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thank you for the question. you are asking what is the best and longestlasting way to treat heavy jowls and you ask on your question about the various techniquesfrom high smas, smasectomy, macs lift, deep plane basically a provider of a list of allthe different techniques. and you state that you see in this mediumthat people, after full smas facelifts have recovered jowls. well the type of question you are asking isthe kind of question that people who do this type of surgery have been asking for decadesand the best technique doesn’t really exist because the human body is going to have alot of variability.

and the reason, i will explain this further,as a background i’m a board certified cosmetic surgeon and fellowship trained oculofacialplastic and reconstructive surgeon. i specialize in helping people look betterspecifically in the area of facial aging and i do all those procedures. and i’ve been in practice for over 20 yearsin manhattan and long island and i treat patients who come for these procedures who come fromall over the world. i can say that the marketing elements of facelifting surgery which further confuses matters and there are doctors who claim that theyonly do deep plane facelifts implying that the other doctors that don’t do those proceduresor that they are doing something that is complicated

than other people are not as brilliant asthey are that’s just not the case. every surgeon who performs face lifting surgerywho is properly trained and has experience can do all those procedures that you justlisted. and more, and when it comes to it, at a certainlevel and experience, you really are customizing even further because you are using your knowledgeand experience to get the best result for that patient. and so, that essentially means that thereis something missing in the equation as to why you noticed that people do get recurrentjowls and there are a few things. so the limitations of face lifting have todo with the realities of what the factors

are related to facial aging. and facial aging is basically two things:it’s volumetric loss which means loss of bones, muscle, fat and soft tissues and it’salso sagging, descent and weakening of soft tissue. so that means you’re lifting against a structurethat has less volume and you are lifting with tissue that is more elastic. a colleague of ours once said that the skinis like taffy and it is very stretchable so whether you go very deep or whether you gosuperficial, in the end, you are still lifting the foundation of the face called the smas.

but the weakest link in the chain is the tissuequality. and so there is invariably a certain amountof regression which the skin in the neck can stretch a little bit. you turn your head up and down, it’s goingto stretch a little bit. the face will stretch a little bit just normalmovement expression. so i explain to my patients that if you area candidate for a facelift, my job first is to reposition and put everything back as towhere it should be but it doesn’t mean volume correction is not going to be appropriate. now volume correction can be the use of chinimplants, cheek implants to restore volume.

or volume correction can be the applicationof fillers, structural volumizing, placement of thicker hyaluronic acid filler at the deeperlevels so that after the facelift is done, you can also get this volume restored. and in fact, i would do a limited faceliftand combine it with injectable fillers to restore volume concurrently. there is a lot of art to this type of practiceand there is a lot of finesse and there is a lot of variation and the personal styleof different doctors. imagine if there was just one way to do thebest job possible then everybody would do it exactly the same way and that is just nota reality of there is one way to do a facelift

and that the best way you can be sure is someonewho trains in this field would do exactly that. i think what you are dealing with is justthe elasticity of the human body and the variabilities in the ways we can lift the face and neckarea. so i think that if you are interested in doinganything, meet with different doctors, explore different options and learn about the differentanesthesia scenarios. every doctor comes to this in a way with theperspective of doing the best job they can with knowledge and experience they have andthere are problems when doctors engage in turf battles and disparaging other doctorsstating they are capable or better qualified.

it just serves to confuse people unnecessarilybecause i think majority of the time, people who often do these procedures do have appropriateexperience and it is just a matter of finding the right fit in terms of this style of theprocedure, in terms of the anesthesia, in terms of the overall vision the you and thedoctor share about the outcome. so i hope that was helpful, i wish you thebest of luck and thank you for your question!