Most patients have spent hours on the internet trying to research the best option for them when it comes to facial rejuvenation. Knowledge is power, and patients who have studied up are that much more able to make an informed decision at the time of the consultation.
In general, surgery including extended deep plane facelift, deep necklift, and direct necklift offer the most powerful and long lasting results, and are "one time" procedures that don't require ongoing treatments to maintain results. Surgery however is not for everyone, and because of that some nonsurgical results can be helpful as well. Let's run through nonsurgical options first, followed by less invasive surgical procedures, and finally the cutting edge surgical options (pun intended):
Kybella for chin fat / submental fat. This is FDA indicated to treat fat under the chin, but it can also be used to dissolve a little bit of jowl fat. The biggest advantage of Kybella is that it does not involve surgery. It is a medication that is injected into the fat over 2-3 sessions, and causes a fat reduction. Recovery is straightforward, but there is some swelling that takes time to resolve after each injection. Results from Kybella are permanent!
Filler for jawline sculpting. Fillers such as Restylane Lyft, Restylane Defyne, RHA4 and RHA3, and the new Juvederm Volux are ideal for sculpting the jawline. For patients not interested in surgery, with mild sagging jowls, filler can be placed to enhance the angle of the jaw and chin, both of which shrink with age and disappear into the neck. By placing filler in front of and behind the jowl, the appearance of the jowl is lessened and a more sharp, defined, and youthful jawline is created. Filler does require maintenance at least yearly in this location.
Threads. "Sugar threads" or PDO threads are made of dissolvable surgical suture, and sometimes have barbs, cones, or anchors to help to suspend tissue. They are inserted through a single puncture in the skin, and dissolve gradually over months. Threads are sometimes able to offer a modest lift, but generally the results are short lived (6 weeks).
Laser and energy based devices. In general, laser can be used aggressively when needed on the face to cause tissue tightening, but on the neck we are not able to treat as aggressively due to the nature of the skin healing in that area.
Erbium deep resurfacing and fractional CO2 laser resurfacing both offer dramatic tissue tightening in the face, and do lessen the appearance of mild jowling, while also dramatically reducing wrinkling. 1-2 weeks of healing with social downtime is involved. Radiofrequency devices such as RF microneedling (SecretRF at our office, also Morpheus8, profound, sylfirm, Infini, genius...) provide subtle tightening to the skin with minimal to no downytime. I describe them as a "shrink wrap" like effect. There are more invasive devices on the market such as Renuvion, Accutight, Facetight, Thermitight which act like a thick needle placed under the skin to heat the skin from the inside out to cause tightening. Their results are more dramatic than RF microneedling, but there is downtime involved.
MyEllevate neck lift with Neck Liposuction. This is a winning combination for early aging changes in the neck, or for patients who have never had a crisp and defined neck shape. The MyEllevate procedure is the surgeon's version of a threadlift. During this procedure, the patient Is administered gentle relaxation medicine in the office surgery suite. Numbing medication is injected. Tunneling is performed to help with skin contraction. A surgical suture is weaved in and out of the neck through separate puncture sites, and placed in the shape of a hammock to support the neck and contents under the jaw, and anchored to the tough tissue behind the ears. Neck liposuction is performed first when necessary, to reduce unwanted fat in a tasteful manner and to sculpt the jawline. Platysmal bands can be divided as well. Recovery is mild over the next 3-5 days. The key advantage of this procedure is that it is minimally invasive without cutting of our body's structures, and the results are really impressive. Results last up to 5 years, and the procedure can be repeated if appropriate. A disadvantage is that it is not effective when patients have jowls, and the appearance of the jowls may actually be worsened after this procedure because when the neck is more crisp the jowls are more noticeable.
Mini lift / Mini facelift. A mini lift can mean different things to different people, but in general this means a minimal incision or minimal access facelift. This type of lift is most appropriate when the jowl or jawline needs to be scuplted. It is not as effective in treating aging changes in the neck. Because there is less dissection with this type of lift, there is less downtime, and patients are able to return to activity after about one week.
Deep Plane and Extended Deep Plane Facelift and Necklift. When the patient has signigicant aging changes, or has a sloped neck that they were born with, it is necessary to surgically rebuild and reshape these structures to offer the most powerful and long lasting results. This procedure can be performed under anesthesia in a certified surgical facility, or under a light sedation with numbing in the office surgery suite. The key advantage of this procedure compared to more outdated styles of facelift surgery, is that the deep plane under the facial muscles is entered, and retaining ligaments are released. This means that instead of pulling on tissue creating a pulled unnatural result, that the tissue can instead be repositioned and gently secured. Extremely dramatic changes in the jawline and sagging neck are achieved. This is the most advanced and current surgical technique, and only the most skilled surgeons are trained to perform this procedure as it requires operating next to the facial muscles and facial nerve branches. Downtime for this procedure is 2 weeks, but the results are permanent.