Thank you for your question.
You’re 42 years old, and in your question, you describe that you’ve had Voluma used
in the upper face and cheeks, and you’re concerned about your jowls and you state that
it hasn’t helped much.
You’re asking whether you’re a candidate for a facelift or a mini facelift.
Well, I can certainly advise you or guide you in how we approach patients like yourself
in our practice.
I’m a Board-certified cosmetic surgeon, which is a differentiation from board certified
plastic surgeon.
The American Board of Cosmetic Surgery is the main organization dedicated specifically
towards the training of the specialty of Cosmetic Surgery.
In addition, I'm also a Fellowship-trained oculofacial plastic surgeon, and this is a
specialty where we focus on training of surgery of the eyelids and the face.
I've been performing cosmetic surgery for over 20 years in Manhattan and Long Island,
so I can certainly give you a lot of guidance based on my experience.
At age 42, a lot of times this is a threshold period where there are some manifestations
of facial aging that can be interpreted or overinterpreted.
So, what I mean by that is, facial aging is essentially two processes: one is volume loss,
one is descent.
So when you talk about about a facelift, you have to think that is your skin/soft tissue,
has it descended.
From the photo you submitted, I would say that it's not likely.
What you're interpreting as a jowl is an area we refer to as the mandibular notch.
The mandibular notch is an area of the mandible, or the jawbone, where the bone actually indents,
and there may be some volume descent or accentuation of the jowl right behind it—And it makes
someone look jowly.
So we see patients very often and they'll be in front of a mirror and they do what's
called a mirror lift—they bring their skin up and go “doesn't that look better?”.
Well, when we do a physical examination, when I perform a physical examination, I look to
see does the skin move?
Is there slide?
If there isn't, then a lift, regardless of the name—mini lift, short scar, SMAS lift,
deep plane, whatever you want to call it—is simply not indicated.
Now, when you mentioned the issue with Voluma in the upper face, I can tell you that a lot
of doctors try to perform—and I don't mean any disparagement to your doctor—but they
try to do something called a liquid face lift, where they try to add volume in the soft tissue
of the face to try to expand the face in a way that creates the illusion or, in their
mind, their perception of an actual lifting.
Well, I can tell you as someone who performs the procedure called the Y Lift, which is
about structural volumizing—and I'll explain that in a moment—there is a problem in that
concept of a liquid facelift as it is traditionally practiced, and that is simple: when you are
adding volume in areas with volume loss—well there is value to that—but what is the problem
is that when the volume is placed, if the volume is too heavy, it causes the cheek to
descend, and if it’s just to replenish volume that's lost, then you're actually going to
just have correction but you're not going to get the effect of lifting.
With the Y Lift procedure, what we're doing is we are using traditional dermal fillers
but at a deeper level, against more solid structure.
So against the bone structure, you can actually get that lifting effect, but by doing this
at a deeper level, in a very specific way, we get very nice and natural-looking results.
We can actually use a lot of filler, considerably more than is used in a traditional volume
correction, which is on average anywhere from 1 to 4 syringes.
In the Y Lift procedure, we can use 14 syringes, and that's when we do a full face.
But for someone like yourself, I can see improving this area with the Y Lift method to improve
the jawline, and I think you'd be impressed with the results.
So I think that you can move away from the idea of going towards surgical lifting, because
another thing that's important to understand is that even when you lift, you don't necessarily
fill that area, unless you're doing a filling procedure concurrently, and those filling
procedures include fat grafting, or placement of some type of implants such as a pre-jowl
implants—that’s a silicone implant similar to a chin implant—or a chin implant, that's
also an option.
But I think you could probably buy some time before doing that and consider this method
called the Y Lift.
There's only a specific group of people who are Y Lift-trained physicians, so when you
do your research about it, identify the right doctors before you go and get just another
liquid facelift type of consultation.
So I hope that was helpful and I wish you the best of luck and thank you for your question.