How Long Do Cosmetic Fillers Last?

cosmetic fillers injection

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Cosmetic fillers are very effective non-surgical solutions for facial volume issues such as hollow under eyes, lip enhancement, cheek definition, the lack of chin projection, and other problems related to genetics or age-related volume loss. Cosmetic fillers can also treat other issues such as wrinkles, lines, and folds as well as acne scars, and even thinned earlobes. Although filler can be used for many situations, some people have reservations about filler treatment because of longevity, and concerns about putting something they think is not natural into their body. I’ll discuss how I counsel my patients who have the same questions and concerns about fillers.

cosmetic fillers injection
Cosmetic fillers are a popular non-surgical procedure to add youthful looking volume.

People often want to improve their appearance caused by loss of volume. As we get older, our faces gradually lose bone, muscle, fat, and soft tissue. In some younger people, a genetic lack of volume in the face such as in the cheeks and eyes make them look older and more tired than they actually are. Facial volume loss can also be seen in people who are very athletic who have very low body fat, or if you ‘ve lost a lot of weight from diet or weight loss surgery.

Patient look younger after cosmetic filler treatment
Hollow faces from aging and/or weight loss can look younger with non-surgical filler application

A lot of people who we see come in requesting fillers which are permanent so they can avoid having to come back regularly for filler placement. In my surgical practice, I’ve had patients come from around the world to have me remove permanent and semi permanent fillers such as silicone and polyacrylamide.

semi-permanent filler removal after complications
Permanent or semi-permanent fillers are prone to complications from infection, foreign body reactions, and difficulty in removal

In addition, if an infection such as a biofilm were to occur, the filler would have to be removed surgically. The reality is that you can never completely remove all the filler, which means that recurrent infections would be likely. In my practice, for any procedure, my recommendations are based first on minimizing risk, and being able to address any issues that may arise quickly and safely. I don’t recommend the use of permanent or semi-permanent fillers. Further, as aging progresses, these fillers will not easily adapt to changing anatomic relationships. There are more than a few celebrities who have publicly expressed regret about having permanent fillers, particularly in their lips.

semi-permanent filler removal surgery
Permanent and semi-permanent fillers require surgical removal, and it’s likely that not all the filler material can be removed.

In any discussion about a natural filler, the subject of fat grafting always comes up. In order to address facial volume loss at the bone level, fat grafting cannot be used. Fat grafting is placed under the skin, which makes it similarly susceptible to the same issues as superficial filler placement. Healing from fat grafting is unpredictable with frequent complaints about lumpiness and asymmetry. Fat grafting does not meet my criteria for predictability and benefit from placement at the bone level.

fat transfer for volume loss
Fat grafting can be done underneath thicker skin, but it is a surgical procedure, and some fat will be absorbed by the body, requiring a second procedure.

My preferred injectable filler material is hyaluronic acid. Hyaluronic acid fillers meet my criteria for safety, predictability, versatility, and reversibility. Hyaluronic acid occurs naturally in the body, they don’t have the same risk of foreign body reaction like semi-permanent fillers.

Hyaluronic acid fillers come in a range of thickness and longevity allowing me creative flexibility to help my patients look their best. Hyaluronic acid fillers are also reversible as they can be dissolved with the injectable enzyme hyaluronidase.

before and after hyaluromic acid fillers on nasolabial and mesolabial folds
Hyaluronic acid fillers can be applied in minutes, without surgery, with thicker fillers lasting 1-2 years.

How long hyaluronic acid fillers last depend on the structure and composition of the filler, as well as an individual’s rate of metabolizing the material.
Longevity of hyaluronic acid fillers

I use softer hyaluronic acid fillers in the under eye area for hollow looking eyes, and to camouflage minimal eye bags, and for plumping the lips. These fillers include Restylane, Restylane Silk, and Juvederm Ultra. A filler like Juvederm Volbella can can be useful for vertical lip lines above the upper lip. These fillers last anywhere between 6-12 months before they are metabolized, and need to be reapplied.

