By Doctor Gilles Korb
Correcting a sagging lower face is a frequent request in aesthetic medicine. Similarly, an aging décolletage contrasts with a rejuvenated face and gives away a patient’s true age. The time when these areas were untreatable is long gone. Today, many advances have been made in aesthetic medicine which have extended the palette of anti-aging treatments available. 
The lower face
Heaviness is responsible for the appearance of jowls: the face is weighed down, the jawline is “broken”, the corners of the lips start to drop.
The theory behind this anti-aging treatment is to create a lifting effect in the lower face, providing the sagging is not too severe.
We fill the marionette lines with hyaluronic acid, using a micro cannula to ensure the product is distributed evenly. An additional injection of botulinum toxin lifts the corners of the mouth.
We reshape the oval with hyaluronic acid injections all the way along the jaw, being careful not to weigh the face down further.
Barbed tensor threads, which can be resorbable or permanent depending on the surgeon’s choice, are suitable for moderate sagging in patients who are still fairly young and whose skin has not thinned out too much. This procedure is carried out under local anaesthetic, and the number of threads to be placed and their position is determined case by case. Any swelling or bruising fades quickly. The results are optimal around two months after the procedure, and the lifting effect lasts 1 to 2 years.
We can densify the skin by implanting a mesh of fine threads over several, pain-free sessions. These resorbable threads lead to the synthesis of new collagen and make the skin less wrinkled and firmer.
Radiofrequency lifts the dermis by heating its collagen, causing it to retract. This relatively-painful procedure requires several sessions to achieve a result. The final effect and durability vary depending on the protocol followed.
Focused SKINLIFT-MGA ultrasounds are more recent. They bring about a non-invasive medical lift by acting on the dermis, the fatty tissue and the muscles. Just one session is required. Practically pain-free, this procedure requires no downtime. The results are achieved after two months and the lifting effect lasts between 1 and 2 years.
It is only when the sagging is too pronounced that a surgical lift will be carried out to tighten up the lower face.
Décolletage
This is a fragile area because its thin skin is exposed to the sun and the attraction of the chest. Over time, wrinkles, rosacea, marks, creases between the breasts and even stretch marks can appear. Treatments are often combined, and are gentle and gradual.
The surface of the skin can be smoothed through superficial or medium peels using glycolic acid or TCA.
To rehydrate the skin, mesolift sessions – the application of a blend of hyaluronic acid and antioxidants − are recommended. These can be complemented with a thread mesh to densify the dermis.
Microneedling is a variation of the mesolift, during which the product is injected using an electric pen equipped with vibrating microneedles. This offers both hydration and dermal stimulation. The results on stretch marks are particularly impressive.
Superficial injections of botulinum toxin are recommended to iron out the skin’s surface, but the results are variable.
Pigmentation marks and rosacea can be treated through repeated sessions of pulsed light, avoiding the summer months. The number of sessions required varies case by case.
Focused SKINLIFT-MGA ultrasounds are also an effective way to smooth the skin and restructure the dermis.
Doctor Gilles Korb
Plastic surgeon of the face and neck in Nantes; specialist in cosmetic surgery and cosmetic medicine for the face and neck. Member of the French Society of Plastic and Cosmetic Surgery of the Face and Neck, and of the World Society of Anti-Aging Medicine (WOSAAM).
