Well...what's next? Jowls, mouth laxity, issues related to gravity. (photos)

A facelift may help you to improve your jowls and sagging skin, however I would need to see you in person to determine the best course of action.

As a cosmetic oculofacial plastic surgeon and someone who
specializes in facial aging, the challenge that is seen in my office everyday
is making decisions on how to deal with the two factors that are related to the
genetics of facial aging: volumetric loss or volume loss - the loss of bone,
muscle, fat and soft tissue; and descent or sagging that requires a procedure
involving lifting.



A facelift is a procedure where the cheeks are elevated from
the cheekbone down to the jawline in a predominant vertical direction. It’s
basically a combination of vertical and lateral or posterior directions but a
significant part of face lifting is to move sagging tissues upward. The
necklift procedure deals with the banding of the skin of the neck that is
sagging and tends to be more posteriorly oriented.



When we do an isolated necklift for a patient, I first do a
very thorough discussion. I let the patient understand that the combination of
jowls and sagging skin in the neck area is often contributed by both the
descent of the face as well as the sagging of the skin and loosening of the
underlying soft tissue of the neck. That being said, a facelift procedure for
you would involve some type of skin elevation as well as tightening of the
underlying structure called the SMAS (superficial muscular aponeurotic system).




There are a number of types of facelifts that are being
marketed, examples are: deep plane facelifts, extended SMAS facelifts, high
SMAS facelifts, SMASectomy and composite facelifts. In addition, when you look
at the history of face lifting surgery in the cosmetic surgery field, there are
many techniques. All techniques are valid but they also depend on the individual
surgeon.



When I meet with my patients, I discuss what their desired
outcome is and what it will take to get to that desired outcome. We do all
those procedures I just mentioned. All those things in the hands of an
experienced surgeon like me can be performed and customized. When you are
choosing a surgeon, what I always recommend is that you have to have very good
communication and a clear understanding of your desired outcome.



Surgeons would often focus on what the surgery can do for
patients, but in my practice I focus on developing a comprehensive plan and
identifying the areas of the face that can’t be addressed by face lifting alone
but rather by a combination approach. Sometimes we will combine things at the
same time with the facelifts such as facial implants like cheek implants or
chin implants. Sometimes we will combine fat grafting and other modalities to
maximize what we can do surgically and what we can do that would overlap the
surgery. You have to come up with a plan where sagging and volume loss can both
be addressed to maximize the appearance. As you enter the late 40s and 50s,
there is going to be some maintenance that is going to be necessary that won’t
be necessarily surgical.



I find that a lot of people are not aware that you can do
these surgeries under local anesthesia with LITE™ sedation. We actually
trademarked a name LITE™ anesthesia because in our practice, we developed a
system to do all these procedures such as: eyelids, facelifts, liposuction,
tummy tucks and breast augmentations all under local anesthesia with light
sedation. I’m not saying that general anesthesia is not appropriate, but we
find that in the spirit of quick recovery and better patient experience, we are
doing full extended face and neck lifts that are the same as the procedures done
under general anesthesia. A very important factor is that these are not
shortcut procedures - it's important to add this into your questions as you
make distinctions between doctors.



At this point, you’re going to have meetings with some
qualified experienced cosmetics surgeons and you should make sure that you feel
that you are in sync with your doctor. Both of you should communicate well and
you are comfortable with the type of procedure that is being recommended. I
hope that was helpful, I wish you the best of luck, and thank you for your
question.

The pointed chin is effecting the facial aesthetics. The easiest and quickest treatment is a filler (my choice would be Radiesse) in MCTs (Marionette Chin Triangles) also called Prejowl Sulci. RegardsDr. J