The Lower Face


Without a doubt, a youthful jawline is a crucial component of the attractive and youthful face. It is important to understand that a nice jawline retains a sense of softness rather than being harsh or boney looking. The softness is ensured by allowing for an appropriate layer of fat within the tissues – one of the reasons why Dr. Fechner feels that aggressive fat removal (i.e. liposuction) is ill-advised and difficult to correct.

Patients commonly complain about jowling due to a soft tissue pouch that starts to drop below the natural line of the jaw. The lower facelift is designed to reposition the jowl up into the low cheek area in order to achieve the cleaner line. For most natural-looking results after the facelifts, Dr. Fechner performs this tissue repositioning with reasonable restraint. People want to look good but not over-done. The importance of attention to detail during facelift surgery cannot be over-emphasized. Dr. Fechner focuses on the direction and extent of repositioning. His technique of deep-plane dissection and structural repositioning allows for a lasting and effective lift avoiding unnatural tension and pulling.

Even along the jawline, volume changes occur. The jowl represents an area of fat collection. At the same time, in front and in the back of the jowl, volume is lost leading to the isolated jowl pouch. Because this occurs in different people to varying extents, specifically designed fat enhancement is routinely necessary for the best outcome. For instance, the region in front of the jowl (a.k.a. pre-jowl sulcus) commonly benefits from a small amount of fat micro-injection. In addition, Dr. Fechner frequently adds small amounts of fat to the mandibular angle for an enhanced but gentle jawline.

Marionette Lines

Commonly more bothersome to the patient than nasolabial creases are bitterness folds and grooves that extent downwards from the mouth corners. These Marionette lines contribute to a sad and aged look and they are accentuated by jowls which are located immediately next to it. A good facelift will soften their appearance; often though, additional filling of the Marionette lines is necessary – a treatment that Dr. Fechner usually performs using conservative fat transfer.

The Chin

Important for the overall jawline appearance and for balance off the face, the chin commonly benefits from rejuvenation. The chin will lose its smoothness and forms dimples. Loss of fat padding in conjunction with hypoactive chin muscles (a.k.a. mentalis muscle) contribute to these changes which can be improved with judicious facial fat grafting. In Dr. Fechner’s experience, it is not advisable to surgically weaken the mentalis muscle. Rather, a conservative treatment with botulinum toxin A (Dysport® or Botox®) will soften the chin further if additional benefits are desired. Interestingly, while a slightly weak chin may be acceptable or even cute looking in young women as we age, this anatomy may become a liability and interfere with the desired profile balance.

Neck rejuvenation

The neck is always affected by the aging process. Therefore, rejuvenation has to include a natural looking neck contour. His years of experience has helped Dr. Fechner understand that, in order to achieve a long lasting improvement of the neck, thorough modification of neck anatomy is necessary. He found it simply not sufficient to pull on the neck muscles and hope that this will provide the years of improvements sought for by his patients. Anatomically, structural changes to the deeper neck anatomy occur in sagging and looseness of the superficial muscles. These changes to the neck occur to various degrees in different people making individualized assessment and treatment necessary. According to Dr. Fechner, doing the same procedure on every patient is an illogical approach to the diversity of aging patterns in people and would therefore simply provide suboptimal outcomes.

The central neck right below the chin is often the area of maximum laxity. Therefore, direct access to this area is achieved through a well hidden incision placed underneath the chin. This allows sculpting of the deep fat and appropriate retyping of the superficial muscles. In addition every effort is made by Dr. Fechner to eradicate the vertical muscle chords commonly observed. In addition, with aging, glands that used to be tucked underneath the jawbone become lax and obvious as displeasing bulges. Therefore, reduction of the size of these glands may be indicated. In order to reduce the possibility of a harsh or skeletonized appearing neck, precious superficial fat padding needs to be left in place and should not be removed with aggressive liposuction.

Call Worcester Face Lift Specialist Dr. Fechner