I’m 53 y.o. I’ve been using fillers and Botox for about 4-5 years. At first 2 syringes of Restylane filler was applied around the marionette lines and chin area but not directly on marionette line. I looked very chin – y and not like myself at all. Four months later Restylane define and refine (2) were applied directly on right and left marionette lines. The marionette lines were corrected but my chin is now lopsided. The left side of my lower face and chin is very noticeably larger and longer than my right side (jowls). I also have a large bump on left side of lower face. I look terrible. I look like a freak! Asked my very reputable plastic surgeon in NYC to correct it and he told me that this bump is the trade off to getting rid of the marionette lines. He said if he dissolved it I’d be back to square one with the marionette lines and to just leave it and eventually the bump will go down. I’m beside myself. I’d like to switch to another plastic surgeon who suggested that I try silhouette lift for he feels that no amount of filler will ever get rid of the jowls. How do you feel about silhouette lifts for the lower and mid face and he also suggested using them to lift my drooping brows? Do you use them.? What is your experience with them or do you know of other physicians who use them and get good lasting results? Thank you so much. C.N.
First, I would really consider changing to an injectables experienced dermatologist. Here’s why. Plastic surgeons are trained to do surgery and most of them love surgery. They have little or no training in the health or diseases of the skin. Fillers, Botox/Dysport, lasers are generally not very interesting to them, and they have injectables in their offices as a way to get patients in the door. Most plastic surgeons delegate the injectables to nurses whom they hire. There are a few exceptions to this: surgeons who truly love facial sculpting with non-surgical methods. In general, I don’t agree that fixing a filler contour problem puts you back to square one, as your surgeon told you.
It’s important to remember that the sagging around the lower mouth/chin area (mesolabial fold) often comes from upstream. We lose volume and skin firmness in our upper faces and that shows up downstream. Often the best solution is to both replace volume in the temple, upper later cheeks, and sometimes midface, and then have just a light touch around the mouth with filler. Or to skin tighten and build collagen with say Profound (deep RF microneedling), Sculptra, and CO2 laser and then fill more lightly.
This often gives a more natural effect than a facelift, or just pulling our skin up in the mirrosr. 🙂
Fillers for Mild Jowls
Usually fillers and injectables are enough to treat mild jowls (more information on procedure, cost and effects of fillers in my article here). When injected in the cheeks, Sculptra causes the body to produce more collagen. Sculptra is classified as a filler, but it’s different in that it is a collagen stimulator also. It fills the cheeks more and lifts the skin in the lower face and jaw line.
There are many fillers that we use for lifting now in the hyaluronic acid family. For example, Voluma, Restylane Lytft, Restylane Defyne, etc. At 54 years old, without the benefit of seeing you, it’s hard to know how much you would need. In my opinion, the key to the jowl area is to understands that the vectors (directional forces) that CAUSE the jowl are coming mostly from upstream. Meaning the pull and the lift should follow the natural curve of the face from the area with the pooch at the jawline, up to the top of the cheekbone (the zygoma). It sounds a little like your doctor is trying to correct the problem from the chin only. It’s true, some filler there may be needed, but certainly not most of it. I truly hope this makes sense. It’s hard to explain in 2D. 🙂
Fillers and Skin Tightening Treatments for Moderate Jowls
The same principals above apply for moderate jowls, only more so. More filler will be needed to correct it. Expect to need approximately 4-8 syringes which are best done slowly and gradually over 2-4 appointments over 2-9 months. This is the base. Maintenance should be discussed with you (for most people is 1-2 times a year). It depends on a lot of factors like health, weight gain/loss, etc. It’s also often good to add a skin tightening treatment once or twice a year at this stage. Radiofrequency and also lasers on this site will help tighten and lift the skin. We now have radiofrequency (RF) deep microneedling treatments which are more effective than Thermage or Ultherapy for moderate or severe jowls.
Treating Severe Jowls
You may want to consider plastic surgery for severe jowls. But there are many who can’t risk general anesthesia, or just don’t like the look aesthetically. Even severe volume loss and jowls, sometimes nonsurgical can be very effective. Usually a combination of radiofrequency skin tightening, fillers, and lasers are used. Multiple treatments are needed. It really depends on bone structure and a lot of other things too complicated for this blog. See a great aesthetic dermatologist for more information on what option might be best for you.
For more information on sagging skin on the chin and jawline, and even more details on the procedures I mention here, see my in-depth resource on it here.
About your filler bumps and contour problems
Here’s my in-depth resource about dermal filler problems like the bump and lopsidedness you mention. It covers fixes, and how to prevent in future. Read more here.
Hope this helps,
Dr. Brandith Irwin
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