Help with Jowls
I have inherited the “family jowls” which are making me look older, saggy and a little overweight in my face. Can this be corrected without having a full facelift and is 39 too early to have surgery?

Although most of us have many family traits that we are grateful for, “family jowls” which conjure up the image of an older relative are not one of them. They make us feel older, tired, heavier and sad-looking.

There are several treatments, besides a full facelift, for you to consider. A recent innovation has been thread-lifting, in which small nylon strings with barbs are placed under the skin with a needle. This bunches and lifts the skin, improving the jowls. While some patients are satisfied with this technique, the threads can sometimes extrude, or tether or slip. Their long-term results are not guaranteed, and so they have not received universal approval from all surgeons.

Non-surgical treatments include injection of a filler such as Hyaluronic acid (e.g. Juvederm™, Restylane™) into the furrow in front of and below the jowls. Although this will not lift the jowl, it can improve the sagging appearance along the jaw line. A fairly large volume of filler may be needed, and the results may last 6-12 months. Permanent fillers are not advised here, especially if you are considering a facelift later.

Fat injections are effective when the fat all lives, or “takes”, but there is a risk of “lumpy-bumpiness” and repeat injections being required. Like permanent fillers, they are not recommended if you are considering a facelift later.

Botox Cosmetic™ will not improve the jowl itself. However, if the corners of your mouth are sagging and creating a sad look, it can be injected into the muscle that pulls down the outer lip (the depressor anguli oris, or DAO) and create a slightly happier look. Radio frequency therapy (Thermage™) may provide a minimal effect for some people.

If you would consider a minimal facelift, you could have a short flap, short scar facelift that would be primarily directed at improving your jowls and would have minimal affect on your neck or cheeks. And it would still allow you to have a “full” facelift such as a sub-SMAS or deep plane at a later date, if and when you wanted one.

You should also not forget good skin care. Sunblock, not smoking, exfoliation of skin using topical creams or facial peels and treatment of brown or red spots with Intense Pulsed Light (IPL) can all help create a more youthful look.

The age someone begins rejuvenation treatments or has surgery is unique for each person. Most important, you should be healthy, find out what each potential treatment can provide you, and confirm in your mind that the result of your chosen treatment will meet your expectations. Certainly many women and men begin non-invasive treatments by age 39.

Regarding facelift surgery, in general the younger and less aged you are, the more subtle your results will be. The older you get, with more sagging and loss of skin tone, the more dramatic your results will be. But the younger you have your lift, the more years you will have to enjoy the result. The goal, in all patients, is a natural, unoperated but refreshed appearance. Skin type, sun damage, smoking, general health and your beauty goals will all play a role in determining the best age for you to have a facelift.

The first step is to decide which treatment options interest you. Then consult with your surgeon, dermatologist or aesthetician to determine the best choice for you. Peter A. Adamson, M.D.,F.R.C.S.C., F.A.C.S