What is the best and most successful non surgical procedure for sagging neckline and jowls on face? I am 63 years old. (photo)

I have lost over 25 pounds and of course I am starting to have trouble with sagging skin especially around the lower face area. I am 63 years old. What is the best non surgical procedure for getting rid of sagging neck/ jowls of the face? I recently tried Ultherapy (two weeks ago) and I still do not see any difference. I do understand it will take time. I am just worried that it will not be enough.

Doctor Answers 13

Treating sagging neckline and jowls

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Thanks for your question and your photo. I feel your concern...I have some looseness in my own mid line neck area that I don't like either. In your case, your facial skin appears quite smooth from the photo.  I don't see much jowling. Nonsurgical options that I might recommend for you in a consultation would probably a include: Precision Smart Lipo to sculpt and tighten the neck and jowls; and Intensif - radio frequency micro needling w/ PRP (platelet-rich plasma) to tighten and improve the thickness and texture of skin of your face and neck. I hope this is helpful.

Surgery options

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When looking into a procedure like this, you need to see what is causing what you don't like in the mirror. The things that can be address surgically are the skin, the fat and the muscle. Definitely seek out a board certified plastic surgeon in your area with an expertise in Facial Aesthetics for a consultation and more details. From these pictures it is hard to say what your best options are. 

Dean Vistnes, M.D.
Vistnes Plastic Surgery
San Francisco Bay Area

#realself #drdeanvistnes #lowerfaceandnecklift

Non Surgical and Surgical Neck Options

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Neck Lift is a general term relating to procedures that will improve your neckline. There are many possibilities both non-surgical and surgical so picking the best neck lift treatment(s) for optimal improvement is most important. A board certified plastic surgeon with a special interest and substantial experience in neck lift and lower face lift surgery is the place to start. The reason for a plastic surgeon is that he/she can offer all possible options and tell you specifically which ones are best for you.

The best recommendations to improve your neck appearance depend on your needs, desires, and most importantly an examination to determine the best procedure for you. Your plastic surgeon will evaluate you for five main features that will determine your best options for neck line improvement:
  1. Amount of excess fat typically found beneath the chin, and in the upper neck. This requires liposuction with small cannulas or direct removal especially if the fat is beneath the platysma muscle.
  2. Presence of Significant (Platysmal) Banding – this requires bringing the muscles together in the upper/mid neck to a more youthful position and occasionally their release. This procedure is called a platysmaplasty or platysma plication. Mild banding can be treated non- surgically with Botox or Dysport but this requires injections 3-4 times a year for maintenance.
  3. Amount of excess/redundant skin (cutis laxa) and condition of your skin. In advanced stages this is called a Turkey Waddle or Gobble deformity. For example, younger age, darker skin colors and no large weight loss history most likely means there will be better elasticity and therefore better post-surgical contraction. In milder cases if not too much fat is present there will be enough skin shrinkage with just lipo alone. Mild to minimal skin tightening using non-surgical means like the Sciton Laser SkinTyte procedure, Ultherapy or Thermage could also be considered. My personal preference for non-surgical skin tightening of the neck is the Sciton Laser BBL SkinTyte® procedure as there is no down time, more comfortable procdure, is effective and is a more targeted treatment. For redundant upper and mid excess neck skin: I prefer the LiteLift® (lower facelift ) procedure or MACS for skin re-draping for mild to moderate excess skin management as there are minimal scars and the skin is lifted vertically allowing for minimal hidden scars resulting in a natural appearance “non pulled” appearance. However: for moderate to severe skin redundancy , a neck lift or traditional lower facelift (e.g.Lite Lift®, MACS and others) is needed with or without lipo for best results. For advanced Turkey Waddle correction wither a traditional facelift or posterior neck lift often with a platysmaplasty is required with more extensive scars that extend at the hairline behind your ears. The advantage of a facelift procedure rather than a posterior neck lift is that your lower jawline (e.g. jowls and marionette lines) are also improved at the same time.
  4. Chin deficiency. If you have a weak chin then you will not have adequate chin support to your neckline skin which affects your entire neck line. Sometimes especially in younger individuals this is all that is required and this can be done in the office under local anesthesia. There are a number of different sizes and shapes and your plastic surgeon will pick the optimal one for you.
  5. Presence of prominent Digastric Muscles or Submandibular gland fullness from laxity or enlargement. Although not a major concern for most patients, if present then partial resection is usually the best solution.
In summary, picking the most qualified and best plastic surgeon with the most experience in neck improvement is essential to ensuring that you will have a wonderful and lasting result. It is the plastic surgeon’s ability to evaluate both your anatomical features and aesthetic goals to guide you to one or more neck lift procedures to give you the best neck line possible.

