51, Saggy neck and chin - what procedure would improve this? (Photos)

Question

I'm 51 and have deep wrinkles on my neck. Sagging chin and neck. Can you please guide me in the right direction. Do I need lower face lift? Neck lift? Ultherapy? Morpheous 8?

Elie Ramly, MD · Answer

Thank you for your question. Based on the photos you shared, your concerns appear to involve a combination of lower face and neck skin laxity, early jowling, loss of jawline definition (especially with movement), and horizontal neck lines.
If your goal is a meaningful and lasting improvement in the sagging neck tissues, jawline, and jowls, a facelift combined with a neck lift would generally provide the most comprehensive and predictable improvement. The facelift addresses laxity and descent of the lower facial tissues and jowls, while the neck lift addresses loose neck skin, the underlying platysma muscle, and deeper tissues contributing to loss of neck and jawline definition.
Treatments such as Ultherapy or Morpheus8 have a much more limited role. They may provide modest improvement in appropriately selected patients with mild skin laxity, but they generally cannot reproduce the structural correction or degree of improvement possible with a facelift and neck lift. These energy-based treatments can also produce inflammation, fibrosis, or harmful changes within the subcutaneous tissues. This is an important consideration, particularly if you are planning to ultimately pursue facial surgery.
Your horizontal neck wrinkles or neck lines are somewhat different from sagging skin. A neck lift may soften their appearance a bit by improving the surrounding skin and neck contour, but deeply established horizontal lines will likely not disappear completely and sometimes benefit from additional skin-focused treatments.
Whether a combined facelift and neck lift is the right solution for you ultimately depends on your anatomy and goals. An in-person examination would allow assessment of your skin, jowls, platysma muscle, fat distribution, underlying neck anatomy, facial volume, and chin and jawline structure.
Based on the photos you provided and the concerns you mentioned, I would recommend consulting with a plastic surgeon experienced in facelift and neck lift surgery before pursuing nonsurgical skin-tightening treatments, which are unlikely to provide a significant degree of improvement.

David Hansen, MD · Answer

Getting the advanced deep plane mid/lower face/neck lift would do so  well to tighten up everything naturally looking and is easy to  undergo under local with a little iv sedation for complete comfort. Minimize the biggest risks by getting rid of general anesthesia. Under local allows the doc to sit you up occasionally to fine tune the results so you look your very best which you can't do under general. Also get the skin resurfacing package of  Morpheus/ TCA peel done at the same time to the face, neck and chest so you look amazing and totally refreshed when you go back to work in 1-2 weeks.

Gary M. Horndeski, MD · Answer

I recommend a traditional facelift.  This will also lift the neck and help the nasolabial folds and marionette deformity.

Best Wishes,

Gary Horndeski, M.D.

Nelson Lee Novick, MD · Answer

A new injection technique where droplets of Botox are injected in a targeted fashion along the upper and lower jawline and upper neckline, rather than in the usual "Nefertiti" approach, can work well for better defining the jawline and tightening the submental region. If necessary, HA filler can be additionally used to define and straighten the jawline. 
A robust HA contouring filler can be further used to define and straighten the jawline if still needed.
Microdroplet Botox can also be used to diminish the "horizontal necklace lines," and a low viscosity malleable HA filler can further improve these lines, if necessary. 
Be cautious in evaluating the use of so many of the expensive "bells and whistles" laser, RF, and ultrasound gizmos out there, since the hard science to back up their use lags well behind the heavy marketing hype and social media buzz to hawk them. So many of these devices are "here-today-gone-tomorrow" and just turn into yesterday's "next big thing" to come along.
Carefully evaluate surgery, too, since, besides the expense and the risks for post-op complications and possible scarring, the promise of permanent results often does not bear out. While the surgery is indeed permanent, with aging, there are changes to underlying bone, muscle and fat that necessitate additional cosmetic intervention--making the overall surgical benefits over time to be not so permanent. 
You would be wise to consult with an experienced, board certified cosmetic dermatologist injection expert. Hope this helps and best of luck.

Darryl J. Blinski, MD · Answer

Based on nicely post to photos recommendation for in virtual consultation is best. I think I would offer a hybrid net or web mini face neck lift with combination of Endo lays and post surgery XERP external treatment. Fee $10,000-$20,000. Best of virtual consult with.

51, Saggy neck and chin - what procedure would improve this? (Photos)

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