Do I need some aspect of a facelift or will fillers help? Early 40s. Jowls bother me a
lot
Do I need some aspect of a facelift or will fillers help? Early 40s.
Thank you for your question!
You are in your early 40s and you submitted two photos showing the lower face, the front
view and the three quarters view. And you’re asking if some type of facelift would be of
benefit or fillers and you specifically asked about jowls.
So this is a very common issue particularly for a lot of women in their 40s. What happens
in this stage of your life? Well, there are two things and it depends a lot on genetics
but there is a basically aspects of manifestation of what you’re experiencing referring to
facial aging. These are two things: one is descent or sagging. That means that the skin
and soft tissue are sagging and drooping and is partially responsible for the jowl as well
the little band of skin below the skin which has resulted in a loss of that nice angularity.
The other part is volume loss. Volume loss, as we get older, involves bone, muscle, fat,
skin and soft tissue. So essentially, as we get older, things kind of like shrink inward
and there’s opportunities to restore volume as well as restore position.
For years, there have been debates continuously between non-surgeons and surgeons about what
is better at any given time but I think that that debate has become even more complicated
with the mix of a lot of devices that are aggressively marketed to offer non-surgical
solutions, to avoid surgery altogether. So to make sense of all of this, what you have
to kind of start with is a simple test. And that is just to physically lift the skin upward,
see what happens to your jawline, see what happens to your neck. Don’t do it too aggressively.
We often refer this to as the mirror lift and what you are doing is you are literally
moving tissue upward to see does it improve your jawline, does it improve your neck. If
it does, a significant element of your concern specifically the jowls is related to some
descent.
Usually, when someone has this type of situation and they are relatively young as you are,
then a limited incision face lifting procedure can be considered. In our practice, we do
these procedures under local anesthesia with LITE™ IV sedation. It’s still not a shortcut
procedure because deeper tissues specifically the layer called the SMAS or superficial musculoaponeurotic
system needs to be addressed in order to maintain the position of the skin.
Now a lot of doctors advocate deep plane and other have advocate lifts that have a particular
marketing label, or name (something slash lift) but in the end, an experienced cosmetic
surgeon who does a lot of facelifts will customize these procedures based not only on the external
physical exam when you meet with the doctor but also what they see when doing surgery.
A lot of decisions have to be made in real time during surgery depending on the quality
of the tissue, the effectiveness of the movement. But in the end, my feeling is that repositioning
sagging tissue is probably the most optimal way to restore a youthful appearance when
there is descent.
In our practice, we do periodically also do fillers to restore volume in people in your
position. A lot of times it’s because you don’t quite have the time yet to do your
facelift. So in the meantime, can we do things to soften the appearance of the jowl? The
answer is yes, you can place fillers. In our practice, we use a material called Radiesse
and we routinely put it in an area that is right in front of the jowl called the mandibular
notch and right adjacent to that is the area called the mesolabial fold and this area which
is often referred to as the marionette line benefits from augmentation or replacement
of some of that loss of volume. Ideally, the sequence would be lift and then add volume.
But if there is not enough time, then you can do things to restore some of that volume.
So moving forward to restoring volume question, when your face is thin as yours is, there
are opportunities in different areas to restore volume. My approach is to always be conservative.
A lot of well-known people are walking around with very swollen looking appearance and they
look smooth and attractive but they look pillowy and doughy and that’s not what we want.
We want to restore just enough so that artistically, the balance of your face is maintained. You
just look a little younger. You look a little bit rested and you don’t look as drawn.
So I think that at this point, you would benefit from meeting with experienced cosmetic surgeons.
I’m recommending surgeons because surgeons can do everything the non-surgeons can do,
so if the practice such as ours, where we offer everything from advanced surgery to
skin care products and everything in between, we are able to customize a plan for each patient.
20 years of practice, I have many patients who have been with me for that long and 10-15
years. What we try to figure out is always to create the right solution for the right
time and very often, to match the person’s desires and budget. With that understanding,
it’s almost primary care for beauty. I think you’ll do well with meeting with a cosmetic
surgeon who is comfortable with that concept and once you are comfortable with someone
and you really trust them, then move forward with whatever you feel is right for you.
So I hope that was helpful, I wish you the best of luck and thank you for your question!