What do you think should I spend my money on Sculptra or put my money into a mid facelift? (Photo)

Question

I'm debating between Sculptra or a Mid facelift. I just turned 40 and money is tight so I need to spend wisely. My main concern are my saggy jowls and neck. I've been treating jowls with Restalyn but they still seem droopy.

Young R. Cho, MD, PhD · Answer

Thank you for your question.  A facelift will definitely give you what you are looking for in terms of softening the jowls.  If you are looking for a non-surgical option, I would recommend Profound, a radiofrequency microneedling device that stimulates Elastin, Collagen and hyaluronic acid.  It may not be as big a change compared with surgery, but it can definitely help soften the jowls.  I would also consider injectables in the midface to lift the jowl tissue and I would use Sculptra to better define the jawline as this will also soften your jowl.

Jason Emer, MD · Answer

Sculptra is very different than a facelift.  It is used for short term lifting and contouring.  It is often used to prevent a face lift or used after to maintain it.  It does not give a facelift like result.  With your pictures, liposuction of the neck and skin tightening with thermage/venus legacy or ultherapy would be great.  Then adding sculptra would help increase collagen and give more lifting and tightening.  But if you want a facelift like result, there is no comparison to noninvasive techniques. Best, Dr. Emer.

Michael I. Echavez, MD · Answer

Based on your photos, your face does not appear to be in need of additional volume so I would not recommend Sculptra for you.  A facelift would give you the most improvement for your jowls and neck, but a less costly alternative would be Ultherapy.  However, Ultherapy would give you more mild improvement than surgery.

Nelson Lee Novick, MD · Answer

From the photos provided, there appears to be some jowl formation along the jawline and some excees submental fat. I am not much of a fan of Sculptra, since it tends to be expensive, doesn't give immediate results, and requires a series of treatments. I am also not surprised that Restylane was not particularly effective. In my experience, it is more for filling fine lines and superficial wrinkles, rather than for raising deep folds and contouring jowls.In my Upper East Side Manhattan practice, I would opt for Voluma XC or Radiesse for treating jowls. The results are seen typically after only one treatment seesion, are immediate ,and tend to last at least 1.5 years. (In my Israel satellite facility, where a far greater number of regulatory agency approved fillers and volumizers are available, I would opt for Emervel Volume or Teosyal Ultra Deep). For submental fat (double chin) I would suggest waiting for the new FDA approved injectable fat dissolver, Kybella to become widely available (probably within the next few months). I have been successfully treating this area in Israel with regulatory agency permitted extemporaneously compounded versions of Kybella that have been available for quite a few years already.I am not much of a fan of lasers, nor radiofrequency and ultrasound devices. They tend to be relatively expensive treatments and their results often subtle and inconsistent.. Consultation with an experienced board certified physician injector would be strongly urged. Make sure to ask to see his/her before and after photos. .

Michele S. Green, MD · Answer

Thank you for posting the photos.  It appears that you have mostly skin laxity in that area as opposed to volume loss.  I would recommend Thermage for non-surgical tightening of the skin.  Thermage will produce new collagen and tighten the jowl area with no down time.  Please consult a board certified dermatologist with a great deal of experience with Thermage for the best cosmetic results.

Dean P. Kane, MD, FACS · Answer

Dear 3pink5blue:Thanks for sharing your photos. It is best for you to consult with a well experienced Board Certified Plastic Surgeon as the options you are considering will not improve the concerns on your photos or in your post. Various options for facelifting and skin texture
improvements are available according to the skin laxity and areas of lift or
tightening you wish or need. To meet your desires and expectations, you must match:the patient with the surgeon with the proper technique and the budget. Fillers will continue to add volume and weight to a relaxing and enlarging skin surface area creating greater jowling. Sculptra will not reposition your jowls nor adequately firm your jawline. Botox will not help you in the lower face and neck. A mid-face lift will elevate your cheeks and possibly improve your nasolabial fold but not the lower face, jowls nor neck. Based on this limited information consider a surgical option for the better improvement and longer term outcome. Lower face and neck contouring with: lipocontouring of the lower cheek, jowl, jawline, double chin and neck,platysmaplasty and / or neck suspension suture,fat grafting to the cheeks.see reference below. If you have significant laxity along the jawline consider adding a short-scar face lift. Choose your most widely skilled surgeon to get your best results for the money. I wish you all the best!

Steven F. Weiner, MD · Answer

I would address the neck and jowls with either the Infini (less $, less results), or with laser lipo and neck/face lift.  Sculptra is used to add volume and that's something you don't need. Infini will define the neck better, but not as much as more invasive procedures.

Karol A. Gutowski, MD, FACS · Answer

If it is your neck & jowls that concern you, then Sculptra and a midface lift will not improve that. Instead, consider a neck laser-assisted liposucition and a MACS lift, both of which can be done under local anesthesia. See link below for an example of neck liposuction

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