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 jowsl 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.
Dr Barry Eppley
http://www.eppleyplasticsurgery.com
http://www.ologyspa.com
Clarian North Medical Center, Carmel, Indiana
Clarian West Medical Center, Avon, Indiana
Indianapolis
My office often gets asked if we perform the ‘LifeStyle Lift’, ‘S-Lift’, and a variety of other names that end in -lift. The callers and patients don’t know, of course, that all these names really refer to the same procedure, otherwise known as a limited facelift. Their interest is peaked by the allure of improvement in sagging jowls or loose neck skin but without the downtime of a full facelift.
The confusion about this procedure stems from general misconceptions about what an actual facelift is. Most patients envision a facelift as a procedure that starts at the top of the head and ends somewhere below the neck. Visions of weeks of seclusion, obscene facial swelling and bruising, and ruinous financial strain make many patients feel that they definitely don’t want a facelift. They don’t understand that a facelift is really a misnamed procedure. A better name which more accurately describes what it is….is a necklift or a jowl-necklift. A facelift, in isolation, does very little above the jawline or for most of the face. It is a procedure that changes the neck and jowl line only. Many patients will have other facial procedures done in conjunction with a facelift, such as the brow, eyes, nose, cheeks, or lips (often referred to as total facial rejuvenation) but these do not constitute a facelift. As a stand-alone procedure, a facelift is really about the neck and jowls and creating a sharper neck angle and a clean jowl line again.
Therefore, a limited facelift is a scaled down version of the full facelift. It has gotten, for a variety of marketing purposes, many catchy names as previously mentioned. Some plastic surgeons even put their own name on it. But, in the end, there are all the same procedure. A limited facelift is…..limited. Meaning the length of the incisions used (in front of the ear), how much skin is undermined and removed, and the amount of subsequent after surgery care and recovery is much less than a full facelift. And an important concept to grasp here is….the result is also less than that of a full facelift. For this reason, the best candidates for a limited facelift is someone younger who has minimal jowling and loose neck skin or someone older, who really needs a full facelift, but prefers a smaller procedure for any number of reasons.
I have found that one-half of the facelifts I do today are of the limited variety. They are very popular due to their quick recovery, lack of pain, and minimal swelling and bruising. They are a great stopgap measure that will substantially delay the need for a facelift is some patients and may, in others, potentiallhy eliminate the long-term need for a full facelift. Whe combined with other small face procedures, such as eye tucks and peels, they really make a nice change with no chance of getting that ‘operated look.’
Dr Barry Eppley
http://www.eppleyplasticsurgery.com
http://www.ologyspa.com
Clarian North Medical Center, Carmel, Indiana
Clarian West Medical Center, Avon, Indiana
Indianapolis
The sagging jawline is one of the first signs of sigificant facial aging. Occurring somewhere in the early to late 40s, the development of jowling begins which may be accompanied by looser skin in the neck and loss of the once-sharp neck angle. In seeing a lot of these early aging patients, they often are initially interested in non-surgical procedures such as threadlifts or device skin tightening. Their belief is that these non-invasive procedures will produce a good result but will not involve any ‘downtime’…..and are relatively inexpensive. At the very least, they definitely want to avoid something radical such as a ‘facelift’.
While most of these early facial aging patients don’t need a full facelift, they are completely unaware of the more limited facelifts options and that significant downtime is not needed. I find most patients don’t even have a good concept of what a facelift is and are under the misconception that it is a ‘full face’ procedure going from the top of the head down to the bottom of the neck with a month for recovery. And, they certainly don’t want that ‘operated look’. These patients require a good education as to a facelift, aka neck-jowl lift, is….which makes transitioning the discussion into the limited facelift options more understandable and appealing. From both a result and value perspective, limited facelifts are definitely superior to threadlifts or any form of external, non-surgical skin tightening.
