Two years ago on a business trip, I found myself meandering the crooked streets of Paris, working off my second éclair. A street artist jumped out of nowhere and insisted I stand still so he could scribble my likeness in a charcoal frenzy.
Each move I made to step away he matched, insisting “Mais attendez, vous etes si belle!”
Worn down and flattered, I handed him 20 euro and waited for the result. I began to think sexy thoughts about that scene in Titanic where Leo draws Kate, and pondered what it was about my je ne sais quoi that inspired this modern-day Monet to create what I was sure would be undiscovered genius (see below).
He flipped his sketch pad around with pride, revealing what looked like my eyes and lips on top of a chubby upside down light bulb.
Sure, I had been high on unpasteurized brie for the past week (warning: French women may not get fat, but American women in France do). But had my face really fallen down to my jowls?
I began to notice that even at my fighting weight, age was winning the battle of my lower face. The contour of my chin was softening, baby jowls and necklace lines started to emerge and a small pocket of fat hung under my chin.
Add to this my iPhone, which when caught by the accidental flip front camera, only serves as a reminder that I’m melting.
I call it the Bermuda Triangle of age, that tricky area where chin, neck and jowls collide in a hot mess of middle age.
Unfortunately, a lot of this is genetic. Over Easter, I found myself staring at my formerly stunning parents who now, despite great skin tone and few wrinkles, each sported a generous waddle. At least they were enjoying their martinis.
Admittedly, my lower face isn’t a complete disaster, but knowing what my genetic destiny looks like has me panicked for a solution that isn’t as extreme as surgery.
There’s been a lot of buzz about Thermage and Ultherapy to tighten skin, as well as ways to use fillers and Botox to spruce up the lower face. But were they worth my time and money, or do I have to just get real and think about a face lift (gulp) in 5 to 10 years?
To find out, I turned my face over to a handful of cosmetic plastic surgeons and dermatologists to help me sort this all out.
Enter Dr. Doris Day, a cosmetic dermatologist who channels one part Fairy Godmother, one part Nefertiti and presides over her palace of pretty on the Upper East Side.
I grumbled about my lower face getting bigger than the rest of my face, and that my annual jabs of Juvederm in my nasalabial folds didn’t seem to do the trick.
She handed me a mirror and explained I was treating the wrong problem. “People always say they hate these lines, but you’re supposed to have those lines, 12 year olds have those lines. It separates your cheeks from the mouth area and makes you look natural,” said Dr. Day.
“When you lift the cheeks, you may still have a bit of nasal fold lines, but your face is in balance. People don’t look at the temples. When the temples are sunken, you become more bottom heavy. That makes you look older.”
“So I’m not crazy, my face really is melting?” I asked.
“It’s more along the periphery of your face” she said “Can I see a big smile?”
“When you look right there,” she said pointing at my cheek “You’ll see where the loss of the fat pad is, and you don’t have much of one. You can see it sinks, but you have to be careful about where you place the filler so it doesn’t look too full.
“If you put a little bit of Perlane right there, behind the cheekbone, you’ll get a nice, natural lift,’ she say. “You might need to do a little Juvaderm in the side of the chin and very high up on your cheeks, a little Perlane just to lift and reflate. Optimally, I would give you a bit of Sculptra around the temples”.
“But first, Ultherapy for the whole face, before fillers. You’ll do one, maybe a second, at a year, and then you’re good for a few years”.
Next up, Dr. W. Matthew White, the cosmetic plastic surgeon who schooled me on the 4 layers of aging, so I was eager to get his take.
“Clench your teeth,” he instructs as he pinches the skin under my chin and inspects it like a mechanic looking under the hood of a car. “You have pretty good tightness; it’s mainly the fatty layer underneath the skin.”
“The surgical option would be chin liposuction,” says Dr. White. “It could be done under local anesthesia and a sedative,” he says. I was relieved he didn’t suggest a neck lift, but chin lipo isn’t exactly a walk in the park. Not only is it $6000, I would have to wear a contraption like this for a week to make sure I heal properly.
“The non-surgical option would be Ultherapy,” offers Dr. White after reading the disappointment on my face. “After, we would follow-up with a bit of filler into your pre jowl sulcus to give you back that more angled jawline, because you’re getting absorption of your jaw”. Dr. White shows me pictures of his patients who have had Ultherapy and the results seem impressive, but at $3500 for the lower face (remember these are NYC prices) it isn’t cheap either. Add to that the cost of fillers, and we’re getting close to the cost chin liposuction.
