How to get rid of sagging cheeks and jowls [Shannon O'Brien, MD, Portland]

Eva Sheie (00:00):
Okay, well, let's expand our horizons here to the rest of the face. At what age do you see people starting to say, I think I need a facelift?

Dr. O'Brien (00:10):
If you're looking at a bell curve, probably 50 to 60 is when people start really noticing. And by 65, a lot of those folks have said, okay, it's now, not now or never, but I've been thinking about it. I'm ready, it's time. I've got time in my life and what have you. But there are folks that come in even as early as their forties that have had some skin changes, particularly in the neck area is where we tend to see things start presenting earliest. The neck skin is challenging, it's thin. We move our heads a lot, and we can't be as aggressive with noninvasive treatments like lasers and peels on the neck as we can on the face. The neck skin just doesn't heal quite the same way, and so we're a little more limited as to how sort of aggressive we can be in those neck treatments. And so we end up with that being what sort of tends to be the first thing that folks notice. And then often some heaviness around the jawline or the dreaded jowls start to show up. And that's where folks often are starting to come in and just say they notice, they feel like their face has slid or has dropped or all of those kinds of things.

Eva Sheie (01:32):
And so what are the options that we have when we reach that point? Can you walk us through all those choices?

Dr. O'Brien (01:38):
So occasionally folks, if their face is really well maintained and they just have sort of neck skin laxity, there are some things that can be done that are nonsurgical, like radiofrequency microneedling or some things like that. There are some laser treatments that can help with discoloration or what have you of the skin. But once that skin reaches a certain degree of laxity, occasionally folks are candidates for neck lifts alone. But I'm pretty selective with that group because oftentimes if you do a neck lift on somebody where their lower face or their jaw line is starting to get heavy and their jowls are starting to show up, if you do just a neck lift, the jowl line or the jaw line is really not addressed. And so then they feel like they missed an opportunity to just take care of it all at the same time. They are not as happy as, they think that that neck skin is all that bugs 'em, but in reality that the other stuff is there too, and you really see it if you don't take care of it at the same time.

(02:47):
There are cases where a neck lift is an option, it's usually in a younger patient, but that would be a surgical option. As far as for the face, as the cheeks sort of lose or the volume starts to drift down, the jawline becomes heavy, what have you, then it's a facelift. And I tend to tell everybody that a facelift basically works from the cheekbones down to the neck. It includes the neck lift component, and it allows me to sort of get some of that weight off of the jawline, reposition sort of fat pockets that may have slid forward on the cheeks and down around the corners of the mouth and on the jawline and what have you, and pull those back up to a more youthful position, tighten everything up. And then I just sort of sweep out the extra skin. That's a facelift and it's amazingly not particularly painful. It's just emotional to have your face operated on. And so it takes a couple of weeks before you feel like you're presentable. And a lot of times people are doing a little bit of computer stuff from home or what have you, after a week they feel well, but they're just not quite ready to maybe show themselves. But even so people, you see the results the day after when the bandage comes off, you can see a change and it's really impressive.

Eva Sheie (04:01):
Is there anything nonsurgical that improves the neck that you know of?

Dr. O'Brien (04:05):
Yeah, so there are some things that we can get rid of fat, little fatty pockets under the chin that are nonsurgical in our office. We utilize Kybella and CoolSculpting as ways to remove fat. The Kybella is a series of injections or sort of a grid of injections of a medication that dissolves the fat in that pocket. And then CoolSculpting has a little attachment head that sort of chills the skin and fat in that area and it causes the cell membranes to alter and eventually the body will kind of break down those fatty, those little fat cells over the course of a couple months. Both treatment options take a couple months to see the full results. Sometimes people need a couple of treatments. I'd say often people need a couple of rounds of either of those treatments, but they're both generally effective against fat. They don't do a lot for skin. And so that's where, from nonsurgical standpoint, things like radiofrequency microneedling, certain laser treatments can be used to sort of refresh the skin,if that's the issue.

Eva Sheie (05:15):
On this podcast, we bring you directly to the doctors who are where before meets after. Links to our guest's website and contact info are in your show notes. Follow us on Instagram @wherebeforemeetsafter. Where Before Meets After is a production of The Axis, the podcast agency for aesthetics, theaxis.io.