Lip augmentation with hyaluronic acid filler
Lip enhancement is among the most popular cosmetic filler procedures for younger and older people

I often combine fillers in the under eye area with platelet-rich plasma, or PRP, which is a concentration of wound healing and growth factors derived from your own blood. PRP helps improve the skin quality and skin thickness under the eyes, as well as discoloration and pigmentation which often accompany hollowness, often described as dark circles under the eyes. PRP often extends the effective life of filler under the eyes, and the two materials work well together.
Fillers in medium thickness and viscosity are usually used for nasolabial folds, the folds around the upper mouth and lower nose, often called the parentheses lines; and the mesolabial folds, the folds around the lower mouth otherwise called the marionette lines.

nasolabial folds and mesolabial folds treated with cosmetic filler
Nasolabial and mesolabial folds, commonly called smile lines and marionette lines, can be treated with cosmetic filler

These areas have thick skin, but still have a fair amount of movement when smiling and talking. Both these types of folds around the mouth are due to volume loss due to aging. These types of fillers include Restylane Refyne, Restylane Defyne, which last between 6-12 months, and Juvederm Vollure that can last up to 18 months.

The thickest hyaluronic acid fillers can be used on bone structure and doesn’t really move with facial expression. Areas where I use these thicker fillers include the upper cheeks, jawline, and chin. These areas are prone to bone loss which naturally occurs with aging.

Jowls and jawline improved with cosmetic fillers
Jowls and jawline continuity can be improved with thicker filler added into the mandibular notch along the jawbone.

The cheeks appear to deflate due to the diminishing cheekbone, as well loss of muscle and soft tissue. The jawline may appear to sag and lose continuity due to the hollowing of an area called the mandibular notch. The chin can lose projection as bone diminishes. I prefer to use Juvederm Ultra Plus, which can last about a year, and Juvederm Voluma which can last up two years. Restylane Lyft can also be applied in these areas, and can last up to 18 months. Successful placement of facial fillers for diminishing facial volume at the cheeks, chin, and jawline is highly dependent on technique.

Deeper placement of hyaluronic acid fillers in the cheeks can avoid the pillowy look
The Structural Volumizing technique can be applied to the cheeks, without looking soft and doughy like traditional filler placement

Most doctors place these fillers more superficially at the dermal and fatty tissue layer. At this level the skin cannot support a significant volume can be weighed down. The filler can shift and make the face look doughy. I use my experience as a facial cosmetic surgeon with extensive experience with facial implants to place filler at the deeper layers, atop the bone structure and under the muscle layer for more natural looking results. This technique is called Structural Volumizing, and is practiced by very few doctors. It results in a more defined and balanced facial structure, and can even have a lifting effect.

cosmetic filler at the dermal level can migrate and look heavy
Most doctors place filler at the dermal level, where filler can migrate, and look heavy
cosmetic filler placed at fat or soft tissue level
Filler is often placed at the deeper fat or soft tissue level, but it still can’t hold much filler material, and can look soft or heavy

By restoring volume at the bony structure level, the skin and soft tissue that may appear to have collapsed and descended due to volume loss become more defined and the overall effect can produce a vertical lift. Structural Volumizing requires more facial filler than traditional placement as it’s placed at the foundational level of bone e where most of the volume loss occurs therefore, more volume is needed. At this level, results can actually last longer than more commonly performed superficial filler placement.

Y Lift place filler at the bone level
Structural Volumizing/ the Y Lift can place filler between at the bone level, between the muscle layer, which is a much more solid foundation, and the muscle can hold it in place so it looks firm and contoured.

This is an exciting time for people interested in improving their appearance with safety, predictability and convenience. In my practice, the use of hyaluronic acid fillers has been a great tool for me to help my patients. I would remind anyone considering having fillers to understand that fillers are just tools, or materials used in the hands of a sculptor. The doctor’s expertise, experience and artistry are critical to achieve the best results for you. Recognizing that filler placement needs to be done at regular intervals, its very important for you to find a doctor who you feel comfortable with. This means someone who shares your aesthetic vision, who communicates well and makes you feel at ease.

