What would you recommend for mid to lower face laxity, jowls and upper neck; surgical or filler solution? (photos)

Question

Skin tightening products had kept the start of jowls at bay, but now my lower face is beginning to sag and jowls are forming, as well as the start of an under chin wattle. A friend recently got Voluma XC and said it provided enough "lift" to fix her jowl issues, but I don't care for the unnatural apple cheek look it gave her. I have an appt for Sculptra, but I don't feel it is going to achieve what I want - to get completely rid of the jowls and laxity. 53 year old female. Suggestions? Thx!

Sam Speron, MD, FACS · Answer

Hello.Your situation is very, very common.  Your photos show a natural aging progression and I do not believe that you have to worry about a solution.  You lack volume, which is to be expected, and you are experiencing sagging.  My advice is to avoid overcomplicating the remedy.  If you take the approach of a face lift combined with filler (fat, Voluma, Radiesse, etc.) you will likely end up hugely improved.  The missing element, though, is the need for youthful skin.  You appear to be fair skinned, which means that at the end of the day a laser or chemical peel treatments could work wonders for giving you jealousy-inducing skin to compliment your lifted face.

Raffy Karamanoukian, MD, FACS · Answer

Morpheus 8 is a non-invasive skin and soft tissue tightening treatment that is consistently amazing in our patients. We use the Morpheus to exact fractional induced RF into the skin or tissue in order to tighten collagen and stimulate contraction of the tissue. For acne scars, it is quite useful to build collagen in patients who have atrophic scars but is not very productive for ice-pick scars which require TCA Cross. For tissue tightening, Morpheus is ideal for the face and neck and we often combine it with CO2 laser or Ultherapy to further enhance results. Chemical peels and skin resurfacing should be done at least 5 to 7 days after, but can be performed earlier, depending on treatment severity. Avoid exfoliating skin treatments before Morpheus and expect a period of 2-4 weeks for skin contraction to set in.

Best,
Dr. Karamanoukian
Realself100 Surgeon

Best, 
Dr. Karamanoukian 
Realself100 Surgeon

Jason Emer, MD · Answer

FaceTite can internally tighten the skin in the lower face and neck. After all the skin has been heated and contracted, we shape the neck with liposuction to give definition and remove stubborn pockets of fat. In one quick treatment, we can tighten skin, remove fat, and contour the lower face, jawline, and jowls with only a weekend of downtime.​  Keep in mind that combination approaches will give you a more significant improvement as opposed to a single procedure. I recommend getting a consultation with a board-certified cosmetic dermatologist and facial sculpting expert. Best, Dr. Emer

Jed H. Horowitz, MD, FACS · Answer

Depending on the level of laxity, the effects of a neck lift will certainly outlast the effects of non-surgical treatments. Non-surgical procedures can only temporary resolve the issue and require few to several attempts or treatment appointments. 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 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 also 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.However, 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 of the #LiteLift 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.

Gustavo A. Diaz, MD · Answer

Hi CarolinaGirl848,The most important step that you need to take is to have a person to person consultation with your facial plastic surgeon. Voluma XC and other fillers will help this condition that you have but only on a temporary basis. You have a sagging tissue problem and a volume problem. despite other comments here, sometimes facelift will help some of the volume of the cheeks, on patients that have a significant amount of hollowness on their cheeks some fat grafting will be necessary.There is no facelift, no mater the technique (SMAS, MACS, modified MACS, Mini Lift, etc.) that will address completely the volume problem. A facelift address sagging tissues, bulging fat, and excess skin. They only address 2 dimension of aging (the sagging and drooping). The third dimension of aging (volume loss) can only be address by fat grafting. The power of any facelift in giving volume restoration is limited. If a surgeon tells you that the volume can be restore by a facelift that they invented that has not had been peer reviewed, my recommendation is RUN!!!!. And look for another consultation.Hope this helps.Dr. Gustavo Diaz.Double Board Certified Facial Plastic Surgeon

William Portuese, MD · Answer

A lower face/neck lift can address tightening loose facial and neck skin, tightening the neck muscles in 3 locations, lifting the jowls and the SMAS in addition to  removal of fatty deposits of the neck above and below the platysma muscle. . A platysma plasty is also performed.  Fillers are only temporary, while a facelift offers a permanent result. For many examples of what a facelift can accomplish, please see the link and the video below

Robert T. Buchanan, MD (retired) · Answer

You do  appear to have all that you have described as well as sub malar hollowing. Fillers like Juvederm Voluma or Radiesse can improve the areas of your concern but you have to fill the sub malar hollow (the so called V-4 area) also to keep from creating an unnatural superior roundness. To correct the problems completely, however, requires significant amount of filler. Sometimes this can be much more expensive than surgery, which, of course, is the other option. This can correct essentially all your problems. My preferred method is a modification of the MACS Lift. Since this replaces the descended tissues into their natural, elevated position. With a standard SMAS Lift, to correct the sub malar depression frequently also requires fat grafting. You need to see a plastic surgeon who is experienced in facial rejuvenation by surgery and non surgical methods.

What would you recommend for mid to lower face laxity, jowls and upper neck; surgical or filler solution? (photos)

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