Facial plastic surgery is no longer one-size-fits-all. In fact, the profession has been evolving for years, and new techniques continue to provide patients with individualized combinations of procedures designed to address specific concerns.

One of the most common complaints involving the aging face is the development of heavy jowls and the accompanying sag under the chin and onto the neck. Lifting the tissue used to be the first line of attack for this problem, but a complete analysis of facial structure and consideration of the array of subtle, yet effective, approaches mean that facelifts no longer are the sole solution.

“The most important thing to know is that one does not have to do a ‘major’ surgery to gain significant improvement, and any approach should be completely compatible with the individual's own desires, not what is in a magazine or what their neighbor or friend had done,” says Dr. Michele Koo, a board-certified plastic surgeon with the Aesthetic Surgery Institute. “If your plastic surgeon is worth anything, she or he will absolutely tell you what you need, and what is real and in your best interest.”

In determining how to address a patient’s concerns about a sagging chin, neck and decollete, "the decision as to which surgery or adjunctive procedure to do is dependent on one's budget, amount of time available for recovery, and overall cosmetic goals, from significant change desired versus maintenance and small steps," Koo says.

In many cases, surgery only is part of the overall plan. For example, a sagging chin may require a combination of treatments due to the forces that cause the problem. “The chin ages primarily because of age-related loss of bone and fat, especially in the area of the chin just in front of the jowl,” explains Dr. Brock Ridenour, a board-certified plastic surgeon with Ridenour Plastic Surgery and Professional Skin Care. “This results in a loss of youthful jaw definition and contributes to the formation of ‘marionette’ lines between the cheek and chin.” Loss of bone support along the jaw also permits loose skin to form in the upper neck, he adds.

“Treatment options include specialized chin implants designed to augment the common areas of bone and fat loss,” Ridenour says. “Implants have the advantage of permanency and require only a minor surgical procedure. However, implants come in a limited number of prefabricated designs, and cannot be customized to every situation. Alternatives include the use of injectable fillers or fat. Both of the latter two procedures allow precise ‘custom’ correction with limited downtime. Fillers do require maintenance and the long-term persistence of fat can be unreliable.”

The relatively thin skin covering the neck typically ages due to a combination of gravity and loss of elasticity. “Significant sagging of the neck is best treated with surgery—a neck-lift or face/neck-lift,” Ridenour says. However, lesser degrees of neck sagging can be addressed with skin-tightening devices, such as fractionated lasers. “Both noninvasive and minimally invasive devices are now on the market and can be used to achieve noticeable tightening of the neck in properly selected patients,” he adds. Sun spots, broken capillaries and textural abnormalities may be treated with light-based technologies and topical products.

Koo reminds patients that “the longevity of a procedure is completely dependent on the person's health, skin quality, lifestyle (smoking and sun exposure), and compliance with maintenance steps. The recovery from Botox and filler can be 30 minutes; the recovery from a chemical peel, three to 10 days; from a face/neck/eye-lift, 10 to 30 days. The more invasive the procedure, the lengthier the recovery.”

Both surgeons emphasize good skin care and daily sunscreen in order to protect the skin from ongoing damage.

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