Structural Volumizing by Dr. Amiya Prasad
Structural Volumizing/ the Y Lift allows patients to have youthful volume that looks contoured and full, without looking soft and pillowy like traditional filler placement

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    The Do’s and Don’ts of Cosmetic Surgery

    Doctor shouldn't rushed consultations

    Do your research

    Information overload can make research overwhelming. Marketing and turf battles between doctors makes it difficult to distinguish professionally credible information from financially motivated scare tactics. There are still a good number of actual caring and ethical doctors. Advancement in medical procedures and technologies combined with higher standards for results is an opportunity for patients to find the right super specialist for them. For example, As a Cosmetic Eyelid Surgery specialist in practice for over 20 years, I can assure my patients about the optimal strategy for their eyelid issues in a way that would be different from a general plastic surgeon who mostly performs body procedures.

    Research into cosmetic procedures
    Research can help in finding specialized doctors who are experts in your specific cosmetic issue.

    Do expect your doctor to spend time with you

    It’s often perceived that a busy practice is a sign that the doctor is good. Although I’m busy, I never rush through a consultation. The consultation is a critically important time for you to learn and see if the doctor has a personality you feel you can trust with your health and appearance. A consultation is also a discussion. In my practice, the patient isn’t only selecting me but I’m selecting the patient. I avoid performing procedures on people who I’m not comfortable with. You should be comfortable with your doctor’s technical abilities and their personality.

    Doctor shouldn't rushed consultations
    Consultations shouldn’t be rushed, and the personalities and expectations of the patient and the doctor should be a good fit

    Do ask

    If you don’t ask, you may be left with questions. Ask to look at your surgeon’s before and after pictures. Ask for a step-by-step explanation of the procedure you’re looking into, including what type of anesthesia. Ask about your surgeon’s specialty area and how often they have worked on similar cases such as yours. I find that a patient who asks questions also learns about options they didn’t think about and have a better outcome.

    patient asking questions to Dr. Prasad
    Ask your doctor whatever you can to make sure you’re getting the treatment and results you want.

    Do tell your surgeon your full medical history

    An issue, which appears to be a cosmetic problem may also be associated with a medical condition. For example, a condition such as eyelid ptosis occurs when the eyelid level droops down. Oftentimes, there is also hooded skin. A plastic surgeon may remove the hooded skin without treating the eyelid ptosis. The plastic surgeon may not have been made aware that the patient sees an ophthalmologist who has been treating the patient with steroid eye drops, which could have contributed to the eyelid ptosis. The take home message is to disclose every detail about your medical history so your cosmetic procedure can be performed safely and successfully.

    Review your detailed medical history with your doctor
    Review your detailed medical history with your doctor prior to any procedure to avoid complications

    Do be open to a combination approach

    One procedure can be part of a solution for a more comprehensive treatment strategy. There may be a combination of 2 or 3 different treatments which can lead to a better outcome. For example, if a patient has concerns about under eye bags, they may not appreciate the bone structure which is lacking and contributes to the prominence of the eye bags. I find that with education and reviewing the patient’s photos from different angles that my patients appreciate the knowledge gained and the opportunity to have a procedure such as fillers to enhance the cheekbones at the same time as surgery for under eye bags. I often combine laser procedures and PRP (platelet rich plasma) treatment to help the skin look more even toned and vibrant at the same time I perform injectable treatment or surgery.

    PRP and Laser combined to treat dark under eye circles
    A combination of surgical and non-surgical procedures most often leads to the best possible results

    Don’t fall for shortcut miracle procedures.

    Shortcuts in medicine do not end well. A company claiming to perform a “revolutionary facelift” procedure with multiple offices and a pop singer from the 70s advertising for them could not hide the countless botched surgeries and fake online reviews which they forced employees to write. As a multispecialty trained Board-certified cosmetic surgeon, I have no limits on the level of procedures I can perform. If I could do a procedure less invasively to get the same results as a more involved surgery, I’d do it. Yet, non-surgeons and non-physicians market irresponsibly procedures with names and language implying if not outright claiming that they can get the same results with lasers and threads that you would get from a surgery like a facelift. There often are better ways to do things, but there are no shortcuts.

