Thank you for your question.
You’re 46-years-old and you submitted two photos and you’re stating in your question
that you had fillers done in the tear troughs, the cheeks, the jowls.
You had gotten Botox® and overall, you’ve been satisfied with the results but you were
somewhat less than satisfied when you had the fillers placed in the jowls.
You felt that it made your face look fat and you want to know whether or not you’re ready
for a facelift and that apparently, you do a very good job with makeup to camouflage
and you don’t want to do as much.
Well I can certainly share with you this type of discussion I have with my patients pretty
much every day in my practice.
A little bit of background, I’m a Board-certified cosmetic surgeon and Fellowship-trained oculofacial
plastic and reconstructive surgeon.
I have been in practice in Manhattan and Long Island for over 20 years and certainly, we
have evolved quite a bit over this time in the numerous options which can be somewhat
overwhelming but I’ll give you an understanding of the step by step approach that I take when
addressing this type of question.
So to begin with, it’s great that the fillers have addressed one significant part of facial
aging.
And to just recap or review what facial aging is about is that essentially, there are two
things: there’s volume loss.
Volume loss is not just skin turning into wrinkles which is what everyone focuses on
but it’s actually bone loss, muscle and fat loss overall.
So you lose projection in the cheeks, the chin, you get less definition of the jawline.
Then there’s of course sagging.
The soft tissue descends and that’s where various types of lifting procedures actually
have a role.
So when a patient asks about this type of scenario whether it’s volume in the cheeks
or whether it’s for the jawline, whether it’s the concern about appearance, basically
I sit with them with a mirror or I show them and hold up a mirror and I’ll lift the skin
and I’ll see how much laxity is there.
That basically answers the question about the role of a facelift in this type of situation
like yourself.
Essentially, what I’ve concluded over the many years of doing this, is that there was
a time where someone with any laxity would probably have gotten some benefit from a face
lifting procedure and it might apply in your case.
Again, this is without the benefit of a physical exam.
But I think that you may be in that in-between stage where you might not be quite ready for
a facelift just based on your age alone.
And a lot of times, people look at their jawline and they see jowls, although that may be a
significant part where there’s a descent, a jowl being defined as skin and fat descending
and disrupting the continuity of the jawline, but also, there is the loss of bone and an
indentation of the bone called the mandibular notch.
And so that area further accentuates the appearance of a jowl.
So in our practice, we do a procedure called structural volumizing where we’re actually
addressing, as I mentioned earlier, the bone loss level of facial aging by placing a long
lasting filler such as Juvederm Ultra Plus or Juvederm Voluma at that level between the
bone and the muscle.
And by doing it in a strategic way in various areas such as the chin, the jawline and the
jaw angle, we’re able to restore that continuity without doing face lifting surgery.
Now sometimes it makes sense to doing a hybrid approach where you do some lifting and do
structural volumizing.
That’s the customization.
But I think there may be an opportunity and although you were pleased with the previous
results with fillers, you might find that the results with structural volumizing where
we place volume at the cheek level, on the bone and create the volume expansion or restoration
of volume loss at the cheek, jawline, chin, jaw angle, you’re able to actually restore
a lot of this volume and get the equivalent of like a facelift look without doing a facelift.
Now of course I’m a surgeon and I like doing surgery.
But my main job is of course to help my patients solve their issues in the most productive
way and most effective way and minimize the amount of risk.
So I found that structural volumizing actually has been very helpful for your particular
age group.
For people in their mid-40s, a lot of times, we would’ve done facelifts years ago.
We’re now restoring volume and getting really very good results.
Again, the range of face lifting procedures as well as the range of age still is flexible.
My youngest patient was in her late 30s for a face lifting surgery and my oldest patient
is 87.
So there is certainly a range there but it depends a lot on the genetics of aging and
the environmental and other issues but it comes down to answering the question: how
much of this facial aging appearance is due to volume loss, how much is due to sagging
and descent.
So I suggest that you meet with doctors who perform this type of procedure.
You may want to question that doctor who did the injectable fillers for you and explore
this option before you go in straight into having lifting surgery.
If the doctor who did your injectables also performs facelifts, this is a perfectly good
question to ask, “Am I ready for a facelift?”
And a lot of my patients who are more than willing to have the facelift, I tell them,
“Not quite yet.”
It’s a matter of getting the best result and doing the best thing at the best time.
So I hope that was helpful, I wish you the best of luck and thank you for your question.