Thank you for the question.
You are asking what is the best and longest lasting way to treat heavy jowls and you ask
on your question about the various techniques from high SMAS, SMASectomy, MACS lift, deep
plane basically a provider of a list of all the different techniques.
And you state that you see in this medium that people, after full SMAS facelifts have
recovered jowls.
Well the type of question you are asking is the kind of question that people who do this
type of surgery have been asking for decades and the best technique doesn’t really exist
because the human body is going to have a lot of variability.
And the reason, I will explain this further, as a background I’m a board certified cosmetic
surgeon and fellowship trained oculofacial plastic and reconstructive surgeon.
I specialize in helping people look better specifically in the area of facial aging and
I do all those procedures.
And I’ve been in practice for over 20 years in Manhattan and Long Island and I treat patients
who come for these procedures who come from all over the world.
I can say that the marketing elements of face lifting surgery which further confuses matters
and there are doctors who claim that they only do deep plane facelifts implying that
the other doctors that don’t do those procedures or that they are doing something that is complicated
than other people are not as brilliant as they are that’s just not the case.
Every surgeon who performs face lifting surgery who is properly trained and has experience
can do all those procedures that you just listed.
And more, and when it comes to it, at a certain level and experience, you really are customizing
even further because you are using your knowledge and experience to get the best result for
that patient.
And so, that essentially means that there is something missing in the equation as to
why you noticed that people do get recurrent jowls and there are a few things.
So the limitations of face lifting have to do with the realities of what the factors
are related to facial aging.
And facial aging is basically two things: it’s volumetric loss which means loss of
bones, muscle, fat and soft tissues and it’s also sagging, descent and weakening of soft
tissue.
So that means you’re lifting against a structure that has less volume and you are lifting with
tissue that is more elastic.
A colleague of ours once said that the skin is like taffy and it is very stretchable so
whether you go very deep or whether you go superficial, in the end, you are still lifting
the foundation of the face called the SMAS.
But the weakest link in the chain is the tissue quality.
And so there is invariably a certain amount of regression which the skin in the neck can
stretch a little bit.
You turn your head up and down, it’s going to stretch a little bit.
The face will stretch a little bit just normal movement expression.
So I explain to my patients that if you are a candidate for a facelift, my job first is
to reposition and put everything back as to where it should be but it doesn’t mean volume
correction is not going to be appropriate.
Now volume correction can be the use of chin implants, cheek implants to restore volume.
Or volume correction can be the application of fillers, structural volumizing, placement
of thicker hyaluronic acid filler at the deeper levels so that after the facelift is done,
you can also get this volume restored.
And in fact, I would do a limited facelift and combine it with injectable fillers to
restore volume concurrently.
There is a lot of art to this type of practice and there is a lot of finesse and there is
a lot of variation and the personal style of different doctors.
Imagine if there was just one way to do the best job possible then everybody would do
it exactly the same way and that is just not a reality of there is one way to do a facelift
and that the best way you can be sure is someone who trains in this field would do exactly
that.
I think what you are dealing with is just the elasticity of the human body and the variabilities
in the ways we can lift the face and neck area.
So I think that if you are interested in doing anything, meet with different doctors, explore
different options and learn about the different anesthesia scenarios.
Every doctor comes to this in a way with the perspective of doing the best job they can
with knowledge and experience they have and there are problems when doctors engage in
turf battles and disparaging other doctors stating they are capable or better qualified.
It just serves to confuse people unnecessarily because I think majority of the time, people
who often do these procedures do have appropriate experience and it is just a matter of finding
the right fit in terms of this style of the procedure, in terms of the anesthesia, in
terms of the overall vision the you and the doctor share about the outcome.
So I hope that was helpful, I wish you the best of luck and thank you for your question!