Lower face saggy and wrinkled, which is best treatment and should I go abroad? (photo)

There are very good facial Aesthetic surgeons in the United States. I personally don't think it's a good idea to travel overseas for an operation were your surgeon will not be able to follow you.

I believe you would be a good candidate for facelift surgery.  As we age, deep
creases form between the nose and mouth; the jawline grows slack and jowly;
folds and fat deposits appear around the neck.   A facelift will remove excess
fat, tighten underlying muscles and re-drape the skin of your face and neck and
can last up to 10 years.  Be sure to seek
a Board Certified Surgeon who has elite credentials with facial cosmetic procedures
to discuss your options.  Be sure to see
before and after photos and be direct with your questions and expectations. Although cost is a factor when deciding to proceed with any cosmetic surgery, I would not recommend travelling abroad. 

It's impossible to make suggestions based on just a small photo segment. When I evaluate the face I need to consider the entire face in order to make suggestions and discuss options to achieve the best overall result. At the end of the day you want to have a balanced rejuvenated appearance. I am not a big fan about surgical tourism, which is the term that is given to those patients traveling abroad primary out of consideration of price. Many surgeons have patients who travel to them from out of town. This is often considered a compliment and testament to their talents. If you choose to travel, do it because of quality results you are seeking.

There are different procedures that can help to improve lower face sagging and wrinkles. A face lift can help with the sagging but may not improve the wrinkles.  Wrinkles can be improved with laser treatments though.  Sometimes, both types of treatments are needed to obtain the best results.  

Dear Debbie, thank you for your question.Facelift surgery can dramatically improve the
cheeks, temple area, jawline, and neck. Our La Jolla Lift procedure offers an easier alternative for some patients. Consult with a board certified facial
plastic surgeon who can offer a variety of options. Good Luck!

From the picture that you have provided, you appear to have jowling, skin laxity, and deep wrinkles in the marionette region. A lower facelift combined with a neck lift is a great option for jowling and neck laxity. I often combine my facelift procedures with fat transfer to the face in order to restore volume in the mid face. As far as longevity goes, different surgeons use different techniques. I would find a surgeon you trust, look at their before and after pictures, and use the technique that he or she is comfortable with.

A lower face and neck lift will address tightening up facial and neck muscles, removal of fatty deposits in the neck, and tightening jowls and facial laxity. For many examples, please see  the link below to our facelift photo  Gallery

Hello
and thank you for your question.The photo you have
submitted is very limited so it really isn't possible to make a definitive
recommendation for you. Likely, a face and/or necklift would be necessary for
you and perhaps some skin resurfacing as well.I do not suggest you
go abroad for any type of procedures. An article just came out in the news
yesterday regarding the risks of medical tourism. The article I'm referring to
was specific to surgeries performed in the Dominican Republic. The health
standards abroad are not necessarily the same as they are in the US. I recommend that you
see a board certified plastic surgeon in consultation to get more specific
answers to your questions which can best be addressed after a thorough history
and examination is performed.
Best of luck to you!

With the aging process we all develop 1.Skin sagging and laxity due to gravity; 2. Volume loss; and 3. Skin surface changes including wrinkling. For comprehensive facial rejuvenation most people in their 50's and older benefit from addressing all three problem areas during surgery. Thus, in my office we often perform a facelift along fat transfer facial volumization and laser resurfacing. Before you consider "medical toursism", especially outside the US, please consider the total cost of travel and hotel stay for ten to fourteen days. Also thing about the potential benefits of establishing a relationship with a reputable facial plastic, cosmetic or plastic surgeon easily accessible in your geographical area. Many of us offer ancillary services for our facelift patients. Best of luck!

I've also answered this question on this video in YouTube:The Fundamentals of a Facelift, Why Shortcut Procedures Don't Work, and Cautions for Medical TourismAs a cosmetic oculofacial plastic surgeon practicing for 20
years, facial rejuvenation happens to be an area I specialize in. I wrote a
book called “The Fine Art of Looking Younger” and I can help people like
yourself who are confused about fillers as well as other optimal procedures.



Facial aging is a combination of volume loss and laxity.
Volume loss means loss of bone, muscle fat, collagen and soft tissue. As we get
older, the face gets a little bit older, the baby fat diminishes and everything
gets smaller. That’s why fillers have such a vital role especially in the
earlier decades of facial aging such as 30s and 40s. On the other hand, laxity
or loss of elasticity where tissues such as the skin and the tissue under the
skin called the superficial muscloaponeurotic system or SMAS gets lose, becomes
thinner and sags.



Over my 20 years of practice, I have seen so many procedures
come and go that are supposed to be shortcuts. These include thread lifts, mini
weekend lifts, various heating devices and lasers that are supposed to take
over facelifts. However, there are no shortcuts. There are ways that procedures
can be done to optimize the results but certainly shortcuts never really work.



When you have to make a decision and money is an issue, from
my perspective, that is where people make a lot of mistakes. As a specialist
and as someone who has become well-known, I have patients who come to me from
all over the world and all over the country who have had some unfortunate
results by going for less expensive options. Unfortunately, in the field of
cosmetic surgery, there appears to be two types of doctors: those who do high
volume and low prices, and low volume and higher prices. There are also people
in the middle. Unfortunately, quality does cost: anesthesia, operating
facilities and the art of doing the surgery cannot be rushed so you do get what
you pay for is true.



People have come back after going to different countries for
surgeries where they needed additional aftercare. Surgery is a single procedure
but there are certain percentage of people that need more care whether it’s the
incision, swelling or other areas that need treatment with steroids. The
aftercare process is so important and they missed that by going to another
country. They come to someone like me or a colleague and they are surprised
that they have to deal with all of these issues. Being in the United States or
going to a doctor who has the qualifications, experience and who is accessible
has tremendous value. I always teach my patients that your procedure is an
investment that will pay long term dividends in terms of the benefit after many
years. Being in practice for many years, my patients and I have gotten old
together and at one point, I’ll do their eyes and they’ll come back and I’ll do
their face. I’m always available to my patients and the accessibility and the
ease makes it a very good journey for the majority of my patients.



My advice is to meet with several experienced cosmetic
surgeons and come up with plan. If it’s about the budget, you choose the things
that you are most concerned about and you address them in a particular time. In
our practice, we do everything under local anesthesia with LITE™ IV sedation. If
someone cannot afford everything, they don’t feel bad that they are not going
under general anesthesia and having to go back to it. When our patients do the
sedation, they recover very quickly and when the time is right they’ll come
back and they’ll do another procedure. Anesthesia is certainly a factor in my
experience that has helped a lot of our patients budget their priorities.
Unfortunately, when you go under general anesthesia, there’s pressure to do
more procedures just because it’s not the best experience in terms of the risks
involved.



Have a plan and an idea of what you need to do. You may need
to do a limited procedure as long as you and the doctor are clear on what the
ultimate benefit is. In my experience, shortcut procedures are not the best way
to do things. Most of our procedures like facelifts or face and neck lifts, we
do aggressively enough so that they feel that their jawline is tight, their
neck angle is well defined, cheeks are up and it looks very good. When you do
shortcut procedures, sometimes you get a better jawline but then there’s a
little neck sagging and laxity. I would discourage you from going abroad. There
are many highly qualified experienced cosmetic surgeons here and I think it’s
the matter of you clicking with the right one and figuring how to budget
intelligently. I hope that was helpful, I wish you the best of luck, and thank
you for your question.