So many options for firming up a sagging jawline

In “I Feel Bad About My Neck,” Nora Ephron expressed the feelings of generations of women who have beenfurtively hiding their necks like turtles in scarves, boas, turtlenecks and chokers. Her blunt advice is to begin concealing the neck at age 43. “Our faces are lies and our necks are the truth. You have to cut open a redwood tree to see how old it is, but you wouldn’t if it had a neck.” Sure, she had a point. But there is an equal source of embarrassment perched right above the neck: the sagging jaw line.   

When you reach your early 40s, you may see that the skin between your neck and jaw, which was once a taut right angle, is now gradually dropping. This “drop zone” is the subject of many heart-to-heart conversations. We have all watched more than one friend (of a certain age) pulling back the skin in front of her ears with two thumbs to demonstrate how much better she would look without the drooping, wavy jaw line. Though she asks, “Tell me the truth, don’t I look better like this?” you answer dishonestly: “Don’t be silly. You look great the way you are.”

The aging jaw and neck are challenges. The neck is comprised of three layers: skin, fat, and muscle. Sagging muscles and bulging fat are situated under the thinnest, crepiest skin on the body (except for eyelid skin). To make matters worse, a thin ropey muscle called platysma tends to split into a V-like formation of two bands that protrude, especially when they contract. To see this problem in action (if you’re over 40) look in a mirror, say “eee,” and watch in horror what happens. A Manhattan plastic surgeon has commented, “Trying to fix all of that with potions and lotions is like waging a two-front war on a sheet of thin ice.” He soggests a neck lift for women in their early to mid-40s who are not ready for a facelift.


Neck Lift/Facelift

The neck lift secures sagging muscles crosswise to the jaw to restore that all-important right angle. Compared with a facelift, sutures are smaller, there is less tightness, and recovery time is much shorter. However, a neck lift has traditionally been a component of a facelift, and many plastic surgeons believe it should remain so. They reason that, anatomically, the muscles of the neck are connected to muscles of the face, so if you try to tighten only the neck muscles, you will do you face a disservice. Along this line of reasoning, even if your big complaint is your neck, you will get better results with a facelift. If you are confused about which procedure is right for you, have a board-certified plastic surgeon, or two, give you feedback while evaluating your very own unique face and neck.


Liposuction and the double chin

The face and neck are usually treated at the simultaneously, often in conjunction with liposuction, to sculpt the area beneath the chin and jaw line. But if you gain weight, the looser skin, weaker muscles, and free falling fat may add to your drop zone. Younger patients who have fatty necks but no significant facial aging may be treated with liposuction alone. There are some plastic surgeons also might use laser or light technology to tighten necks.


Preventive Botox

It has been seen that injecting Botox in areas where wrinkling and creases occur will prevent deeper lines from forming and will help maintain a youthful appearance. It’s better to not have those angry or tired lines develop, so people will not notice that you’ve had any treatments.  Botox can also soften those V-shaped platysma bands.


Your own fat

Another alternative is injecting abdominal fat into the jawline area to provide extra volume. This includes the bonus of your own stem cells. Extra stem cells are sometimes separated from the fat via centrifuge and then added, making the skin glow more and enhancing collagen production.


Trendy approaches

Plastic surgeons were recently interviewed by W Magazine about some trendier devices, such as Thermage and Ulthera. These devices deliver radio frequency, ultrasound and/or infrared lasers to stimulate deep skin layers below the epidermis, an area in which collagen and elastic production slows down as we get older. But according to the surgeons interviewed, the problem is that these devices may not deliver enough energy to have a substantial effect. However, if you have only mild laxity and expect modest results, they may be a good option.


Even though you may favor one of these options, it’s a good idea to keep an open mind when you go for a consultation. Your best bet is to come in for a consultation so your plastic surgeon can suggest the very best procedure for your very own unique facial characteristics.

