Is Ellanse the best option for me? Concerned about my lower face.

Question

Hi doctors, I’d like to hear your opinions regarding the lower area of my face (showed in pictures). I’m really concerned about the areas of my face marked with arrows and highlighted. What kind of treatment would you suggest? Thanks

George Yang, MD · Answer

Hi Sarah,
FIRST PHOTO
The first photo that you posted, your arrows are pointing to jowls.  Most RS providers would likely recommend a lower facelift or mini-facelift to “lift” that area.  That does work most of the time if the person has well defined jaw bone and jaw angle.  However, if the person lacks jaw angle definition, their early post-operative appearance after a lower facelift and necklift will actually look good really good (honeymoon swelling), but as the swelling in the jaw angle area diminishes, the jowling may come back a certain percentage depending on how much jaw angle volume loss they have.  Sometimes on one side the jaw angle is naturally more filled and that side will look better than the side with more significant volume loss in that jaw angle.
SECOND PHOTO
Your second photo clearly shows you have volume loss in the jaw angle.  As the jaw angle gets filled-in, the jawline will get tighter, and and the jowl will get lifted up as the jaw angle becomes more defined.  I would love to do a live demonstration on video to try to demonstrate this.  I call this my “mini-facelift killer” since when I fill this area, I have noticed a significant decrease in the number of patients who proceed forward with a mini-facelift after they see that the jawline appears straighter and smoother.  On a front view, the sides of the face from the cheekbones goes down more vertically before a single convexity at the jaw angle about 3/4” from the bottom of the earlobe.  From this jaw angle, there should be a straight line to the chin convexity.
Go through any fashion magazine, and you should find that if you draw a straight line under these models ideal jawlines, that the line is clearly below the earlobe by at least 1/2” to 3/4”. If the person is a full 1” or more they will look very square like a Brad Pitt type jaw.  So for women, I aim for 1/2” to 3/4” based on their goals and their budget, since filling down to 3/4” will cost more than 1/2”
Without aiming for this aesthetic, from the jowl to the earlobe is nearly a straight line.  If a facelift is performed SO TIGHT, that the chin to earlobe looks like a straight line (no jowl which is good), but it will look weird having a jawline going from the chin to the ear (which is bad.).  Again take a good look through any fashion magazine.  Most likely those models will be genetically gifted and as they age their facial skin will drape around that jaw angle and prevent them from having any significant jawline or neck sagging until a much older age.  People with ill-defined jaw angles will be prone to jowling and neck sagging.For patients who lack volume on the jaw angle, but also have sagging of the skin under the chin, I will bundle in fillers or fat grafting together with their facelift necklift to mimic the “honeymoon swelling” but as the real result.
THIRD PHOTO
The last photo you posted, shows sagging muscle under the chin.  I am a big proponent of tightening any loose platysma muscle under the chin to help create a more defined neck profile.  The muscle tightening is call a platysmaplasty (or corset platysmaplasty), and this tucks any loose muscle to create a smoother surface for the chin/neck skin to drape over it.  To perform a platysmaplasty, a 3/4” incision (my preference) to up to a 1.5” (I’ve seen it, and there are examples on Realself) under the chin to find and tighten this muscle.  Can this loose muscle be tightened with volume?  Maybe a little bit. 10-30% at most.  The filler or fat grafting on the jaw angle should be performed deep to the platysma and SMAS to force the SMAS/platysma to have to go over this additional volume.  If the Filler or Fat is injected on top of the SMAS or platysma, it will only bury the SMAS/platysma, without creating any tension or stretch.  Analogy.  If I have an empty pillowcase (SMAS/platysma), and you pinch the surface of the pillow case, it will be easy to pinch the fabric of the pillow case.  If I insert a pillow inside the pillow case, then you pinch the surface of the pillow case, it will have a nice bounce like a baby’s cheek.  If I place the pillow on top of the pillow case, the pillow case will not be any tighter than it was when there was no pillow.
SUMMARY
For patients who are afraid of surgery or want to avoid surgery, trying the “mini-facelift killer” first may give enough improvement (although not as good) that they will simply let the idea of facial surgery go.  Why would I as a facial plastic surgeon who specializes in Facelifts and Necklift even want to do this procedure?  I think it looks good to have that jawline 1/2” to 3/4” below the earlobe instead of going directly at the earlobe or even higher.  For patients who don’t want fillers, they could consider Fat grafting or in your case Ellanse.  I’m not sure how good Ellanse is.  It sounds like Radiesse which is calcium beads with a gel carrier which goes away within a month, but using a Sculptra like bead instead of calcium.  The radiesse gives an immediate result but never lasted very long 12-15 months at maximum.  Sculptra lasts longer at 2 years before needing a touch up, but you can’t see how it will look until 10-14 weeks later.  Maybe it is a good product which takes the best features from both of those products.  I don’t have experience with Ellanse, so I will defer to my colleagues to answer. 
I hope this helped.  Good luck on your cosmetic Facial Journey.
Best,
Dr. Yang
P.S. If you find my answers or other doctors answers to questions are helpful, please +1 those answers to push up the better answers to the top, which helps others who read the same post, get to the more helpful answers first.
P.P.S. There is a new feature on Realself, which is the "Follow" button. It is similar to the "Like" button on Facebook. If you like my response or any of the doctor responses while you research on Realself, you should "Follow" them. You will get email updates, when the doctors you follow post any new answers to questions, post new photos, or have any new reviews.

David Hansen, MD · Answer

Fractora RF is such a great skin tightener and resurfacer that we use it all the time.  When you are not quite ready for a lower face/neck lift, fractora RF is ideal.

Darryl J. Blinski, MD · Answer

I personally do not recommend that HA filler. After trying it on a group of patients I was NOT satisfied with results. In your case based solely on the few posted photos you could improve with a Y Lift and sub chn lipo or KyBella. Best results are surgical mini FL/NL with sub chin lipo.

Is Ellanse the best option for me? Concerned about my lower face.

Answers (3)

Recommended reading

Everything you need to know about Ellanse

Our mission is to create a world where every investment in modern beauty is Worth It.

Is Ellanse the best option for me? Concerned about my lower face.

Answers (3)

Browse related questions

Recommended reading

Everything you need to know about Ellanse

Our mission is to create a world where every investment in modern beauty is Worth It.