Thank you for your question.
You submitted your question with several photos.
And you state in your question that you’ve never had a well-defined jawline, that you’re
40-years-old and that you’ve lost 40 pounds.
And you have a scheduled appointment with a doctor and you want to know what you can
do to help improve the sharpness of your jawline.
Well, I can certainly share with you my approach to helping patients like yourself who come
to my practice with very similar questions.
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.
Helping people improve their jawline definition through a variety of strategies, everything
from facelift, liposuction and fillers have been an evolution that has continued since
the beginning of my practice.
So I can essentially give you my physical exam approach that I can’t do with the photos
alone.
So to begin with, it’s important to understand that there are first some anatomic issues
which is the basis for why you never had a very sharp jawline.
So what are those anatomic issues.
Well very commonly, it is often the arrangements of certain bone structures and soft tissue
structures in the face and neck that are responsible.
For example, there is a bone called the hyoid bone and when that hyoid bone is low and forward
or sometimes low and referred to as anterior, well then you don’t get this high defined
neck.
And so your jawline is not as well defined.
Other variables also include the actual structural shape of the jawbone or the mandible.
So certainly, the genetic components are one part of this equation.
The other part of this equation is of course the significant weight loss.
It is not uncommon for someone after losing a lot of weight to have a relative excess
of skin under their chin or in their neck area.
Now from this photo, it looks like your skin has retracted fairly well and I think one
of the things that’s going to be done when you see your doctor is that they’re going
to do the maneuver where you push the skin up to see how much relative skin excess there
is.
Now traditional approaches to facial aging when the jawline and neck skin is loose is
always some variation of a facelift or a face and neck lift.
The challenge in your situation is that you’re 40-years-old.
Being 40-years-old and male means that essentially, there’s a challenge of justifying the procedure
for the incision that is involved.
And this is something that I discuss with my male patients every day.
When we deal with men above a certain age and again, it does depend on ethnicity as
well as skin type but even the most well placed incisions can be more visible in a male patient.
There’s also a risk no matter how well an incision is closed and cared for, for the
incision to either be thickened or indented or widened.
And again, when people are a little bit older, there’s a little bit more forgiveness because
of the nature of the skin in the later decades.
You’re still very young.
And so I would be cautioned about choosing a procedure like a face and neck lift.
Now a lot of times, a little bit of liposuction along the jawline can help also define the
jaw even if there isn't a lot of fat in that area.
Now this is something that has to be done very carefully.
And the flip side of this is that your skin still has to retract well enough in order
to define the jawline to the way you would want and sometimes the skin doesn't behave
to that level.
A lot of times, people try thermal energy device to shrink the skin but generally speaking,
that amount of shrinkage is not that significant.
I see thermal energy devices whether it’s radiofrequency or laser-based device to be
more about skin and tissue remodeling more than it is about tightening especially when
you compare it to lifting.
Another option that we have been employing is called Structural Volumizing.
Now what’s particularly interesting about Structural Volumizing is that you’re actually
dealing with the level of the bone where there may be a relative deficit from genetics as
well as aging.
By placing thicker fillers such as Juvederm Ultra Plus or Juvederm Voluma, you’re actually
able to define the jawline by enhancing the bone structure.
And this may actually be the most practical step for you to do depending on your physical
examination.
Now this is a procedure that’s not commonly done so it’s something to discuss with your
doctor.
Basically, using blunt cannulas, we’re able to place filler at a level in a way between
the bone and the muscle so that the bone structure looks sharper and more defined.
A lot of times, our male patients who are in this in between stage of skin being kind
of loose but not too loose to justify a lift or maybe even a blended approach of combining
lipo and filler I think might be the least invasive and the safest approach and the most
predictable approach before eventually choosing to do a face and neck lift.
So discuss these options with your doctor.
I’m sure your doctor will have plenty of ideas.
But I think that from the photos you submitted, I would lean towards the more conservative.
I would evaluate the skin to see if there’s any value to liposuction and as well as to
Structural Volumizing with filler to add to the bone structure.
And thus, maybe one or the other or the combination of the two will give you the better definition
of your jawline that you’re trying to achieve.
So I hope that was helpful, I wish you the best of luck and thank you for your question.