Thank you for your question.
You've submitted a photo and you're basically asking what you can do to take a few years
off.
And the substance of your question, you state you're 46 years old, you've not had any other
procedures other than a TCA peel.
And in particular, you're concerned about the appearance of some lines under the cheeks
as well as around the mouth.
Well certainly I can assist you with these.
These are questions that we deal with everyday in our practice.
I'm a board certified cosmetic surgeon certified by the American Board of Cosmetic Surgery
and fellowship trained oculofacial plastic surgeon through the American Society of Ophthalmic
Plastic and Reconstructive Surgery practicing in Manhattan and Long Island for over 20 years.
And the addressing of facial aging through cosmetic eyelid procedures and facial rejuvenation
procedures from short scar facelifts to extensive face and neck lifts, to now additionally non-surgical
facelifts is something we do every week and deal a lot with in our practice.
So with the photo you've submitted, it’s clear that your analysis is really very accurate.
But to give you an idea of how to make this decision about whether to lift or to add volume
is to understand the facial aging process.
Facial aging is two things, one is it’s volume loss.
Volume loss could lost a bone, muscle, fat, soft tissue.
The face in – especially in particular areas where there’s bone loss, you noticed these
lines starting to form; particularly in the lower face where the vertical lines next to
the lips called the marionette lines.
In addition, it’s also sagging where you lose the elasticity of both the skin and the
support structure of the skin called the SMAS or superficial musculoaponeurotic System in
addition to the other volume loss.
So one of the things that I would suggest considering in a situation like yours which
has been very successful for us – and again, this is in the absence of a physical exam.
When I evaluate a patient and they will very often hold up a mirror and they will pull
their face up, they say, “Doc, can you just make me look like this?”
We often referred to it as a mirror lift.
It’s essentially identifying that they don’t like certain lines and they feel like getting
rid of those lines or soften those lines makes things better.
Well, the decision to lift or to fill at a certain point in time is based on how much
sag there is.
And judging by the photo, it doesn’t look like you have that much sag.
Which means that there is a role of some type of volume correction.
Now traditionally in the cosmetic field, it has been always the focus to help people by
treating the lines.
So whether it’s the nasolabial fold or the mesolabial fold, it’s a treat to the lines.
And in addition, there’s also some soft tissue augmentation where you're – let’s
say that someone has cheeks that are getting flatter, adding volume in the cheeks.
But part of the problem with traditional methods of filling is that you are treating lines
that are reflective of the loss of volume in the structure.
And it’s very hard to really get a great correction of those lines.
When it comes to the filling of soft tissue, you are limited by the elasticity and the
ability to hold the material that you fill into the skin when the skin is getting thinner
and sagging, it can become lumpy.
It can become irregular.
So a lot of times people who have a lot of filler with the intention of having smoother
skin and looking younger, they end up looking pillowy and doughy.
Well in our practice, we perform a procedure called the Y Lift.
And the Y Lift is based on the idea of structural volumizing where we’re putting the fillers
that you're familiar with such as Juvederm Ultra Plus at a deeper level on the bone structure
to expand and restore some of that structure that you are missing.
It’s a very interesting phenomena when we look ourselves in the mirror and people look
at themselves, they focus on lines.
And we have examples of patients who came with that concern and then when we restore
structure to the other areas – actually the last thing we did was we didn’t actually
fill those lines when we restore structure.
So in the Y Lift, what we’re doing is we’re structuring cheekbone structure, vertical
aspect of the jaw and the jawline, as well as the chin.
And so what we’re doing is when we’re restoring structure, it’s almost creating
a lift but a lift through expansion and restoration of structure rather than to the vertical lifting
of skin.
There’s even a combination approach where we can do a limited lift of the skin and the
underlying structure called the SMAS and do filler at the same time using this Y Lift
method.
It’s sounds – often – and sometimes it seems too good to be true and the results
often look too good to be true because it’s really a very special technique that a handful
of us are trained to do and do.
And unfortunately a lot of doctors who don’t do this don’t understand it and naturally
in the competitive, unprofessional environment we live in, we’ll disparage it.
So understanding that, you may want to at least find a doctor who performs the Y Lift
and learn more about this because I – my impression is, is that a little bit of structural
volume will go a long way for you.
And you don’t necessarily have to go for a surgical facelift unless there’s a lot
of sagging which, of course, I can’t really tell without an examination.
So I hope that was helpful.
I wish you the best of luck.
Thank you for your question.