Thank you for your question.
You submitted your question with a single photo.
And you state that you are 41-years-old and that you are concerned about the marionette
lines and jowls, the overall skin laxity and that you are aware that you have under eye
bags.
And you are stating that you are not quite ready for a facelift.
And you are concerned that injectable fillers can make the lower part of your face look
wide.
And so you’re asking can laser essentially improve these areas and I think you are looking
to get some clarification as to a strategy.
Well, I can certainly share with you how I discuss these concerns with my patients which
is essentially every day, all day in my practice.
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.
Customizing solutions using lasers, injectables as well as surgical and other non-surgical
options is what we spend all day doing to help our patients and it is very much the
questions you’re asking reflective of the current state of options in the aesthetic
field.
Thanks to a lot of very aggressive marketing between manufacturers of various devices and
products as well as the different interests of different types of medical and non-medical
providers, it creates quite a lot of confusion.
So I think that just by looking at your photo and I would tell you that it is unlikely that
you would be a good candidate for a facelift at this stage.
Basically, having done a lot of facelifts in my career and continuing to do so, the
reason why a lot of patients will first consider a facelift is that when they pull their skin
upward or do what’s called the mirror lift, things look better.
But the reality is that unless the skin moves significantly and essentially what you are
trying to do is improve the jawline and neck, through that action, at this age, this is
usually not the right time.
Now that doesn't mean that it’s not possible.
My youngest patient I ever did a facelift for was 37-years-old but that was more of
a limited facelift as opposed to a type of a facelift that we do on someone who would
typically get a facelift who tends to be in their 60s and older which is more of a face
and neck lift.
So it’s very important, before defining the solutions is to define the problem.
And you define the problem by going to the core basis which is anatomy.
So what happens at 41 that’s different than what you were like when you were 31?
Well, there are two basic issues: one is volume loss in the bone level as well as in the fat
and soft tissue level.
This is what implies that there is laxity.
That’s why when you pull, you feel like there’s loose skin.
If you imagine, if the foundation has diminished then the covering will get loose.
Now certainly, there is no shortage of lasers that can help with this overall situation.
And I understand your concerns about the use of fillers.
Fillers traditionally are used in a way to chase lines.
Basically, when you have a nasolabial fold that’s deep or marionette lines that are
deep, you can get fillers to soften those lines.
But generally speaking, the lines are really more of a reflection of a global change and
more of symptom.
We offer a procedure in our practice called Structural Volumizing and this is probably
relevant to your situation.
The concept of Structural Volumizing is the application of fillers.
We’re placing fillers at a deeper level basically on the bone structure so that the
underlying bone and the muscle overlying the bone work together in a way that creates restoration
of some of that lost volume that I described earlier, the loss of bone as well as fat.
What’s nice about this approach is that the skin doesn't get weighed down by the volume
of the filler.
A lot of times people don't like the results that they see of people who have had fillers
because they can look rounded or they can look widened.
But with Structural Volumizing, we can actually enhance and balance a lot of the angularities
that could be missing.
In fact, there is something called the Golden Ratio which is something that in nature is
seen as very attractive.
So when you compare and you see this in models, you look at the cheek structure relative to
the jawline structure and it’s like a 1.6 to 1 ratio.
So you can potentially consider this.
This also applies to the profile so that the jowl areas and the cheekbones can also be
enhanced.
When this material such as a long lasting HA or hyaluronic acid filler such as Juvederm
Ultra Plus or Juvederm Voluma is placed at this level, the material can also last over
one year so there’s also a very nice benefit in not needing frequent reapplication.
Now that being said, where does laser fall into this?
As far as your under eye bags are concerned, laser will really not get rid of your under
eye bags.
There are a lot of different types of lasers and there are certainly ways to try to do
things to help soften the under eye bags.
But depending on the degree of the under eye bags, the under eye bags represent something
called lower eyelid fat prolapse.
Depending on the degree of the prominence of the under eye bags, we can soften their
appearance by using an injectable filler such as Restylane or softer hyaluronic acid filler
or we do a procedure called transconjunctival lower eyelid blepharoplasty where the fat
pockets are actually reduced so that they don't bulge out.
This requires more of a physical examination but these are options that I think would be
more effective than laser.
So where does laser fit in?
Laser does fit in to help skin quality and texture.
The spectrum of lasers we have can essentially do a lot for pigmentation, for vessels and
for skin quality and limited in terms of skin tightening.
Generally speaking, I find that when you restore volume, then tightening is less of a priority
for the patient who wants to initially come in asking to be tightened.
Basically, I look at skin as more as the icing, what we do after everything else is done.
Too many people keep trying to use lasers or thermal energy devices to be substitutes
for surgical procedures or other procedures but you can only do so much.
And you have to remember, the skin is about 2 millimeters in thickness.
There’s not a lot of room to work with and you can only do so much.
We in our practice, we have several types of lasers that provide solutions from everything
from wrinkles, to pigmentation, to vessels and a lot of other things including skin tightening
but we have to use them as tools appropriately.
So meet with qualified, experienced physicians who can review these issues with you.
Make sure that you spend a lot of time in analysis so that you would be able to get
a sense of what strategy makes the most sense to you in terms of your resources, in terms
of your time and in terms of expected outcome.
So I hope that was helpful, I wish you the best of luck and thank you for your question.