    Miracle treatments often lead to expensive complications
    Miracle treatments often cost people a lot more in the long run because of botched results requiring revision procedures

    Don’t assume that the doctor knows what you want and expect out of cosmetic surgery.

    When you consult with a very experienced surgeon, you might think, “Oh, he or she has done a lot of these procedures before, they’ll know what to do right away.” However, your situation is still unique to you, because your body, your face, your medical history is unlike anyone else’s, so communication is key. It is important that you are able to articulate what your aesthetic goals are, so that the surgeon may be aligned with those goals and develop a proper understanding of who you are, what is important to you, and what is motivating you to take this step.

    Communicate your aesthetic goals to your surgeon
    Communicate your aesthetic goals clearly to your surgeon to get the results you want

    Don’t assume that cosmetic or plastic surgeons are experts in every field of cosmetic surgery.

    Much in the same way that cosmetic surgeons and plastic surgeons practice separate and specialized disciplines, There are some surgeons who may be more focused on the eyes or face, while others may be more focused on body procedures. It is important that you seek out a cosmetic surgeon who specializes in the particular area that you want to have addressed. Going to a super specialist should significantly reduce the chances of complications and other undesirable outcomes.

    lower eyelid blepharoplasty complication done somewhere else
    Plastic and cosmetic surgeons are not specialists in every cosmetic procedure

    Don’t have unrealistic expectations.

    I have a core philosophy when it comes to cosmetic procedures: no one should be able to tell you’ve had a procedure. This means I enhance my patient’s appearance while retaining their character. You look like you; refreshed or well rested. I help my patients return to work typically in 1 week. I’ve made significant advances in the art of the procedures I perform, such as techniques to minimize bruising or swelling. I’ve made the sedation process easy to recover from and I get people back to work in typically one week. There is still a healing process which takes time to complete. Having realistic expectations as to the results and the speed of full healing needs to be well understood before having any procedure.

    Don’t have unrealistic expectations.
    Expect cosmetic procedures to make you look about 10 years younger, not several decades younger.

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      5 Things to Consider Before Having Cosmetic Surgery

      cosmetic procedure risks are reduced by doctor's knowledge
      Can your cosmetic concern be addressed by a lifestyle change?

      During consultation, I often begin by asking about lifestyle with a focus on healthy habits. Some people find themselves focusing on aspects of their appearance without factoring in lifestyle related actions which can also help them look better. There are often certain cosmetic issues which can be improved with diet, weight management, exercise and skin care.

      ideal body weight for cosmetic procedures
      Cosmetic medical procedures are best done when within 10 pounds of ideal body weight.

      For example, someone who complains of excess fat under the chin or love handles may see a significant difference after a change of diet which results in weight loss. This is particularly relevant for people who are more than 10 pounds over their optimal body weight. In terms of procedures such as liposuction, ideal candidates are those who are within 10 pounds of their ideal weight.

      What do you really want?
       have clear and focused aesthetic goals
      Have clear and focused aesthetic goals before consulting a cosmetic surgeon.

      Make sure that your goals for cosmetic surgery are clear and realistic. In my opinion, the purpose of cosmetic surgery is not to change your looks, but to enhance your appearance in a natural way. If you’re concerned about the appearance of your face and looking in detail on a particular area of concern will more likely result in being able to express specifically what you’d like to address. This is more helpful to the doctor something like “I don’t like my nose.” Of course, I am asked daily by patients “Doctor, look at my face and tell me what you think I need.” I’m always ready to offer my perception as an to what features are more significant in terms of the overall facial appearance.

      Be clear and detailed with your doctor
      Be clear and detailed with your doctor about you want to improve. If your doctor suggests something, make sure you understand it clearly before deciding on it.

