The explosion of facial fillers, Botox, and significant rejuvenation provided non-surgically continues to grow in the world of plastic surgery. It used to be that if a patient came into a surgeon’s office complaining about a “dropping” face, the only viable solution was a surgical facelift to lift and tighten the skin. The issue, however, is not loose/too much skin; a dropping face has much to do with losing facial volume.
Due to both the growing understanding of facial volume and an array of non-surgical techniques, modern plastic surgery aims to refill that lost volume. Dr. Sean Doherty, a board certified plastic surgeon practicing in Boston, discusses the best ways to improve an aging face non-surgically.
What Causes a Dropping Face?
Plastic surgeons see patients everyday who come in complaining that their face is dropping. It doesn’t look the same as it did just a few years ago and the growing gaunt look keeps them “looking tired”. “[Many of them] think that it just happened last night,” says Doherty. Nearly all of these patients are curious as to correction while balking at the idea of surgery. Reasons to avoid surgery in this patient population include:
- the expense
- they can’t the time off work for the recovery
- they are nervous about the anesthesia
- their health issues or weight may make surgery too risky
Doherty always likes to discuss surgery, but, “[I’m] very respectful of patients who don’t want to have [it].” The most important step, always, is to find a surgeon who performs procedures surgically and non-surgically, as they will have the most complete set of options from which to choose.
Consulting in person is vital as it’s paramount that the surgeon assess the facial structure, muscle laxity and skin texture. It is truly the only way to determine the ideal procedure or procedures for achieving your goals. “A dropped face is not just because of sagging skin. It’s because of loss of fat. It’s because of dropping fat. And, it’s because of loss of elasticity of your skin,” explains Doherty.
The Jowls are a Key Indicator
When men and women come in to discuss their “dropping” face, they are typically referring to their jowls and the area around their mouths. This is really where the loose skin seems to hang, defining the notion that the face is “dropping”. Doherty starts every consultation by reminding his patients that a non-surgical approach to facial rejuvenation is not necessarily about putting filler around the mouth and in the jowls. In fact, this can have disastrous results. We’ve all seen those people who look as if they sucked on a hose, and some even refer to it as “the simian look” where their upper lip puffs out like a monkey. It looks odd and unnatural.
Re-harmonize, Refill, Resurface – Non-Surgically
Re-harmonizing the mid-face by restoring the cheeks to their former position is always Dr. Doherty’s fist step in any non-surgical facelift. For this, filler is the procedure of choice. He usually uses one of the bigger fillers such as Voluma or Restylane Lyft. He’ll even use fat in the right patient. Once the surgeon replaces the lost volume in your cheeks, it helps to rejuvenate the entire face. Now, “it’s certainly not going to lift and tighten skin like a facelift, but it will re-harmonize,” explains Doherty.
Once the cheeks are lifted, Doherty assesses the wrinkles around the mouth. Vollure is one of the newer fillers that is ideal for use in this area. Thanks to it’s cross-linking technology, Vollure can smooth out some of the lines without introducing a lot of volume. If a patient has significantly heavy skin and jowls, then a surgical facelift is truly the best option. However, re-harmonizing the cheeks with filler does help to diminish the jowls because a fuller mid-face is a lifted mid-face. A surgeon may also place filler in front of the ear in order to create “pillars” to support the skin for a more rejuvenated look around the mouth.
Once the face is harmonized with volume, Doherty then moves on to skin laxity. Non-invasive treatments for skin tightening such as laser resurfacing, micro-needling, and RF or radio frequency treatments can all deliver some improvement.
It is extremely, extremely important to manage expectations as a patient. For some, the time for non-surgical options has passed; only surgery will provide the desired and/or necessary rejuvenation. Due to this very important fact, it’s on the patient to find and trust an experienced, board certified surgeon to determine whether or not their goals can be achieved non-surgically. Non-invasive procedures like fillers, resurfacing, and micro-needling can deliver rejuvenation and great success, as long as the patient doesn’t expect nor require a surgical result.