One of the earliest signs of facial aging is the
development of jowls or jowling. The jowls are areas of
skin and fat that have fallen from the side of the face to
hang along or below the jawline. As we age, these areas
tend to become more noticeable as the sag worsens. The once
straight jawline of youth is gradually replaced by the
saggy full jowls of the aging face. Why this occurs is the
age-old phenomenon of time and gravity, weakening the
attachments of the skin to the underlying muscle so that a
tight bond between the two no longer exists.
I see many patients who are bothered by jowling, including
younger patients who often see this as one of the first
signs of real aging. There are numerous options to treat
the jowls, both surgical and non-surgical, with varying
degrees of effectiveness. The most effective methods, to no
surprise, are surgical and include facelifts and
liposuction. A facelift in its fullest extent is a
jowl-neck lift. In its more limited form, it is primarily a
jowl lift. It works by pulling skin and deeper tissues up
and back, eliminating the jowls by pulling loose tissue
above the jawline again. The loose jowl tissue is simply
repositioned and not removed. More minor procedures that
have recently gained popularity, which aims to do the same
thing, are the Threadlifts or Featherlifts. In this simple
procedure, barned sutures are passed deep into the cheek
and facial tissue above the jowl area and cinched up from
above. For very minor degress of jowling, this has some
benefit but is not effective enough with large amounts of
jowling and the long-term results with these procedures is
suspect. Actually removing jowl fat can be done with
liposuction, reducing their size. This can be done alone or
in conjunction with some form of a facelift. When performed
alone, liposuction of the jowls must be done very carefully
and conservatively, lest you get irregularities that are
apparent in the overlying skin. When done with a facelift,
the lifting and tightening of the skin usually eliminates
this concern.
Non-surgical options include skin tightening by
heat-generating devices and LipoDissolve. neither approach
treats both of the jowl issues, skin and fat, and therefore
they are usually less effective than surgery. Heating the
underside of the skin through a series of treatments can
cause a tightening effect. Devices such as Thermage or
SkinTyte do it differently but the objective is the same,
heat up and the skin on its underside and cause it to
tighten. The long-term results of this procedure appear to
be short-lived and that is why I perform them in
conjunction with other procedures rather than as a stand
alone technique. LipoDissolve treats the jowls by
fat-dissolving injections done as a series. As the fat
dissolves, the jowl is reduced in size. In my experience,
it is just as effective as liposuction, albeit a lot
slower. When performing non-surgical jowl reduction, I like
the combination of LipoDissolve and Skin Tyte. That
combination seems be particularly effective as both
components of the problem, skin and fat, are addressed.
They are also great touch-up procedures to do after a
facelift when a little rebound relaxation in the jowl area
occurs.
The jowls can be treated by numerous surgical and
non-surgical methods. Limited and full facelifts produce
the best and most long-lasting results and should be the
first choice when moderate to severe jowling is present. In
more minor jowling, LipoDissolve and Skin Tyte work well if
the patient can tolerate a slower speed of noticeable
improvement.
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Dr Barry Eppley runs a private plastic surgery practice
through his hospital-based medspa locations at Clarian
Health in Indianapolis. To learn more about the latest
trends in plastic surgery, spa therapies, or skin care, go
to his daily blog, http://www.exploreplasticsurgery.com .
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