Permanent Solution for Marionette Lines, Drooping Cheeks and Jawline?

As a young 35 years old, you should aim to postpone need for full facelift. Where there is no permanent solution, or rather permanent fillers are not advisable, period, because you want fillers to evolve as you mature and not protrude out when your facial contour changes ever so subtlely. Best long-term solution may be Sculptra, whose longevity may be 2 to 2 and 1/2 years, restoring volume to your upper cheeks, eyebrows, temples, that can provide subtle but effective lift to help you better defy force of gravity.

I recommend fillers to soften the nasolabial folds themselves and also lift around the mouth and cheeks to build underlying anatomical support. In our practice we combine Sculptra with other fillers "layered" on top and lasers, skin tightening treatments such as Thermage, Fractora, and Renuvion (J Plasma), thread lifting, and peels to get the most conservative, natural look. I suggest seeing a facial sculpting expert for a formal consultation. Best, Dr. Emer

Hello norestarI would advice you schedule a consultation wit a board certified plastic surgeon for physical examination.

Thank you for your question. The concerns that you have expressed are the likely combined results of both facial volume loss and sagging - two of the hallmarks of facial aging. 'Liquid face lift' is a misnomer which usually describes facial volume replacement without any true lifting. Volume replacement alone may be effectively employed during the earlier stages of facial aging to improve facial appearance. At more advanced stages of facial aging or for more substantial or longer-lasting results, lifting is considered. A mid-face lift or cheek lift can help to restore fullness to the midface by vertically repositioning the soft tissue of the cheek to a higher, more youthful position on the cheek bone. At the same time, lower eyelid appearance is often improved as the repositioned cheek tissue is more favorably redraped over the lower orbital rim, minimizing the unfavorable hollow appearance of the lower eye region. Similarly, the nasolabial folds are somewhat effaced as the lower lying cheek tissues are lifted. A lower facelift is undertaken to improve the appearance of the lower face and neck including improvement in the jowels and marionette lines. If you are interested in learning if these procedures would address your specific concerns, an in-person consultation with an experienced facial surgeon would likely be very helpful. Warm regards.

Despite the fact that you are only 35 y/o, the "deformities" you describe are easily addressed with a traditional facelift. I perform an extensive SMAS facelift which directly addresses the lower two thirds of the face. Though this procedure is excellent for improving cheek laxity and marionette lines, it may not improve the downturned corners of the mouth. If that does appear to be the case, I will then do a separate lateral corner lip lift to raise these areas. Regarding the hollows under your eyes, I have found that fat injections or even a mid facelift going through the lower eyelids will improve this.

  it is rarely appropriate to use the word "permanent" when discussing the world of cosmetic surgery.  This is especially true because no matter what you do or don't do, time marches on and gravitational forces continue to be out play.  Nonetheless, you will have far greater LONG TERM results with surgery than with fillers for the Marionette Lines.

The areas of concern would be addressed with two different procedures.  A mid facelift for the cheek sagging and hollowness around the eyes and a regular facelift for the neck, jowls, marionette lines and descending lateral lip.  At 35 it is very young for a facelift and I would recommend trying to temporize the problem with facial fillers, botox, and/or chemical/laser peels.  You can only get a limited number of facelifts in your life before things just start to look strange.  Just ask Joan Rivers.  

Surgery is the longest lasting result, but you continue to age over the next 40 years. It will give the best result but is also the most costly. Fillers are cheaper and can give you up to 18 months improvement. See an experienced facelift surgeon that is not trying to sell you one treatment and get the advantages and disadvantages of ech.

Without a photo or face to face examination no physician can truthfully say what would be best in your case. Given the lack of such specific information I can only say that mild marionette lines can be treated with injectable fillers (liquid whatever you want to call it) more severe marionette lines require your old fashioned run of the mill incision around the ear facelift. In my experience few 35 year olds have such a severe marionette line and most likely fillers would be better for you. It is best to leave the more aggressive surgical approaches for when you are older.

Hi Noreaster,
At only 35 years old, it sounds as if you have lost quite a bit of facial volume already. Certainly, a surgical procedure would be the most permanent and lasting measure to address some of your concerns.
If you like the appearance of "liquid facelifts", fat transfer is the most permanent of filling agents. Sculptra is a collagen stimulator. Many patients treated with a series of Sculptra injections to "complete correction" have lasting results for 2 to 3 years, in some "lucky" patients the results may even be permanent.
Stay out of that nasty Noreaster weather. Good luck and be well.
Dr. P