I was beginning to see a trend when Dr. Ariel Ostad, a NYC cosmetic dermatologist offered the same treatment plan of chin lipo, fillers and Ultherapy. He was confident that his micro cannula technique would give beautiful results on my face.
Still, I really don’t want to wear that thing on my head for a week.
I got a slightly different take from Dr. Brandith Irwin, the genius cosmetic dermatologist behind Skin Tour. She’s in Seattle so we didn’t have the benefit of a face to face, but she had some helpful insight from my pictures.
“I tell my patients all the time is that as we age, that volume starts to move in and down, right here, almost like you are putting your hands on the sides of your cheeks and pushing them down and in”.
“What’s happening around your chin is the thinning through the fat pad that’s adjacent to your chin, which is creating that notch. Part of the solution is to pull the volume up and out in your entire cheek area and recreating a smooth oval on your jaw line,” says Dr. Irwin.
Similar to Dr. Day, Dr. Irwin felt the root of my jowly problem was volume loss and droop, and that the solution is in revolumizing the mid face.
“Your jowl is coming from your volume loss in your cheeks. That’s all it is. There’s no magic to that, it’s more about volume redistribution back to a more youthful contour,” said Dr. Irwin.
“For treatment, I would say probably Sculptra. It will last the longest and be the most cost effective for you in the long run although you’re kind of in that group where I could go either way.
I wince when she mentions Sculptra. “Isn’t it a bit challenging to work with” I asked, conjuring up images of Calvin Klein’s latest facecapades which is rumored to be Sculptra gone wild.
“If someone said to me, I’m scared of Sculpture, you could do a lot of with three syringes of Perlane. There are a lot of doctors out there that are not as experienced with Sculptra, but I’ve been using it for nine years now and know I could get a better result with Sculptra”
Dr. Irwin explains that part of the issue with Sculptra is that it’s original indication in 2004 was for use in HIV patients who had a facial wasting, which is where she learned how to perfect the technique. Although many doctors used Sculptra off label, it didn’t get indicated for cosmetic use until 2009, so not every doctor understands the intricacies of using it.
Interestingly though, Dr. Irwin didn’t mention Thermage or Ultherapy right away, so I was curious as to why.
“I personally think that radiofrequency is poised to move on to the next level. I think there are some systems now that are engineered significantly better than Thermage. Those are the ones I’m looking at. Maybe I should relook at Ultherapy too”.
“But, I would not recommend that as the first treatment no. You may get a reasonable result, a little bit of tightening but you’re not going to get revolumization with repositioning of your volume where you want it. I would just say yes, a little bit of tightening would be great but my first choices for you would be volume, surface, then tightening.”
A lot of experts, a lot to think about, but it appears this boils down to a three pronged treatment in my particular case:
- Uplift and tighten my lower face sag. Ultherapy or Thermage to tighten my waddle.
- Chin liposuction. To get rid that little utter of fat hanging dangling under my jaw line.
- Revolumize to smooth out my jaw contour. Lift up my migrating face in the mid face (possibly temples) with Perlane or Sculptra. Then fill in my pre jowl sulcus with a touch of Juvederm.
The total ballpark cost of my lower face rejuvenation? Out of mine, clocking in at around $14,800. My high-end mental budget was $5000, but was hoping for $2500.
Next step for me will be wrapping my head around how to prioritize all of this.
Thermage and particularly Ultherapy have my interest piqued. So this week they’ll be carefully explored before I commit to see if they’re worth the dough. The fillers, I think I can embrace, but which one to choose and where it gets placed (because it all adds up) will be a decision. I don’t want to wind up broke and with filler face!
I know for sure chin lipo isn’t in my immediate plan, largely because I can’t afford to disappear for a week with that flying nun contraption wrapped my head.
But speak to me in a few years. Meanwhile, bring on the non-invasives!
- Chin Up (W Magazine)
- Chin And Jawline Issues (Skin Tour)
- How To Lose A Double Chin (Real Self)
- Alternative Procedure To Tighten Jawline (Real Self)
- Procedures To Improve Bottom Heavy Face (Real Self)
- Skin Deep: A Facial Filler Needs A Dose Of Patience (NY Times)