The limited facelift goes by a lot of different names such as a mini-facelift, S-lift, Quicklift, Swiftlift, EpiLift, etc. Despite the different names, the procedure is largely the same. It consists of neck liposuction in most cases combined with skin excision and tightening in front of the ear and some deeper tissue tightening. Given that the neck is not widely undermined, and often not undermined at all, the procedure is associated with less than one week of swelling and bruising. I find most of my patients truly look good in a week. Close inspection will reveal the incision into and out of the ear but it is not all that easy to see. The procedure does a beautiful job of lifting the jowl area, and when liposuction is done in the neck, some real neck changes can be seen as well. The limited facelift can be combined with many other less invasive procedures such as Botox, injectable fillers, and light laser skin resurfacing to enhance the overall effect. Much is made of being able to do this procedure under local anesthesia, but I prefer to do it under a general anesthesia. That enables the patient to be ideally comfortable and the procedure is done in a time-efficient manner.
The limited facelift was a procedure first introduced in the early 1900s and was used then because it was limited and surgery was very primtive at that time. The limited facelift is used today because it is a perfect match for early facial aging when more extensive procedures are not warranted or desired.
Dr Barry Eppley
http://www.eppleyplasticsurgery.com
http://www.ologyspa.com
Clarian North Medical Center, Carmel, Indiana
Clarian West Medical Center, Avon, Indiana
Indianapolis
A facelift is one of the most recognized procedures in aesthetic plastic surgery…..but also one of the most misunderstood. The general public’s perception of a facelift….based on TV shows and the internet…is someone after such surgery being bruised from their eyes to their neck and their face wrapped up in a big dressing…like they had been involved in a major accident. And that it will take weeks to even look good enough to go out in public. In reality, this perception is flawed at best and even grossly inaccurate at worst.
The name of the operation, facelift, is misleading. It does not really describe what the surgery actually does or what the objectives of the procedure are. More accurately, a facelift should be called a neck-jowl lift, for this is what it actually helps. It is a great procedure for tightening the neck, getting rid of the that neck waddle, and lifting those sagging jowls. The medical name for a facelift, rhytidectomy (old plastic surgery meaning cutting out wrinkles), should be described as a cervicoplasty. (reshaping of the neck) However, the name facelift persists and always will as it is embedded in our plastic surgery nomenclature.
Therefore, when you realize that only the neck and jowl are affected by the procedure, many of its misconceptions fade away. In isolation as a stand-alone procedure (which half of my ‘facelift’ patients only have), a facelift causes no bruising or swelling from the nose up. While many facelift patients get their eyes, forehead, nose and other facial procedures done at the same time, this is not a requirement and is only done if one wants the ‘total face’ rejuvenated. I find that after an isolated facelift, one can look pretty good in about a week and can easily be out in public in a few days with a little make-up in the neck area.
Remember, the eyes are not swollen at all!
One of the great misconceptions about a facelift is what is actually done in the operation. A facelift operation is all about tissue layers and vectors of lifting. The lifting off of the skin from the underlying tissues over the side of the face (to the cheek area) and across the neck through incisions placed in and around the ears is obvious in any diagram of a facelift operation. And movement of loose skin pulled back and over the ears at about a 45 degree angle to the face probably accounts for about 80% - 90% of the result created by a facelift. And often this is the only tissue moved in a facelift. This is the safest and easiest approach with the least likelihood of complications. Deeper layers have also been raised up and moved in more recent versions of facelift surgery. These deep layer that can be moved independent of the skin, is a special layer of tissue over the muscle. This tissue, known as SMAS, is raised and sutured up in a more vertical direction compared to the direction of the skin pull, closer to 60 degrees usually. The public erroneously believes that it is muscle that is moved which is not possible. The SMAS sits on top of the muscle. There is considerable debate as to whether the ‘deeper’ versions of the facelift produce better long-term results than skin movement only.
The neck-jowl lift, known historically as a facelift, can lift two different layers of sagging facial tissues in two slightly different up and backward directions.
Dr Barry Eppley
http://www.eppleyplasticsurgery.com/
http://www.eppleyfacelift.com
http://www.ologymd.com/
Clarian North Medical Center, Carmel, Indiana
Clarian West Medical Center, Avon, Indiana
Indianapolis
