Question from Los Angeles, CA: Noticed slight descent of face, jawline is no longer sharp as it used to be. Had filler in cheeks before (results have worn off) but am reluctant to continue to see this as the quick fix. Filler does little for the structure and the lower face and jowling. I’ve researched into a mini/lifestyle lift, ultherapy, Nefertiti lift. I already have fairly good cheekbones but wonder if I’d benefit from small cheek implants too. Rather invest in a procedure(s) with lasting effects for a good few years.
Answer from Dr. Dean Kane, Board Certified Plastic Surgeon from Baltimore:
I do see very minimal laxity causing your cheeks elongating slightly and creating a minimal wave across your nasolabial and marionette folds.
I would like to review the options that go through a well experienced and Board Certified Plastic Surgeons mind AND THEN make some recommendations… Various options for face enhancements including facelift, minimally and non-invasive facial options and skin texture improvements are available according to the skin laxity and areas of lift or tightening you wish or need. Both surgical and minimally invasive / non-surgical options are listed below. Surgical lifts would be likened to pulling the bedspread and or top-sheet of your bed up to the head-board and removing the excess material. Minimally invasive procedures such as fillers provide volume such as adjusting a pillow under the bedspread. Botox and Dysport act by pulling the top-sheet which drags the bedspread upwardly. If the bedspread (or skin) continues to fall to the foot of the bed despite fillers, Botox or Dysport you will need to consider a facelift. Non-invasive options such as laser and light therapies, skin tightening products and technologies perform their tightening and smoothening of the skin similar to sending your bedspread to the dry cleaners. A more refreshed, even colored, glowing smoother and tighter spread covers the surface of the bed. The most popular of the fillers, Restylane and Perlane, a jelly-like clear skin filler is used to fill lines, wrinkles and folds. Juvederm and its longer lasting “cousin” Juvederm Ultra Plus are similar skin fillers, used to soften and fill the nasolabial (“parentheses”) and marionette folds, the brow (“number 11”) lines and fill and lift the cheeks and lateral brow or chin.Voluma is the longest lasting, up to 2 year duration HA filler. Each one is used to expand or volumize the loss of tissue associated with expression, weathering or aging. All the fillers come with numbing anesthetic!. Non-surgical facial contouring is possible with fillers such as Radiesse, a bone mineral for the nose or cheeks, jaw and chin as well. Scuptra is the latest of the injectibles stimulating collagen at different levels of the skin, adding volume but primarily firming and adding resistance to the formation of wrinkles, folds and descent. Botox and Dyspor ttoo have been found to rebalance excessive facial expression, provide a non-surgical brow lift and lip lift and reshape the nose, as well as reducing wrinkles! Dr. Obagi’s new, second generation ZO Skin Health programs may be added to personalized chemical peels, light and laser resurfacing and tightening and will, smoothen and even the color of your skin. IPL and fractionated lasers such as CO2 and erbium and now RF (radiofrequency) are additions to smooth the texture of the skin, tighten and reduce red and brown uneven pigmentation. As for you, you seemed to enjoy cheek fillers before. Try Voluma as it is a very projecting 2 year filler. Add Juvederm or Perlane to the nasolabial and marionette folds. Sculptra will continuously stimulate firming of the skin for up to 2 years. Zo (Zein Obagi) Skin Health programs with retinoids will exfoliate and stimulate the skin for added external rejuvenation. Any of these procedures and their combinations should be discussed following a proper examination by a Board Certified Plastic Surgeon who performs all of these options so you will not receive a biased approach because he or she is limited in their skills. All the best!