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Thank you for your question. Kybella is the best nonsurgical treatment for contouring the jawline. Please consult with your board certified facial plastic surgeon to learn more about the technique and its ability to tailor to your desires and needs.

Best wishes,

Ross A. Clevens, MD
Melbourne Facial Plastic Surgeon
4.7 out of 5 stars 123 reviews

Neck/face lift

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Based on this very limited view it looks that surgical correction of your neck and face is much better solution. You can continue trying non-surgical rejuvenation modalities but nothing will make visible change in this stage. Face and neck surgery is essentially very comfortable procedure with minimal risks if done in experienced hands. Although initial cost of surgery may be significant it is still "cheaper" in comparison what you will spent next 10 years for non-surgical rejuvenation. An average SMAS type face/neck lift will last 8-10 years in your age group.

You should schedule a consultation with an experienced board certified plastic surgeon with good reputation in facial rejuvenation and discuss your options. Good luck.

Zoran Potparic, MD
Fort Lauderdale Plastic Surgeon
5.0 out of 5 stars 19 reviews

Surgical vs Nonsurgical

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Surgical procedures such as a necklift or facelift are going to provide the most dramatic and optimal results. Nonsurgical treatments such as Ultherapy, ThermiRF, and filler treatments may help subtly improve your concerns. I would recommend an in person exam to determine candidacy.

Dr. Leonard Lu

Facial rejuvenation for a 63 year old female

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Unfortunately for a fifty year old individual, there is no non-surgical treatment to get the same results as a facelift. There are few non-surgical treatments that can provide some rejuvenation and buy some times for those who just don't want to have surgical treatment.Facial fillers such as Juvederm, Restylane, Radiesse, or fat grafting can camouflage the deflated area of the face and laser treatments can improve the tone of skin.

facelift is a great option for your aging face. I recommend local anesthesia and twilight sedation instead of general anesthesia. I have performed well over 2,500 facelifts under local anesthesia with oral sedation for the past ten years. Without doubt it is safe and well tolerated by patients. Compare to the traditional facelift procedures that are performed under general anesthesia, the post operative complications associated with local anesthesia cases are lower and risk of bleeding is minimized.

Treatment of jowls

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You mentioned that you would prefer to avoid surgery in your question, but frankly, most non-invasive modalities deliver only minimal results for soft tissue laxity and descent.  It might be worth reconsidering your preference for non-surgical treatments if you really want to achieve any significant results.  At the very least, a direct consultation with a surgeon who performs many facelifts would provide you with some valuable information.  I have included a link for more details on surgical options.  Good luck.

What is the best and most successful non surgical procedure for sagging neckline and jowls on face? I am 63 years old.

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At 63 years of age with a 25 pound weight loss I do not think there is any procedure that will give you lasting benefit other than a facelift and necklift.  Achieving a healthy and maintainable weight before the procedure would be very helpful.  I have seen some patients who had a good response to Ultherapy but generally not long lasting improvement.You have to make a decision whether possible temporary benefit is worth the expense involved but many patients do choose to proceed with a facelift with the likelihood that they will have 10 to 12 years or possibly longer of benefit along with a slimmed and more youthful appearance of their face.Good luck and best wishes.Jon A Perlman M.D., FACS
Diplomate, American Board of Plastic Surgery
Member, American Society for Aesthetic Plastic Surgery (ASAPS)
ABC-TV Extreme Makeover Surgeon
Beverly Hills, California

Jon A. Perlman, MD
Beverly Hills Plastic Surgeon
5.0 out of 5 stars 31 reviews

Facial Aging and Lasers like Fraxel/Clear + Brilliant, RF like VIVA, Peels, Fillers, Skin Care, Face Lift, Fat Injections

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You are likely a face and neck lifting candidate.  If you only want non invasive, you will get only a small result compared to surgery.  Sagging face needs volume with fillers or fat, skin tightening procedures or face/neck lifting, and lasers for complexion/fine lines. I suggest you see an expert for a formal consultation. Best, Dr. Emer.

Jason Emer, MD
Los Angeles Dermatologic Surgeon
4.8 out of 5 stars 203 reviews

These answers are for educational purposes and should not be relied upon as a substitute for medical advice you may receive from your physician. If you have a medical emergency, please call 911. These answers do not constitute or initiate a patient/doctor relationship.