Is a Facelift required or can this be improved with injectables?
See attached pic, hate my lower face area, looks puffy in some areas, and dimply in other
areas, saggy?
I don't like the area to the left and right of my chin.
I also don't like the horizontal line that curves up around my chin, and the outside
areas of my lips to the left and right.
Can fillers or Dysport be used to improve these areas, or is a facelift necessary?
Thank you for your question!
You submitted a photo and you expressed several concerns about the area around the mouth and
you’re asking can fillers treat the situation or a facelift if necessary.
We’ll, I’ll certainly share with you my experience and my recommendations when someone
like yourself come to my practice.
I’m a cosmetic oculofacial plastic surgeon practicing in Manhattan and Long Island for
over 20 years.
I’m board certified by the American Board of Cosmetic Surgery and facial aging issue
is an area that is very important to me.
It’s an area of focus in my practice and I even wrote a book a few years ago about
this for consumers.
So let’s begin by understanding what you’re dealing with.
You’re dealing with two issues: one is volume loss.
You described dimpling and lines and sagging.
Well, volume loss in the lower third of the face, especially in women, seems to be significantly
more advanced when compared to the aging that happens in the upper third and the middle
third of the face.
Now what that means is that essentially there’s bone loss along the jawline, in the mandible
or the jaw bone and it accentuates any jowls as well as volume loss in the lips and the
mesolabial folds also known as the marionette lines.
Now when patients like yourself come to our practice, I explain that part.
Then I also sit with them and have them look at a mirror and I do a vertical lift of the
skin.
And I ask them do they do this at home.
Of course, I do this all the time.
They do what’s called the mirror lift.
They place both of their hands on the face and they push upward.
So when you ask a question like this, ideally in the perfect world, both procedures, both
face lifting and fillers would be optimal.
Because the reality is that you can’t do just one and get as close to that line of
the 100% solution.
You can never replace all the volume and you can’t lift some aggressive enough to make
them look 30 years younger but you can address the elements.
So with lifting, I always tell my patients that if you are able to do a facelift, then
facelift is the first procedure because that’s repositioning the sagging and displaced tissue.
In other words, the skin, the muscle, everything that goes downwards is put back upwards.
However, it does leave volume loss that isn’t addressed.
Now sometimes during face lifting procedures, we’ll address some of that.
We do something like fat graft.
However, a lot of times, the majority of times, I tell my patients that we do the face lifting
first and then we assess what is the concern afterwards.
And I show them that once I lift the face, that a certain element of the mesolabial fold
will still remain and a certain amount of the mandibular notch and the notch where the
bone just kind of goes inward is still going to be present.
Now there are many ways to address these issues and of course we discuss all of these things.
Now there are other patients who want to do the facelift and plan to do a facelift but
they don’t have time.
For them, we offer the fillers.
The fillers such as Radiesse, Restylane, Juvederm and we also use something called platelet-rich
plasma (PRP).
It’s not a filler but it helps improve skin quality.
It’s derived from your own blood.
But the fillers can be done very strategically in a way to help improve the mesolabial folds
or the marionette lines and improve the jawline by filling in the area of the mandibular notch.
There’s a real art to this.
And understanding how you want to strategize and what’s right for you is very individual.
So I recommend you meet with qualified experienced cosmetic surgeons.
I tend to always recommend surgeons because as surgeons, we can do both the non-surgical
and the surgical.
A lot of times people who are non-surgeons, with all do respect, have a tendency to want
to only do offer non-surgical procedures basically because of limitation of the scope.
So essentially, the strategy that works right for you is one that you’re comfortable with.
And so you have to connect and feel comfortable with the doctor who’s advising you.
There’s a lot of ways to solve this issues but the art is doing it in the way that is
right for you, that you’re comfortable with and financial and other factors are necessarily
integrated in to this plan.
So I hope that was helpful, I wish you the best of luck and thank you for your question!