Q:I`m wondering whether a neck lift improves the look of the far edges of the jawline? Is there any procedure that lifts to the jawline or does that mean a full lower face lift?

 A: “Neck lift” is a name for not one procedure but a number of possibilities.  This may include fat removal, smoothing of muscular bands, and possibly skin removal.  For the most part, when someone speaks of a neck lift they are speaking of a procedure which will not give much, if any, improvement to jowls.  A lower face lift is absolutely the best way to address jowls and it will take care of the neck as well.

 

Q: What is the best option for tightening the jawline for the very beginning of jowls? I am only 43 and have been told that I am not ready for any type of facelift however, I don’t like the appearance of my lower face.  I have tried Thermage twice and it has not produced the effect I had hoped for.  

 

It certainly is possible to address both situations simultaneously.  It does depend on the details but a reduction in the size of the nose can be combined with mid-face/lower eyelid filling.  I would suggest that you not use injectable fat but rather a Tear-Trough implant for the hollowness.  This implant is not subject to the unpredictability of fat survival and does not require a separate surgical site for harvest.  It also is far more likely that your hollowness is skeletal, not soft tissue.  The implant directly addresses skeletal deficiency since it looks and behaves as though it were bone once in position.

Doing the procedures separately could potentially make for more accuracy because of greater ease in deciding how much to do at each location.  But with a surgeon experienced in both procedures, this should only be a minor consideration.

The extra skin will not be a problem.  It will contract over the new nose.

The septum (which is the partition starting at the nostrils and going all the way to the throat) can have a spur (a spiked out section) that is so large that it completely crosses the air passage part of your nose, embedding itself into the sidewall.  The result of this may be severe and persistent headaches.  This is far from being the most common cause of headaches, however, it is common enough to consider.  This type of headache may get worse with conditions that cause swelling in your nose like colds and allergies.  A proper exam of your nose in the office can rule it out immediately if no spur is present.  If a spur is present and pressing against the sidewall, the possibility exists that it is the source of your headaches.  If numbing the inside of your nose alleviates the headache, it is highly likely that it is the cause.  However, if the headache doesn’t go away with numbing, that doesn’t rule-out the spur as the culprit.  Surgical removal of the spur would be the only true way to rule it out as the cause.  The headache would be immediately “cured” by surgical removal of the spur if indeed it were the culprit.  I have “cured” about a dozen patients of these headaches in my career.  Curiously, several of those patients never reported the headache issue prior to surgery, had no expectation of the surgery fixing the headaches, and were surprised afterward when they no longer had headaches. 

A septoplasty would potentially improve the airway if an obstructive deviation or spur were present.  Not all spurs and deviations result in airway obstruction.  A turbinate reduction is also a very good way to improve the airway and often times is more important than the septoplasty.  Turbinates are outcroppings from the sidewall of the inside of your nose and have a large capacity to swell and shrink.  They are the primary cause of obstruction that comes and goes with such things as colds, allergies, and position (laying down vs being upright, even laying on the left vs right).  A turbinate reduction will not stop them from fluctuating, but at any given degree of swelling, they will be smaller than they would otherwise have been.

Rhinoplasty is a surgery that alters the appearance of your nose.  Typically a rhinoplasty alone would have no affect on your breathing.  I say “typically” because there are situations where it could improve or worsen the airway.

A: 40 year old with early jowls

At 40 years old and a touch of jowls, I would  suggest camouflage techniques such as Radiesse.  This often works well, is safe, and does not hinder your ability to do other procedures in the future.  It does not surprise me that you are dissatisfied with Thermage, I don’t believe I have ever met a patient who was.  I would encourage you to avoid all of the various machines that claim to provide a facelift without surgery, patients rarely see the promised changes, or even any change at all for that matter.  At your age I encourage you to be conservative.

My parenthesis are noticeable and definitely age me, how much of a reduction can I expect by having this procedure done?

A: Juvederm is a Great Solution

A: Earlobe Reduction Surgery

Earlobe reduction surgery is a regular part of my practice.  There are different approaches depending on what type of earlobe you have, past piercings, and what it is you would like to end up with.  Cost is usually around $1000 for both earlobes.  While it is possible to have issues with poor scarring, this is quite unusual in the earlobe.  If you have piercings in your ears and they didn’t form unsightly scars or create pigment problems, probably earlobe reduction won’t either.

A: Botox in the Lips

Treating “smokers” lines in the lips is best done with a multi-modality approach.  Botox alone is not likely to give you a satisfactory result.  I suggest as a primary treatment using injectable fillers (Restylane) and then adding very small amounts of Botox as an adjunct.  Treating creases in the lips should be left to someone who has a great deal of skill and experience as you will likely be unsatisfied otherwise.

To be effective, Botox in the lip needs to be done in much smaller amounts and at a much shorter interval than other areas.  For example, you might treat the upper lip with a total of 5 units every 6 weeks.  Fillers on the other hand typically only need to be repeated in this area once per year or maybe less, especially if you maintain your Botox.

When you ask “is it safe”, the answer is certainly yes.  There would not be any permanent harm as a result of a poorly done treatment.  You could end up over treated which would certainly be annoying, embarrassing, and challenging, but it would wear off.  It is best to err on the side of under treatment.  Returning after one week for a little more is better than having to wait a month to get control of your lip back!

A: Dysport vs. Botox Cost

There is no universal answer to this question.  However, I think you will find on average that you can get the same result for less money using Dysport.  In my office it will cost you about 10% less, not including any rebates.  But, just like buying anything, it will depend on who you are buying it from.  Dysport is currently offering rebates of $50 per treatment , which will make it more cost effective virtually everywhere.