Sculpting the Jawline: A youthful jawline makes for a youthful face

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Perhaps you’ve felt bad about your neck, as Nora Ephron famously lamented.  But have you considered your jawline (and I don’t mean just the jowls)?  We all have plenty of things to worry about so who wants to add to the list?  Nevertheless consider this:  “The jawline, unlike the neck, is almost an impossible thing to hide.  It’s very telling of a person’s age,” says New York City facial plastic surgeon Dr. Andrew Jacono.  “And the gauntlet of youth is a youthful arc to the jawline.”  Known as the gonial angle, that arc extends from the back of the jaw towards the chin.  Think of Angelina Jolie’s or Audrey Hepburn’s sculpted mandibles, i.e. lower jawbones.

As we get older, we start to lose our jawline.  It’s not only the anterior or forward part of the jaw that begins to droop, resulting in jowls.  The posterior or back part of the jaw near the ears begins to lose volume too.  As these dual processes take place, that angle or convex arc gets truncated.  The jawline then is shortened by about half according to Dr. Jacono.  To combat this issue, doctors have traditionally tightened the sagging soft tissue which eliminated the jowls.  But this had the disadvantage of flattening the back part of the jaw, making the face look tight and the jaw compressed.

The gonial angle. “Until now, facelifts have focused on rejuvenating fallen jowls, failing to restore the extended arc of youth.  An easy way to pinpoint someone’s age regardless of whether they have undergone a facelift is to look at the length of their jawline,” says Dr. Andrew Jacono. But his technique of shifting surplus tissue from the jowls to the back part of the jaw extends the MDL, thereby adding youthful length and definition to the jawline from chin to ear.

The overall effect was an aging one. “Most models that you’ll see in VogueCosmo or Elle, have a very crisp border of their jawline that goes from their ear all the way forward to the chin.  That resonates with youth,” says Dr. Jacono.  “It’s elegant, soft, plush.  It doesn’t look pulled and flat and that’s the reason why so many people don’t look like they’re that much younger when they’ve had a facelift.  They just look altered.”

So, how can a distinct jawline be achieved?  Dr. Jacono and two of his Manhattan colleagues, plastic surgeons Dr. Matthew White and Dr. Dilip Madnani reveal the modern methods below.

In an innovative modification of an extended deep plane facelift, Dr. Jacono re-purposes the tissue from droopy jowls — made up of muscle and deep facial fat — by rotating it to the back part of the jaw.  “In essence, we’re robbing Peter to pay Paul.  We’re taking away the extra tissue that we don’t need and we’re putting it in a place where we need it,” explains the surgeon.  Unlike fillers that dissolve and re-absorb, this adds volume back permanently.  And it is part and parcel of a facelift, so there’s no additional procedure and no additional cost.  “For me, this has been a game-changer in the way my facelift outcomes look,” says Dr. Jacono.  “Patients don’t look flat and tight.  They look soft and youthful.  Part of youth is having volume in all the right places and one of those important places is over the back part of the jaw bone.”

Before & After photos of Dr. Jacono’s patients illustrating his novel rotational flap modification:

Dr. Matthew White is also concerned with angles in the reconstruction of a youthful jawline, but his focus is on the geometry below the chin.  With his signature procedure, the Golden Angle Lift, the surgeon concentrates on  releasing three key supporting ligaments of the face:  zygomatic, mandibular and platysmal.  “I’m becoming an orthopedic surgeon,” jokes the doctor.

According to Dr. White:  “We’ve been conditioned when we think about our faces to only think about the skin. While the skin is extremely important, we can’t essentially just shrink wrap the skin over the face.  Nor can we just ‘fill up the tank’ to restore lost volume.  The musculoskeletal system is more critical to understanding facial aging than we ever realized.”

The ligaments released by Dr. White in his Golden Angle facelift are the platysmal, mandibular and zygomatic ligaments.

Ligaments serve as anchoring units for the face, tethering the connective muscle and tissue (SMAS) to our facial bone structure in the same way that elastic bands allow a fitted sheet to hug a mattress, explains Dr. White.  The platysmal ligament at the back of the jaw delineates the gonial angle and is the most important ligament in defining the jawline, according to the surgeon.  The mandibular ligament reinforces the front part of the jaw (locus of the jowls) while the zygomatic ligaments support the cheeks.  As we age, these ligaments stretch out.  The repair of these three supporting ligaments then effectively contours the cheek, jawline and neck.