      Nonetheless, being able to articulate as clearly as you can what bothers you helps the surgeon gain a better sense of what you want to achieve and what issues are most important to you.

      Are you ready to make lifestyle changes?

      After cosmetic surgery, a healthy lifestyle will continue to support and maintain the benefits of your surgery. This can include adopting a good skin care routine, protecting your skin against the sun, watching what you eat, and eliminating unhealthy habits such as smoking and excessive alcohol use. Cosmetic surgery is an enhancement of the external appearance which can be optimally sustained by taking care of your health.

      lifestyle changes after cosmetic procedures
      Lifestyle changes such as reduced to minimal sun exposure are needed right after certain procedures, and to maintain results of most procedures
      What are the risks?

      Like any surgery, cosmetic surgery comes with some risks. It is important that you sit down with your surgeon and discuss all the possible outcomes of your procedure so you can fully understand the risks and benefits of your planned procedure. An experienced and safety focused surgeon can minimize risk. Each surgeon is an individual with experience in specific procedures based on training and practice.

      cosmetic procedure risks are reduced by doctor's knowledge
      There are risks to any cosmetic procedure, but they are reduced by the experience, expertise, specialization of the doctor

      For example, as an oculoplastic Surgeon, my training was focused intensively on cosmetic eyelid surgery which is in contrast to a general plastic surgeon whose residency is typically hospital based reconstructive surgery. Understanding what specific areas your prospective surgeon is most proficient in is in my opinion a good way to lower the risks of the surgery you’re going to have. There is (in my experience) no surgeon who is great at “everything” .

      Are you doing it for yourself or for someone else?
      happy after cosmetic procedures
      When choosing to do a cosmetic procedure, it’s important that the person you want to please most is yourself

      Cosmetic surgery is a very personal decision, and while there is no harm in asking for the opinions of close friends or family members, the final decision is ultimately only yours to make. Some people will undergo surgery because they feel pressured by certain people in their lives to look a certain way, or they’re trying to make someone else happy by changing an aspect of their appearance. As long as you’re excited about improving your appearance for yourself, your happiness is the only thing that matters.

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        Plastic Fantastic: Platelet Rich Plasma fillers

        Written by: Valentina Zannoni – Source: Swide.com

        Between an eye-lift and a hair transplant, Dr Prasad took some time out of his busy schedule to talk to Swide about Platelet Rich Plasma (PRP) fillers, the latest must have age defying practice.

        But first here’s a brief biology lesson to get to grips with the terminology. Plasma is the yellow liquid which makes up over 50% of the blood. The actual blood cells are suspended in the plasma, making it the petrol of our organism. Platelets are those tiny cells that serve to create blood clots and therefore start the healing process of the skin.

        PRP has been used for a while in other medical specialities, such as in orthopaedics for the cure of joints and chronic injuries to help stimulate the healing process. While three years ago, medical professionals from the cosmetic sphere started to think about the uses of PRP in their field. Dr Prasad, a facial rejuvination specialist at the Prasad Cosmetic Surgery Clinic in New York City, has been using this substance as a filler for two years now. “By placing it [PRP] in the skin” Dr Prasad explains, “you are injuring the skin in a controlled way and you are essentially healing a wrinkle by filling it with a material that will recruit the body’s collagen and start the healing process.” In layman’s terms, unlike Botox, PRP is used to restore volume under the skin.

        PRP fillers are particularly effective on fine lines around the mouth, eyes, even bags under the eyes and also to reduce the depth of acne scars. The optimum age to undergo a treatment is when you are over forty, unless you want to treat acne scars, then the median age of the patient is halved.

        And how about those stubborn expression lines? Well PRP fillers can also work on those. Dr Prasad says that this treatment can be used“ anywhere where the lines are relatively small, forehead lines are shallow, Botox can relax them but there is no good filler to plump them out and we’ve been using PRP.”

