What needs to be done on my face in order to 'take few years off' and look fresh? (Especially Lower face) (Photo)

Thank you for your question. I understand you’re 46-years-old and you’ve never had any cosmetic procedures done aside from a TCA peel. You are beginning to feel more concerned about some lines around your mouth and under your cheeks, so you’d like to improve their appearance.I'm a Board-certified cosmetic surgeon, certified by the American Board of Cosmetic Surgery, and Fellowship-trained oculofacial plastic surgeon, through the American Society of Ophthalmic Plastic and Reconstructive Surgery. I’ve been practicing in Manhattan and Long Island for over 20 years, and addressing facial aging through cosmetic eyelid and facial rejuvenation procedures is something I do regularly in my practice.Facial aging involves two things: volume loss and sagging. Volume loss is a natural occurrence as we age, which refers to loss of bone, muscle, fat, or soft tissue. Usually in areas of volume loss, lines will start to form. With sagging, you lose elasticity and support of the skin, particularly with the SMAS (superficial musculoaponeurotic system).The decision to lift or to fill at a certain point in time is based on how much sag there is. Based on your photos, there doesn’t appear to be much sag, which means that there is a role for some type of volume correction. Traditionally, in the cosmetic field, the approach is to treat the lines themselves — whether they are nasolabial folds or the mesolabial folds — is to augment the soft tissue by adding more volume. The problem with treating the lines themselves is that it’s very difficult to get really great correction of those lines. The problem with soft tissue augmentation in aging, sagging skin is that you are limited by the ability of the skin to hold the material properly. Sometimes the skin can become lumpy or irregular, and in some instances, the patient ends up looking pillowy and doughy.That said, what we do in our practice is a procedure called the Y Lift™. The Y Lift™ is an elegant procedure based on the idea of structural volumizing. We place a long-lasting cosmetic filler, such as Juvederm Ultra Plus, into the deeper structural levels of the face —near the bone structure — in order to expand and restore the structure and volume in key areas such as the cheekbones, vertical aspect of the jaw and the jawline, as well as the chin. In a way, when we place the volume at this deeper level, it’s almost creating a lift through expansion and restoration of structure rather than by the vertical lifting of the skin itself. We can even do a combination approach where we can do a limited lift of the skin and the underlying structure called the SMAS, and do filler at the same time using this Y Lift™ method. Interestingly, we are able to improve the appearance of lines without actually touching or filling out the lines themselves.I recommend you learn more about this procedure, and find a doctor who performs this procedure, as it is a very special technique that only a handful of doctors are trained in. Ultimately, my impression is that a little bit of structural volume can go a long way for you. You don’t necessarily have to go for a surgical facelift, unless there’s a lot of sagging, though unfortunately I cannot determine this without a proper examination.I hope that was helpful and I wish you the best of luck!This personalized video answer to your question is posted on RealSelf and on YouTube. To provide you with a personal and expert response, we use the image(s) you submitted on RealSelf in the video, but with respect to your privacy, we only show the body feature in question so you are not personally identifiable. If you prefer not to have your video question visible on YouTube, please contact us.

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

For facial rejuvenation I would suggest a combination approach including:1) skin care with products and microneedling/PRP2) PDT Light Therapy a few times per month with growth factors3) laser treatments like Clear + Brilliant regularly and others (Fraxel, Viva, CO2, Erbium) a few times per year4) Sculptra injections a few times per year for collagen production with fillers like Juvederm, Restylane, Belotero, Radiesse, and/or Bellafill5) Thermage/Ultherapy for yearly skin tightening with or without PDO or cone-based Instalift threads for lifting6) Botox every 2 to 3 months to stop movement lines and prevent lines at rest
See an expert. Best, Dr. Emer