Q. I’m 71 years old and my face is big. My jaw and neck have fat and sag. I have anxiety about going under anesthesia. Are there any procedures that will correct this without surgery?
A. Facial Aging develops 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 mature 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:
- Retin-A (ZO Obagi Skin Health System), which also renews and regulates improved function of the deeper epidermis
- Some lasers and chemical peels.
2. 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 to stimulate firming and thickening of the dermis
- Thermi RF is a non – surgical option.We use ThermiSMOOTH superficially or ThermiTIGHT to tighten THE skin using a micro-invasive technique. ThermiTIGHT™ is a non-surgical. minimally invasive procedure. As it is the first aesthetic procedure that delivers controlled thermal energy under the skin, it reverses many of the effects of aging including loose and sagging skin. ThermiTight is ideal for patients who want more results than superficial skin-only non-invasive treatments but do not want surgery. ThermiTight is effective for problem areas of the face, neck, breasts, tummy, love handles, arms, thighs, knees and other areas. ThermiTight uses local anesthetic to achieve a painless, micro-invasive procedure that usually takes less than one hour with little downtime. A tiny probe is inserted under the skin and radio-frequency energy is applied directly to the target tissues causing immediate shrinkage and longer-term collagen formation. Results are immediate and improve over time.
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)
- LipoContouring of the face and neck with or without fat grafting may provide the balance and contour you seek without general anesthesia.
4. 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.
At the same level of the muscle are the fibrous tissues which support the fat. The thread lift is back using Silhouette InstaLift (SIL) sutures! Doctor Dean Kanes experience with prior Contour Threads for a minimally invasive face lift was unparalleled over 10 years ago when this option was removed from the marketplace. Today’s SIL absorbable sutures and anchoring cones lift the tissues of the face, neck, brow, breast, tummy, upper arms and thighs using simple puncture sites. The sutures themselves are made of absorbable poly-L-lactic acid and poly-glycolic acid which is the foundation of Sculptra and Vicryl molecules stimulating formation of collagen and elastin to maintain the lift in place up to 18 months as well as tighten, firm and improve the skin texture of surrounding skin and soft tissues.
5. Bone also undergoes a dynamic process of resorption, thinning and descent. Options for cosmetic enhancements include:
- structural fillers, particularly like Radiesse (bone mineral)
- volumizing gel fillers like Juvederm and Restylane
6. 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.
Chemical peels and laser tightening are single, “static” attempts to “jump” the repair system into collagen formation. They should be performed every 3 months in order to achieve a more dynamic stimulation of the immune system.
Based on the limited photo you have provided, my non-surgical recommendations may include:
- Lipocontouring to the lower cheek, jowl and neck
- ThermiTIGHT to stimulate tightening of the lower face and neck
- Silhouette InstaLift to suspend or lift the skin and soft tissues of the face and neck
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 with great experience to evaluate your needs and find a plan that works best for you.
I wish you the best! Happy Holidays!
This information is not meant as medical advice. It is provided solely for education. Our practice would be pleased to discuss your unique circumstances and needs as they relate to these topics.