        How do PRP fillers compare to more traditional chemical fillers like Restylane? Dr Prasad explains that it’s a matter of patience, the two provide more or less, equivalent results, its just a question of time. “With Restylane you get immediate results, because 1cc of liquid equals 1cc of correction. With PRP you may get immediate appearance of improvement but you have to wait to see the result because body has to respond by generating collagen. It’s a healing process.” Even though the results may come more slowly, the effects of PRPs however, can last a year or more, while other chemical fillers start fading after about six months. A PRP session, which can consist of 3 or 4 injections, is also better value for money, as typically it costs $1.500, while for one syringe of Restylane the retail price is $800.

        PRP fillers are attracting an increasing amount of would be clients. “People do a lot of research, they learn a lot online, and they come and ask about it.” Dr Prasad has found that his role as surgeon has developed into teacher as well, “ often I have to educate them on what [fillers] can and can’t do. It takes the judgement of a professional to understand what they can do and how to apply them so you get the maximum benefit.”

        In recent years, cinema, TV and literature have resurfaced the public’s fascination and interest in Vampires- today, in cosmetic surgery, the benefits of blood go further than fantasy and are becoming reality.

        The Pelleve Wrinkle Reduction System – noninvasive, virtually pain-free, nonablative facial skin tightening.

        The aging process and the cumulative effects of sun exposure, gravity, genetics, and other factors cause a loss of skin elasticity, which unfortunately leads to sagging of the skin and a loss of facial structural support. The key to tightening up loose skin without undergoing a facelift lies in a process known as “neocollagenesis” or stimulating new collagen. Whereas lasers use light to target the tissue, radiofrequency devices use energy to heat the skin below the surface to produce a tightening effect. The Pellevé™ Wrinkle Reduction System is one of the newest innovations in noninvasive, virtually pain-free, nonablative facial skin tightening. The technology utilizes advanced radiofrequency to induce collagen contraction without damaging the skin’s surface.

        Dr. Prasad reports the most significant areas of improvement in terms of visible reduction of wrinkles are in areas of thinner skin, such as around the eyes, “Pellevé can eliminate “crow’s feet” in eye area, caused by aging. Pellevé can also get rid of wrinkling that causes frown lines above the brow, renewing the appearance. Pellevé has been proven to provide safe and effective skin tightening in medical studies. Because Pellevé is a non-invasive procedure, there are minimal side effects and discomfort. Unlike other skin tightening systems, no anesthesia or skin cooling is needed during the procedure.”Pellevé device is that it’s a skin tightening procedure that doesn’t have any downtime. The tightening occurs at the under surface of the skin as the radiofrequency gets applied to the deep tissues. The technology allows me to tailor the procedure to each individual, which means I work on the eye area or on the fine lines around the mouth as needed. This ability to customize the treatment is a significant benefit.” (Read full article below.)

        Click on article above to view full screen.

        Neck Nonsurgical Rejuvenation: Beware of Media Hype, It’s Your Neck, Your Results

        When your neck skin started sagging, you took it in stride. Then, you invested in neck-firming creams and serums that your friends swore by. Now, after too many turtlenecks and failed DIY efforts, you’re in search of a serious solution. Can a nonsurgical procedure tighten your turkey neck? The answer may depend more on whom you ask than the state of your sinking skin. If a cosmetic cure sounds too good to be true, it just might be. Use my guidelines to tease out the truth behind neck treatments:

        Proper Prep:

        After you book a consultation with an M.D., do your neck rejuvenation research. But, don’t scour the Internet for every statistic and story of woe—too much info might confuse rather than clarify. Brush up on the basics:

        When and Why: When middle age rears its head, you may notice neck skin sinking south. With aging, you lose muscle tone and subcutaneous fat, which define your jaw line and maintain skin elasticity.

        Surgical Neck Rejuvenation, or a neck lift, refers to two procedures:

          Cervicoplasty: the removal of excess loose skin.

        Platysmaplasty: the tightening of the neck muscle.

          Nonsurgical procedures address different levels and types of surface damage. Once skin loses elasticity, however, surgical neck rejuvenation is the only solution. Don’t trust anyone—expert or friend—who contends otherwise.