Rejuvenating Your Face – What are the Options? Surgical and nonsurgical solutions

When you go to your high school reunion, do you want your classmates to squint at your name tag in confusion? No! Instead, you want them to instantly recognize you and think that you look well-rested and “good” for your age. Formerly there was only one way to resurrect your face: it took a scalpel, several weeks off from work and a nice chunk of change. But now, new nonsurgical options that promise to turn back the clock are proliferating at a rate that can make you dizzy.

It would be overwhelming to consider so many options on your own. Instead, schedule a consultation with a board-certified plastic surgeon, like Dr. Genter, who is experienced in traditional approaches, but also equipped with the latest and greatest nonsurgical innovations. Face-to-face a doctor can recommend to you procedures that offer the results you want. Both surgical and nonsurgical options definitely yield improvements but, as you may expect, the level of improvement will not be the same and the surgical option will result in more significant and longer lasting changes.

So you don’t go to your consultation totally “green,” here are, from hairline to the base of the neck, some of the surgical and nonsurgical approaches to the common facial problems that occur with aging:


Drooping Forehead

Surgical: A forehead lift involves hidden incisions in the hair-bearing scalp to rejuvenate the upper third of the face through lifting and weakening frown muscles.

Nonsurgical: Botox is injected into the forehead to soften frown lines. Botox and fillers may be injected together around brows to lift and add fullness.


Dark Circles, Eye Bags, Hooding of the Upper Eyelid

Surgical: Blepharoplasty removes fat deposits and tightens the skin and muscle of the eyelids to improve the appearance of the eyes.

Nonsurgical: Frown lines can be softened and crow’s feet minimized with injections of Botox; three times a year in both areas will do the trick. When injected above the eyebrows, Botox may also give a ten-degree lift to the arch and a slight lift to the tail. To get rid of bags under the eyes, a plastic surgeon can inject your own fat, which will last 2 years or more, or hyaluronic acid, which will last up to a year.


Sagging Cheeks

Surgical: With age, the distance between the eyes and cheeks increases. In the midface lift, the malar fat pad in the upper cheek is lifted to its former youthful position with either sutures or an absorbable implant, restoring your youthful, heart shaped face.

Nonsurgical: A doctor can restore high, full youthful cheeks using injectables such as Radiesse, Juvederm or other fillers. Injected over the cheekbones or in depressions, these fillers can add fullness to sunken or sagging cheeks for many months.


Droopy Nose

Surgical: With age, the tip of the nose may drop down and inwards towards the face. The drooping nasal tip may cause a slight hump on the bridge and appear to cover part of the upper lip, especially when you smile. A rhinoplasty procedure rejuvenates the nasal tip, which is re-supported with cartilage grafts. An added bonus is that re-elevation of the tip can improve nasal air flow and breathing.

Nonsurgical: If Botox is injected into the base of the nose by a skilled injector, slight nasal tip elevation may be achieved, resulting in a nose that turns upwards, rather than droops—even with big smiles. If your nose droops when your face is static, Botox will not help. Injections with fillers such as Radiesse or Juvederm may be used for nose shaping/augmenting purposes in a nonsurgical rhinoplasty.


Thinning upper lip and droopy mouth

Surgical: With age, the upper lip lengthens, sags and thins. An upper lip lift shortens the lip by removing a small ellipse of skin under the nose-lip junction, creating fuller mucosal show. The corner lift, removing a small triangle of skin above the corners of the mouth, elevates a downturned mouth, making you appear happier. 

Nonsurgical: Volumizers, such as Juvederm Ultra Plus, injected in the lips, can restore the ideal volume ratio of upper to lower lip, creating fuller plumped lips. “Smoker’s” or “lipstick bleed” lines can be treated every six months with Botox to soften them and micro droplets of fillers to plump them.  Lips may also be injected with collagen or your own fat harvested from another site. Both liquid collagen and fat are absorbed, so repeat treatments are necessary to maintain results.


Sagging jawline, redundant neck, prominent neck cords

Surgical: There are many different varieties of facelift approaches to smooth the face and neck skin, tighten the underlying loose tissues and muscle and remove excess skin.

