Facial Rejuvenation And The Jowl: How Far Should We Go?

Main Category: Cosmetic Medicine / Plastic Surgery
Article Date: 27 Apr 2010 - 1:00 PDT

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One facial change that really bothers people is the appearance of jowls - those fleshy, droopy folds at the jaw line that typically come with age. Many surgeons consider jowl correction as the single most important part of a facelifting procedure. The issue will be debated by leading experts at the Annual Meeting of the American Society for Aesthetic Plastic Surgery (ASAPS), being held at the Gaylord National Hotel and Convention Center April 23-27, 2010. "The Jowls - Their Importance in Achieving Successful Facial Rejuvenations" will be moderated by Charles H. Thorne, MD, and will include Fritz E. Barton, MD, Alain Fogli, MD, James C. Grotting, MD, and Nigel Mercer, MD.

Jowls eventually appear in a large percentage of people. The appearance of jowls is a "double whammy" because it also brings with it a distinct change in facial shape (wider and more rectangular in the lower face) characteristic of "older" people. At first glance it appears that the jowls simply drop from the face and are a result of gravity; research, however, suggests that atrophy of surrounding fat may be as important as gravity in the etiology of jowls.

"A theme in recent years has been the maintenance and enhancement of facial volume. Patients, however, do not want volume in their jowls. Should fat be excised or suctioned? Should the fat be pulled up into the face by tension on the SMAS (musculature of the face)? Should the pre-jowl area be filled with fat to make the transition from chin to jaw line smoother? Or are jowls so difficult that they require all of the above maneuvers?" said Dr. Thorne, a plastic surgeon in Manhattan and moderator of the panel. "The panel will address all of these questions, and it promises to be a fascinating and potentially controversial discussion."

The formation of jowls is one of the earlier signs of aging along with laxity in the neck. Generally part of an overall facelift procedure, correction may be accomplished by trimming fat, repositioning the jowl fat at a higher level, disguising the jowl by injecting more fat along the jaw line, or by a combination of these procedures. There were 94,927 surgical facelift procedures performed in the U.S. in 2009, according to ASAPS statistics.

"There is no 'one size fits all' approach to jowl correction," said Dr. Grotting, a plastic surgeon in Birmingham, AL. "We will examine various techniques for improving the jowls in different types of patients."

Panelists have been assembled from the U.S. and Europe in order to get diverse opinions on the subject of jowl correction.

"Europeans are reacting against a 'look different' facelift that delivers dramatic results - the trend in Europe is toward less invasive surgery when it comes to facelift procedures," added Dr. Mercer, a plastic surgeon from the United Kingdom. "Toward this end, a 'short scar lift' with minimal incision and more subtle result has developed, and has broadened the scope of facelifting."

When it comes to facial rejuvenation, many considerations must be made when determining the most appropriate approach for correcting the jowl, not the least of which being patient expectations, physical characteristics of the face and a patient's medical history, and an ever-increasing number of potential procedures. Thus, selecting a qualified, board-certified plastic surgeon is the first and most important step toward safely achieving the ideal result.

Source
American Society for Aesthetic Plastic Surgery

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