        Injectibles: Botox can help reduce horizontal neck wrinkles when skin is still elastic. One treatment may last three or four months.

        Noninvasive Ultrasound Therapy: Thermage, Titan, the newer Ulthera, and Pelleve, which I prefer and offer, tighten skin and treat wrinkles by heating the skin to generate collagen.. This, however, only applies to finer wrinkles and minor conditions-it should never substitute for real surgery in more extreme cases.

          Laser Treatment: Fraxel, among other laser treatments, can improve skin quality, but it cannot tighten loose skin.

        The Devil’s in the Details: Regardless of the procedure, make sure you’re picturing the same jowl-free jaw as your doctor. Don’t let anyone use vague beauty buzzwords like “tight” or “smooth,” to describe expected results. If you don’t establish shared expectations early on, you risk hearing the dreaded, “it looks good to me…” Remember, as the patient, you have leverage—use it! They should have pictures, facts, and figures, and you have the power of “next, please.” Don’t leave any consultation without knowing:

        The Cost: non-surgical treatments may require upkeep, which drives up cost considerably. Ask your doctor how long the results from a given procedure last, and always compare apples with apples. Permanent means one procedure; temporary keeps the tab rolling.

        The Physical Impact: Simply put, people don’t want surgery. But surgical procedures keep improving. Before you equate neck surgery with extensive recovery and unbearable pain, get the whole post-operative picture—from the minute you wake to the last painkiller you take.

        What if…?” Don’t avoid asking hypothetical questions. You have a right to probe into the possibility of something not going as planned. Ask about the guarantee for non-surgical and surgical procedures.

        Confusing Fact with Fiction: Thanks to powerful marketing campaigns, new technology can earn a reputation before it deserves one. When hype builds and word spreads, even physicians feel comfortable recommending something “they hear has gotten great results…” Tread lightly around treatments until they’ve been on the market for at least a year, preferably two.

        Doctor Knows Best:  An M.D. should be part of any medical decision, neck rejuvenation included. Doctors who perform the full scope of surgical and non-surgical procedures are most likely to furnish impartial advice. Don’t rely on a cosmetic center that isn’t affiliated with a certified physician, especially since a number of doctors, like myself, have added medical spas to our surgical practices.  I engage every patient in an open dialogue about treatment options, and establish a mutual understanding of realistic expectations. When a non-surgical procedure will best remedy minimal sagging or wrinkling, I explain and recommend the appropriate non-surgical approach.

        Do I Need a Facelift? What Happened to Me? I Look 20 Years Older

        Dr. Amiya Prasad, author of “The Fine Art of Looking Younger” answers RealSelf.com Question:

        Q. Do I Need a Facelift? What Happened to Me? I Look 20 Years Older

        Hello.. I am 34 years old, 5″2 147lbs..I am about 20 lbs overweight, however looking at my face and all the fat concentrated on my neck looks like I am more like 50 lbs overweight…I already had a chin lipo 2 years ago. Should I get a facelift? Am I too young? my family says I am paranoid..but I see other people with beautiful jawlines specially TV anchors..My eyes are also droopy…What happened to me? How can I look younger? My skin has large pores also.

        View Dr. Prasad’s video response below.

        A. Lifestyle adjustments or facial cosmetic surgery to look younger

        You’ve described a lot of elements of what a youthful face is, and many people on television illustrate that: bright beautiful eyes and a sharp jawline makes one look young or even energetic. When you are younger and overweight, not just on the body but also in the face – due to genetics and the way the fat is distributed- can make you look older. You have choices for procedure. However, if you are 20 pounds overweight, adjustments to your lifestyle and diet will build a strong foundation for your appearance. Being in peak physical fitness and looking young goes together – basically, being healthier helps! To better define the jawline, you can opt to have facial liposuction or other procedures determined by a board certified cosmetic surgeon. If you do consider improving the appearance of the eyelids, eyelid surgery is an option.