How Sagging Jowls are Treated with Face Lifting Procedures and Facial Fillers
A 40-year-old woman has jowls that bother her a lot. She wants to know if she needs a facelift.
Dr. Amiya Prasad, a cosmetic oculofacial plastic surgeon, says that this is a very common issue particularly for a lot of women in their 40s. He explains that there are two aspects of facial aging: one is descent or sagging, the other is volume loss. Facial descent means that the skin and soft tissues are sagging or drooping, which ispartially responsible for the jowls and the little band of skin below the chin which has resulted in a loss of angularity. The other part is volume loss which is gradual diminishment of bone, muscle, fat, skin and soft tissue.
For years, there have been debates between non-surgeons and surgeons about the better procedure for facial aging. Before deciding a procedure, Dr. Prasad often asks patients to do a simple test by lifting the skin upward and seeing what happens to their jawline and neck, often referred to as a "mirror lift". This moves tissue upward to see if it improves the jawline and neck. If it does, a significant element of their concern, specifically the jowls, is related to some descent.
Usually, when someone has this type of situation and they are relatively young, a limited incision face lifting procedure can be considered. In Dr. Prasad’s practice, he does 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. Unfortunately, a lot of doctors advocate deep plane and other lifting procedures. However, an experienced cosmetic surgeon who does a lot of facelifts will customize these procedures based not only on the external physical exam 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 and the effectiveness of the movement. Dr. Prasad thinks that repositioning sagging tissue is probably the most optimal way to restore a youthful appearance when there is descent.
In Dr. Prasad’s practice, he also uses fillers to restore volume. Sometimes he does this when patients don’t have the time yet to do a facelift. In the meantime, he does things to soften the appearance of the jowl using fillers like Radiesse. He routinely places it in an area that is right in front of the jowl called the mandibular notch. Adjacent to that is the area called the mesolabial fold which is often referred to as the marionette line. These areas benefit from augmentation or replacement of some of that loss of volume. Ideally, the sequence would be to lift and then add volume. When the face is thin, there are opportunities in different areas to restore volume. Dr. Prasad’s approach is to always be conservative. He wants to restore just enough so that artistically, the balance of the face is maintained.
Dr. Prasad thinks that she would benefit from meeting with experienced cosmetic surgeons. In his practice, he offers everything from advanced surgery to skin care products and everything in between. He is able to customize a plan for each patient. With 20 years of practice, he always tries to figure out ways to create the right solution for the right time to match the person’s desires and budget.
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