaluation one can give you very basic suggestion. It appears that you would be a candidate for neck and face lift which will allow  shaping of your jawline and jowls to create a heart shaped, youthful looking face. Fat graft augmentation of cheeks and periorbital area would further contribute to this concept.
You should seek a consultation with a board certified plastic surgeon with good reputation in facial rejuvenation to discuss your goals and options. Good luck.

Barry L. Eppley, MD, DMD · Answer

Based in your pictures you have correctly identified the facial procedures that would have the most benefit for your goals. The one that your have to be careful about is the chin augmentation. Without the right implant shape you can make your chin/.jaw look wider and not more V-shaped.

Vasdev Rai, MD · Answer

You seem to know what you want and what you will need to achieve it. Just find a surgeon who is capable of doing it and get it done.

Sean Freeman, MD · Answer

Pebbles2016, I cannot tell you about the chin based on your photos. I would never do a SMAS lift; deep plane surgery is much better. I do not recommend blind liposuction of the neck; open liposculpture is much more predictable. See a plastic surgeon that specializes in "only faces" and has good Internet photos. See the video and good luck!

William Portuese, MD · Answer

A lower face and neck lift can accomplish tightening loose facial and neck skin, tightening loose facial and neck muscles, removing fatty deposits in the neck along with a platysma plasty, lifting the jowls and tightening the SMAS. The soft tissue asymmetries can also be addressed all the same time. The photograph also demonstrates bony asymmetries in the chin area as well.  A custom carved solid silicone chin implant may be required to address the bony asymmetry. For more information and many before-and-after examples of lower face and necklifts from our practice, please see the link and the video below

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

Hi, I have performed many facial shaping procedure for over 30 years using dermal fillers, silastic facial implants (cheek implants, chin implants, lip implants), SMAS and many minimally invasive SMAS facelifts.  From the photos your cheeks are a bit flat in the front (left more flat than right), there is significant excess fat in the mid and lower face (this accelerates the pull of gravity and creates sagging tissues of the face and neck), jowls are present, the chin is weak, the back portions of the jaw line are wean and there is excess fat and skin in the neck.  These factors combine to create an elongated, rectangular shaped 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.  Liposuction would be combined to reduce the excess fat to further shape the cheeks, neck and face.  In contrast, buccal lipectomy (or removal of the buccal fat) is an old, outdated procedure that removes a teaspoon size portion of fat from below the cheek bone.  As such, this technique can not change the "actual" shape of the cheek bone but can create hollowing in the face below the cheeks.  This technique would not reduce the excess subcutaneous fat that exists in your mid face, lower face (jowl area) and neck.
 When the chin is weak, this creates an imbalance making the nose appear larger, the mid face top heavy and the lower face look short that de-emphasizes the lips and allows early formation of a double chin.  Chin augmentation using a chin implant will add projection to the chin creating harmony and balance to the lower face.   I have found that placement of a silastic chin implant, through a small curved incision under the chin (also allows excess skin removal) to be very safe, quick and highly effective.
 "Jowls” are sagging facial tissues and the main 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
The back portion of your jaw line is a bit weak and can be augmented, without making your face appear masculine, using precise placement of a dermal filler (I prefer using Restylane Lyft).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.  
Hope this helps.

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