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Posted: 10:53 a.m. Friday, April 17, 2015

By Anita Mandal, M.D.
Question: I have heavy jowls. One plastic surgeon advised a facelift whereas another surgeon recommended filler to lift the jowls. How do I know whether to choose surgery or filler?

Answer: Facial sagging can have several different causes. It is important to seek a specialist who can identify the correct cause before proceeding to treatment.

Loss of bone mass and/or fat volume in the upper two thirds of the face, especially the temples and cheeks, results in loss of skin support. This, in turn, can lead to tissue sagging in the lower face. A third cause is loss of collagen and elastin production with age. As a result, the tissues are not able to fight the downward pull of gravity,

While some patients experience only one of these three phenomenon, many have a combination. Once the cause of sagging is identified, one can proceed with proper treatment.

Sagging due to volume loss, whether it’s due to bone or fat, can effectively be treated with injectable fillers. Temporary fillers that last months to up to two years include Juvederm, Perlane, Radiesse and Sculptra. Long lasting “permanent” fillers such as Bellafill are safe and most cost-effective over the long-term.

Sagging from loss of skin collagen and elastin can effectively be treated with devices that stimulate collagen. While such devices include Ulthera and Infini, Infini can give up to five times more collagen stimulation compared to Ultherapy. Infini also addresses the entire full thickness of the skin whereas Ultherapy only targets deeper skin layers. In patients with more significant sagging, surgical correction with a facelift may be needed.

Careful consultation with a Board Certified Facial Plastic Surgeon to determine the most suitable treatment for facial sagging is the first step.

 

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