Thank you for your question.
You submitted your question with several photos in different angles and you’re stating essentially
that you don’t like the way your face is changing at the age of 47.
And specifically, you feel like your cheeks look more sunken and that it’s making your
nose look more prominent and your eyes look different and sunken as well.
You also describe a situation where you feel like your mouth or lips have almost disappeared.
And also, you’re concerned about the quality or appearance of the skin of your neck.
So you’re asking, filler or facelift and I think that’s a really relevant question
in the current time.
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 helping people with facial aging has been a significant part of my practice.
And there has been certainly an evolution of options to help our patients as well as
an evolution in the understanding of facial aging when I think of where we were 20 years
ago compared to where we are now.
So I think your description is actually very accurate about what you’re seeing in terms
of “things sinking in”.
One of the unfortunate realities of facial aging is that there is a significant change
in bone loss.
Bone, muscle, fat and soft tissue actually diminishes and therefore, you look more hollowed.
And so, what would have been a strategy decades ago would have been trying to lift everything
to try to shift position of sagging tissue, what appears to be sagging.
In my practice, in my approach now is more about volume correction.
Now when it comes to volume correction, there are certainly many options.
But what I lean towards is actually the use of different injectable fillers in a way that
can provide the longest lasting benefit as well as the most natural appearance.
So what does that mean?
Well, if we look at the current choices of inventory when it comes to the fillers specifically
the hyaluronic acid fillers like in the Juvederm family or Restylane family, we have a wide
variety of fillers of different thicknesses, of different behaviors.
And so, it’s a very nice opportunity to customize the approach for every patient.
So what we do often in our practice for someone like yourself is a procedure called Structural
Volumizing.
Structural Volumizing is a concept where the use of long lasting fillers such as Juvederm
Voluma or Juvederm Ultra Plus is placed at the bone level where there is the most significant
loss.
And by doing that, you’re actually able to restore the lost volume.
Well, you can never restore everything but when you work at this level, one of the biggest
fears patients have about injectable fillers is looking puffy, looking doughy or when it
comes to the lips, looking like a trout or a duck and then being afraid of looking unnatural.
There is an art to everything we do and whether it’s surgery or fillers, I treat the procedure
comparably.
When I do the Structural Volumizing approach, I actually treat it like surgery where we
do things in a very sterile way.
And between myself and my assistants, there is always this dynamic feedback of how things
are looking.
So we can restore the volume in the cheek area, for volume in the jawline, the jaw angle,
chin and you can actually, in many ways, create the perception of someone of having a facelift
without having surgery.
Not to mention, this procedure can take less than 30 minutes.
Now, when it comes to enhancing the lips, you are also on target when it comes to the
volume loss around the mouth.
And although a lot of people who are, as they are getting older, are afraid of looking overdone,
I always explain that lip volume correction is very different from lip volume augmentation.
The point is, if you restore just a conservative amount of volume in the lips, it really makes
the mouth area, or what we refer to as the perioral area, very nice and natural.
Studies have shown that when a person looks at you, their eyes go in this triangular shape
in the center of the face.
Basically from the eyes down to the chin.
And so, in that triangular area, it’s very nice to have balance and proportion.
Now, when it comes to the skin issues and the neck laxity, I think you’ll find, if
you do something like Structural Volumizing, you might be able to get some tone back to
the skin but you also have to understand a lot of times, we’re dealing more with the
skin quantity differentiation from quality.
So in other words, what you are dealing with right now is more of skin quality issue.
When someone has a lot of sagging, then face lifting is certainly appropriate.
When the jowl has dropped below the jawline significantly and there is a lot of neck skin,
then face lifting is certainly generally more indicated than volume correction.
But in your situation, I think volume correction would make a bigger impact.
So I would recommend that you meet with qualified, experienced doctors who do this type of procedure.
I think that you’re going to find yourself kind of overwhelmed by the many choices you
have but I think understand that this concept of Structural Volumizing is not practiced
by most doctors and it really is a specific technique and I say that doctors like myself
who are surgeons have a certain perspective that’s different from non-surgeons or people
who have not done surgery at the deeper levels of the face and the bone and it gives us a
certain, I would say, advantage in some ways how to place the fillers as many ways we could
think of when we do facial implants.
So that’s also something to factor in if you like.
So I hope that was helpful, I wish you the best of luck and thank you for your question.