Nonsurgical: To camouflage a sagging jawline, Juvederm or Radiesse may be injected, lasting up to 18 months. Botox and injections with fillers can be used to reduce the appearance of neck cords. Botox and fillers can smooth a pebbly chin. Fillers can be injected to reduce smile lines between the nose and mouth corners. Botox injections can make neck cords recede. Neckline appearance can be softened with mini doses of Juvederm combined with Botox.


Fine Facial Lines

Surgical: Fine facial lines can be treated surgically with dermabrasion, laser resurfacing, or deep chemical peels.  Although a facelift is useful for tightening the facial skin and deeper structures, it will not smooth fine facial lines on the skin’s surface.

Nonsurgical: New injection techniques have been developed to treat fine facial lines around the mouth, on the cheeks, etc. Dilute Juvederm is injected with very thin needles into these facial lines to smooth them, producing very successful results. Botox can supplement the effect. It is believed that new collagen growth in the skin is stimulated from these injections. 


Final advice: Get the best results by finding a plastic surgeon with the appropriate board certification. Wherever you go for treatment, be sure to ask how long and how often this doctor has been doing the procedure you desire. Dr. Genter is very experienced with these techniques.  In a tough economy, nonsurgical facial rejuvenation may seem to offer a cost-effective alternative for looking good. But, does it really? Ask your doctor how frequently you will need to repeat the nonsurgical procedure. Then consider your age and do the math. You may discover that a surgical procedure will be more economical in the long run…or you may not. Some investigators believe that fillers help skin regenerate natural collagen and neurotoxins like Botox can help retrain your muscles so the face creases less.

Be sure to schedule your surgical or nonsurgical procedure far enough in advance of an important event so you are healed and look your very best. 

Workout your skin!

Unless you’re lucky enough to move from one air-conditioned space to another this summer, you’re likely to have had some sweat-related skin problems. Add exercise or outdoor swimming into it, and you’re headed to the land of clogged pores, breakouts and aging from the sun.Shape Magazine has some helpful tips for exercising during the hot, sunny months where skin takes a beating, but this info can also be used all year round in warmer climates and at the gym. The main focus is to keep pores open, skin clean and SPF on whenever you’re outside.

  1. Clean before and after a workout: It’s important when you start sweating excessively that all that moisture and oil has somewhere to go. Clean your face with a cleansing wipe, makeup remover or a plain old face wash to make sure there’s no foundation or residual makeup clogging your pores. After a long sweat session, you want to remove the sweat and oil using the same means. Remember not to use anything too harsh to clean lest you strip off all your moisture.
  2. Keep it off your face: Pull back your hair and grab a towel so you won’t be tempted to touch your face. Hair has oils and products that might cause your skin to react, so tie it up and out of the way. Touching your face after touching weights, equipment or anything you might encounter outside is also not a great idea. Other than causing a breakout, it’s a great way to catch germs. Washing your hands should be the first thing you do after you’re done working out.
  3. Keep cool and fresh: When you’re exercising, it’s important to use the right equipment right? Same goes for your clothes – wear breathable outfits that keep you comfortable. Then, within half an hour after your workout, get in the shower and change your clothes. To avoid drying out or overproducing oil, use a gentle cleanser and moisturize after every shower. Gently exfoliating your face and body 2-3 times a week will make sure the dead skin cells are at bay.
  4. Protect yourself: The sun is the number one culprit for premature aging of the skin. It can cause sunspots, freckling, wrinkles, and for those at high risk, skin cancer. While natural foods and ingredients like carrot and coconut can boost SPF, it’s important to use sunscreen and reapply outside whether you’re exercising, at the pool or just enjoying a weekend barbeque. Try finding a tinted moisturizer with SPF for daily use.

These tips can help keep summer breakouts at bay, but to treat a more serious problem, please see a licensed skin professional associated with a board-certified plastic surgeon, like Dr. Genter, or a dermatologist. Large pores, oily skin, acne and constant breakouts might need a more aggressive skin regimen that might include micro-peels, laser skin resurfacing, skin tightening, chemical peels, and injectables.