Is there a reason my doctor would not give me Radiesse at the prejowl sulcus? (photo)

Treating the pre- and post-jowl sulcus (not apparently needed in this case) in order to straighten and define and jowly jawline is by no means a new procedure. Experienced injectors have been doing this for years. I have before and after photographs in my own personal collection that date back well over fifteen years. While newer and better materials have been developed for this purpose through the years, the procedure is not new at all. It certainly leaves open conjecture as to why jawline augmentation was not performed in this case, especially when specifically requested and clearly needed. If we put injector inexperience aside, it is possible that the injecting physician felt that treating the nasolabial and marionette lines above first might improve the definition of the jawline below as occasionally happens. However, this would not explain the reluctance to treat when it was clear that the jowls had not improved. (Incidentally, when nasolabial lines, marionette lines, and jowls are all present, I often choose to address all three at once with The Nonsurgical 3D Vectoring Facelift. (For more details on this more advanced nonsurgical technique, you can check out the Realself archives or my website.)My favorite combination for treating the pre- and post-jowl sulcus in my Upper East Side Manhattan practice are a combination of Radiesse and Voluma. In my Israel office, where many more regulatory agency approved products are available, I prefer to combine Radiesse with Restylane SubQ or Stylage XXL.

Radiesse works very well to fill the pre-jowl sulcus region and camoflage the jowling that bothers you. Surgery (a facelift) will improve that area much more when the time is right for you, but I think you are on the right track. Maybe you need to find another physician who specializes in facial plastic surgery to address that concern for you? Radiofrequency energy (like the Exilis) may help some by tightening the jowl skin, but you do need volume addition there also.

Personally, I think Radiesse is fine to use in the pre-jowl sulcus. Other options would be any of the HA fillers or Sculptra. I'm not sure why your particular doctor is against using Radiesse in that area.

Dear writer, Radiesse and Hyaluronic Acid Fillers Work Well in the Pre-Jowl Sulcus. Please see link for images of correction of pre-jowl volume loss, as well as corners of the mouth. You may discuss this option further with your doctor, or seek a second opinion by another Radiesse certified doctor.

I think Radiesse works nicely in this area. There are other fillers that work fine there as well. There are alot of options for non-surgical augmentation of the pre-jowl area. Your injector might not have any experience in this area. You should ask. If they don't you might consider seeking another experienced injector to treat the pre-jowl area, at least. Stephen Weber MD, FACS

It's impossible for me to guess why your plastic surgeon would or would not do something...but it looks like you're a good candidate for filler to the prejowl sulcus.  That procedure does not, of course, eliminate the eventual "need" for a facelift to minimize excess skin or, to the extent that it's effective, non-surgical treatment, such as RF.  Many different types of fillers can and have been used.  The general idea is to fill in the space between the chin and the "early jowling," so it does not eliminate the prejowl sulcus as much as minimize it by evening out the peaks and the trough.I hope that this helps and good luck,Dr. E