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Fillers or facelift? I’m 49 years old, always wear sunscreen, and want to look more youthful.

Dr. Dean Kane Q & A Q. I have asked a couple questions earlier about fillers. According to the pictures I’m posting, what would you do about the jowls that are beginning and the “shifting” of the fat from my cheeks? I mean, just on the sides of my nose. When I smile, I have really nice, round apple cheeks. I do not want to have surgery. There should be enough advances in plastic surgery today to get great results without surgery. I could stand to loose 20 lbs, but that would affect my face too much. A. Thank you for sharing your photos!  While long-winded, the following may help guide you through the maze of options we have available today. Review these and seek consultation with a well experienced, Board Certified Plastic Surgeon or ENT Facial surgical team who provides all the options and therefore a more balance recommendation. At 49, you appear to have some sagging of the skin and the soft-tissues of the upper cheek, lower cheek, jowls and neck. There is significant sun-damage changes noted in the lines, folds and pigmentation of your skin. Various options for facelifting, minimally and non-invasive facial enhancements 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 fillersRestylane 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 Dysport too 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. If you can pinch more than an inch of skin along the jawline in front of your earlobe, you should consider a surgical option to redrape and remove extra skin. You may consider: a traditional face and neck lift, short scar face and / or neck lift. The recent resurgence of the S-Lift (created in the early 1900’s), also called by other names as the Quick-Lift, Lifestyle-Lift, Swift-Lift, Soft-Lift, MACS-Lift and others; are a single modification of the S-lift targeted to elevate sagging lower cheeks jowls and lateral upper neck. Lipocontouring of the lower cheek, jowls and neck with fat grafting to the upper cheek has resulted in many happy patients as well. You can see there are lots of options. There is no quick-fix nor magic bullet. A managed anti-aging program which fits your desires and budget will be best. I hope this is helpful. All the best!
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