Although surgical procedures remain the gold standard for defining the lower face, some patients can benefit from nonsurgical solutions.
Selfies and social media are drawing people’s attention to facial imperfections they might not have realized existed. The results: increasing awareness and demand for nonsurgical solutions aimed at chiseling or softening the lower face and neck.
The reality is, while treatments that tighten skin and more youthfully define the lower face remain mostly surgical, there are some patients who might benefit from a nonsurgical treatment or a combination of nonsurgical approaches, according to Phillip R. Langsdon, M.D., president of the American Academy of Facial Plastic and Reconstructive Surgery (AAFPRS).
AAFPRS members predict that jawline aesthetics with minimally invasive options will be more in demand in 2019, according to a recent Academy press release.
“There are a lot of people that seek out these nonsurgical treatments, which in individual cases may not be what they need. In the end, they’re disappointed because they can’t get the results they envision,” Dr. Langsdon says. “But for those properly selected patients that don’t need a lot of tissue repositioning and just have minimal relaxation and volume loss, some of these techniques can be helpful.”
Fat Below the Chin
Reducing fat below the chin can help to enhance jawline aesthetics in patients as young as in their 20s. There are two basic options for treating small pockets of submental or cervical area fatty tissue, according to Dr. Langsdon.
In some cases, he’ll dissolve the fatty accumulation under the chin with deoxycholate injection (Kybella, Allergan).
“In patients with a minimal amount of fat, Kybella might help. In patients that have more than a little fat, we need to liposuction the fat out because it’ll take too many injections to get rid of the fat in those cases,” he says.
Dr. Langsdon stresses the importance of proper patient selection.
“What I’m describing are the patients that have just a little bit of fat,” he says. “That’s different than the patient whose muscles under the neck need to be refigured.”
Those patients generally need surgery to be satisfied with their results, he says. Dr. Langsdon recently described a new surgical technique called the submental muscular medialization and suspension (SMMS), in a paper published in JAMA Facial Plastic Surgery. He compared outcomes from SMMS with the traditional rhytidectomy technique for treating an obtuse cervical angle and found submental muscular medialization and suspension appears to more effectively address the obtuse neck in select patients.
An Aging Jawline
Men and women usually begin noticing jawline tissue sagging and irregularities around their 40s, according to Dr. Langsdon. Approaches for treating their cosmetic concerns vary but the message is the same: Surgery is optimal for patients with significant sagging around the jawline, he says.
“That’s where we would do a lower facelift to lift the sagging muscle, skin and fatty tissue back up to where `it used to be,” he says.
Nonsurgical options for tapering the lower face, including softening the jawline, should be reserved for patients with minimal sagging or irregularities. In those cases, Dr. Langsdon might use an off-the-shelf filler, which he injects along the jawline to smooth out irregularities. Radiesse (Merz) and Voluma (Allergan) work well to enhance the jawline from the side of the chin back to the angle of the mandible, he says.
While lasers can minimally tighten loose skin on the lower face, Dr. Langsdon says he hasn’t seen great results for even small amounts of sagging tissue with radiofrequency devices.
“I have more faith in fillers to enhance the irregularities, and when that doesn’t work, I believe that lifting and repositioning tissue is the best option,” he says.
Dr. Langsdon might combine laser therapy and fillers to subtly tighten skin around the jawline and sculpt the jawline or lower face.
“I use the laser on the neck on a very light setting. That’s important. It is risky to use a CO2 laser on the neck at a high power. But you can put it on a very low setting and do periodic very light treatments, like three or four treatments in a year, and get some improvement in that crepey look in the lower neck,” he says.
He’ll sometimes combine that with a filler to achieve a more youthful definition for the jawline, then, if a patient has visible neck banding, inject botulinum toxin A into the area to soften it.
Nonsurgical treatments and combinations of those treatments offer limited results but in the right candidates can make patients happy, according to Dr. Langsdon.
“It is paramount that every physician educate patients about what’s realistic before they go get treatments because we’re facing a greater trend where people have misconceptions due to what they’re seeing on the internet and social media. It’s heightened the awareness, but it’s also increased the percent of people who are unrealistic,” he says.
Langsdon PR, Renukuntla S, Obeid AA, Smith AM, Karter NS. Analysis of Cervical Angle in the Submental Muscular Medialization and Suspension Procedure. JAMA Facial Plast Surg. 2019;21(1):56-60.