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Any advice on fullness around the corners of my mouth, jowls, & some thickness under my neck & wrinkles around my eyes?

Dr. Dean Kane Q & A Q. Any advice on fullness around the corners of my mouth, jowls, & some thickness under my neck & wrinkles around my eyes? What would be the best course of treatment ? Short-term and long term. I am 38 years old. A. You show the beginnings of facial skin laxity. The skin stretches and elongates developing a growing “wave” at points of attachment such as the:
  • ​hooding along the eyes,
  • ​lower eyelid / cheek junction or tear trough / nasojugal fold,
  • ​nasolabial fold,
  • ​lateral mouth commissure and marionette folds,
  • ​jowls and neck.
Since I do not have the advantage to examine you, I hope you will be helped by the information below. ​My immediate recommendations include:
  • ​Consultation with a talented, Board Certified Plastic Surgeon with extensive skills in:
  • ​non-surgical skin tightening
  • ​minimally invasive injectables
  • ​surgical options.
Facial Aging are created from the 5 different layers of the skin, fat, muscle and bone. During the first 20 years or so of life, the body genetically determines how to develop and repair a constantly changing “face” including all these layers (as it does elsewhere in the body). Thereafter it remains robust in repairing itself from injury but the accumulation of environmental, health and nutritional exposure will add to the passive inability for the body to care for itself after 30. This is when physical changes such as skin laxity, irregular pigmentation, lines and wrinkles and skin diseases occur. We now have many options to rejuvenate the layer or layers of the face which need care or stimulation to reverse the aging trend. 1. The top layer or stratum corneum of the epidermis is the rough, pigmented layer of the skin; creating most of the depth of the wrinkle.
  • Exfoliation is best for this using:
  • microdermabrasion,
  • Retin-A (ZO Obagi Skin Health System), which also renews and regulates improved function of the deeper epidermis,
  • Some lasers and chemical peels.
  1. The second layer is the dermis which thins with aging. The natural collagen, elastin and hyaluronic acid (which hydrate and toughen the skin) are thickened by the use of:
  • fillers (Restylane and Juvederm), or
  • Retinoids (ZO Obagi Skin Health System), which also renews and regulates improved function of the deeper dermal skin cells.
  • Sculptra properly managed is the latest sensation in stimulating firming and thickening of the dermis
3. The next layer or fat also thins or droops with age and maybe:
  • filled (Restylane and Juvederm), fat grafting or
  • redraped (threadlift, short-scar, traditional, endoscopic face / neck / brow lifts / cheek)
  1. The muscle which creases the skin into wrinkles and folds is weakened and rebalanced with
  • Botox or similar injectable muscle relaxers like Dysport or Xeomin.
  1. Bone also undergoes a dynamic process of resorption, thinning and descent. Options for cosmetic enhancements include:
  • implants
  • structural fillers, particularly like Radiesse (bone mineral)
  • volumizing gel fillers like Juvederm and Restylane
Facelift, necklift and forehead lift are surgical procedures which include:
  • an incision along the periphery of the tissues
  • a suspension or re-positioning of the underlying soft tissues, and
  • a redraping of the skin with removal of skin excess.
A sub-group to the facelift is the mid-face lift. This is used to detach the soft-tissues of the cheek which have descended, separated and lost volume and suspend them to the lower orbital rim. Generally, the fat pockets under the eyes are trimmed or added to the volume of the cheek and the eyelid skin is redraped. Everyone needs one or more layered improvement and in personalized combinations to achieve their optimal result. You can understand why it takes a talented individual, preferably a Board Certified Plastic Surgeon or ENT Facial Surgeon with great experience to evaluate your needs and find a plan that works best for you. All surgical, minimally invasive and non-invasive procedures and their combinations should be discussed following a proper examination with a well versed, Board Certified Plastic Surgeon who performs all of these options so you will not receive a biased approach because he limited in his skills. I hope this is helpful. I wish you the very best. Happy Holidays!  
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