“Traditional facelifts have attempted to pull the skin tighter, but patients looked windswept and distorted,” says Dr. White.
“The Golden Angle Lift does not pull the skin tight, and there is no pulling or cutting of facial muscles. Instead, [I focus] on repairing the three critical supporting ligaments in our faces, to contour the cheek, jawline, and neck.” Scarring with this procedure is minimal as only a small incision is required.

Before & After photos of Dr. White’s Golden Angle Lift:

To create a youthful jawline, Dr. Dilip Madnani relies on deep plane surgical techniques which entail the release of facial ligaments and the elevation of the SMAS flap over the jawline, building up the mandible and part of the cheek in the process.  The jawline is an important component of the overall aesthetic of the face – one that is not always immediately appreciated by patients.  “People come in focusing on one thing – lines are really bothering them, for example, but their necks are super-heavy and they have these heavy jowls.  So you have to educate them on what’s going on globally,” advises Dr. Madnani.  “Therefore, during the consultation process, we take pictures from multiple angles.  And their first remark is ‘Oh, that’s me?  I never see myself on that side.’”

When appropriate, the surgeon also uses noninvasive methods.  “Injectable treatments, such as dermal fillers and Botox,” according to Dr. Madnani, “can create dramatic results on the jawline, giving you a more youthful facial profile.”  Fillers like Voluma, Restylane Lyft and Radiesse on the lower part of the face may be used to restore volume, creating a rounder more youthful lower face.  Neuromodulators like Botox or Xeomin are employed to relax and reduce the jaw muscles, resulting in a more attractive heart-shaped face.

Lastly, chin implants can also build out the jaw.  Serious defects like overbites, underbites, recessed jawlines and chins and jaw advancements are the province of orthognathic doctors, who are also facial plastic surgeons.  For centuries, facial symmetry has been a determining factor when it comes to beauty.  Today, it appears that geometry plays a defining role.

Before & After photos of a patient of Dr. Madnani’s who has had both surgical and non-surgical procedures:  a mini lift, lip lift, Restylane to the cheeks and Voluma to the jawline:

Before & After photos of Dr. Madnani’s facelift:

Expert Beauty Tips:

The Park Avenue Face.

Dr. Jacono:  “It’s impossible to stress how important it is to take care of your skin.  Healthy skin is beautiful skin and beautiful skin goes a long way in making you feel youthful and confident.  Skin health should be the first stop on your plastic surgery journey,” emphasizes Dr. Jacono in his new book, The Park Avenue Face.  To that end, the surgeon recommends “several easy and inexpensive daily steps … for optimal skin at any age:  exfoliating (skin resurfacing), moisturizing, building collagen layers, and evening skin tone and reducing hyperpigmentation.”  The book offers much useful advice on the ideal skin care routine and products along, of course, with a good deal of useful information on non-surgical and surgical procedures alike.

Dr. White:  “The one beauty tip that I would give is for us to all treat our faces in the same manner we do our bodies.  I think one of the most exciting developments we have seen in treating the aging face is the knowledge that aging is not skin deep.  We now understand that the layers beneath the skin are extremely important, including a patient’s facial bone structure, the health of the facial ligaments, and the fibromuscular layer of the facial canvas.

When I encounter someone who looks tremendously great for their age, there are two habits that are highly predictable.  The first habit is that they have very good dietary routines.  They eat frequent, small, low calorie meals; and they don’t put anything into their bodies that has been processed. And they definitely stay away from sugars in any food or drink.  The second habit is that they enjoy sticking to an exercise routine.  It doesn’t have to be particularly demanding, but it must be at least a few times per week.  A commitment to regular exercise, even a few times per week, can have amazing effects on your bone structure, muscle health, and tone of your face and neck.”

Dr. Madnani:  “I like my patients to bring in pictures of themselves from five and ten years ago, so I can better explain the aging process and what I am able to do for them.  I’m happy to get ideal faces like Angelina Jolie or Audrey Hepburn – they have fantastic bone structure – but not everyone has that.  I can’t bring that to everyone.  But I can bring you back to where you were.”

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