Tighten sagging cheeks: effective methods for correcting jowls

Bryli – This is an aesthetic defect, which is characterized by excessive prolapse of the skin and subcutaneous fat of the face, mainly in the area of ​​the lower jaw. Fleeces are more commonly known as "saggy cheeks" among patients and are one of the most common reasons for seeking medical attention from a specialist in the field of aesthetic medicine.

Today there are many approaches to the correction of jowls. Olga Tumar, an anesthesiologist, dermatologist, an active member of the Ukrainian Association of Dermatovenereologists and Cosmetologists, an international medical trainer of the Institute Hyalual company, spoke in more detail about the most effective methods aimed at eliminating “sagging cheeks”, exclusively for estet-portal.com.

Why cheeks sag: the main mechanisms of the formation of jowls

Bryli – an aesthetic defect that is most difficult to solve using minimally invasive techniques.

The breeches make the face heavier, blurring the clarity of the features. But we, aesthetic doctors, are used to meeting the expectations of our clients.

The following reasons for the formation of jets should be highlighted:

1.    Weakening of the mandibular ligament - the retaining ligamentous apparatus located in the projection of the jug;

2.    Hyoid prolapse;

3.    Excessive muscle activity mm.platysma et depressor anguli oris, which "pulls" face tissue down.

After 35-40 years of age, microcirculatory, hormonal and metabolic changes take place in all tissue layers of the face. Oxidative processes predominate, damaging structural glycosaminoglycan formations (fibers of the reticular layer of the dermis) and ligament fibers. This, in turn, leads to a decrease in skin elasticity and subsequent tissue ptosis.

Retaining ligaments weaken, superficial subcutaneous fat packs sag. If the deposition of subcutaneous fat is excessive, this only emphasizes and exacerbates the bryl. In some cases, sagging is due to atony of the masticatory muscle.

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What are the modern surgical methods for correcting jowls

There are many techniques to correct the bryl. Among them, three main groups should be distinguished:

1.    surgical;

2.    hardware;

3.    minimally invasive techniques (injectable).

Surgical methods for correcting jowls include an endoscopic facelift. It consists in carrying out a suprapiosteal lift of the soft tissues of the face through small incisions in the scalp. The skin during this intervention is not truncated, so this type of surgical intervention is only suitable for the initial stage of the formation of jowls.

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Mid face lifting – a mid-face lift performed on patients who do not yet need a full face oval correction. At the same time, the ptotic tissues rise up from the under-ciliary access.

MACS facelift – a type of surgical intervention that is performed through access in front of the auricle.

MACS-lifting is the most effective, but at the same time, the most traumatic surgical technique for the correction of jowls.

With the help of MACS-lifting, it is also possible to work out the front surface of the neck. Due to the pronounced tension of the tissues in the middle third of the face, the jowls are tightened, the nasolabial folds are smoothed out.

SMAS-lifting (surgical) – the most common operation for the correction of jowls. The result of applying this technique is the most visible rejuvenating effect.

SMAS-lifting involves tightening and fixing the entire musculoaponeurotic complex. Access is made through incisions in front and behind the auricle.

There is also a Deep Plane Lifting technique – the facelift takes place at a deep level, under the musculoaponeurotic structures.

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What are the modern hardware methods for correcting jowls

Perhaps the most popular instrumental method of jowl correction is ultrasonic SMAS-lifting. This technology is based on the application of focused ultrasound with visualization for non-invasive lifting at the SMAS level.

The essence of the SMAS-lifting hardware technique can be described as follows: the active impact of ultrasonic collimated directed energy leads to the formation of thermal coagulation points in the skin and underlying structures (subcutaneous fat, muscles). This happens due to the heating of muscle tissue to 60-70 degrees (in the process of work - up to 100), which causes protein coagulation, strengthening of old and regeneration of new collagen fibers.

Regeneration of post-coagulative point lesions during SMAS-lifting entails the formation of new collagen fibers that create a structural "framework"; in tissues.

Thermage is a cosmetology hardware procedure aimed at skin rejuvenation, which is based on the effect on the body of radiofrequency waves that warm up the tissues. Local tissue heating during the Thermage procedure can reach 60°C. This achieves the effect of reducing the skin flap and, as a result, lifting.

RF lifting – due to heating to 60-65 degrees, the fibrils lose moisture, shrink and become unable to stretch, and collagen molecules fold into tight spirals. This results in a powerful lifting effect. A frame is formed inside the dermis, due to which the skin is stretched.

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What are the modern injection methods for the correction of jowls

In my practice, in order to tighten the breeze, I use dense fillers based on hyaluronic acid. In particular, recently for this kind of corrections, I use the Alexa Volume filler from

Institute Hyalual.

Of course, it is best for the patient to see an esthetician when the flare is just beginning to form.

There are two main areas of facial contouring:

1.    working with a medium third party;

2.    combined technique (middle third and contour of the lower jaw).

Depending on the individual client, I use either the cannula technique or the bolus technique. For example, if a more natural effect is needed, I use a cannula. If you need a more geometric effect, "Instagram"; - then I use the bolus technique (more often in the case of young patients).

If the bryl is at the initial stage of formation – correction of the middle third is enough to return a clear oval of the face. Just as the edges of the tablecloth would tighten up if we put a vase on it, for example.

If the restoration of the volume of the middle third of the face is not enough to return its oval shape, contouring of the lower third is added to correct the jowls.

I recommend doing this procedure as follows:

1.    Replenish the volume of the middle third of the face in the most familiar and effective ways for the doctor;

2.    Inject Alexa Volume filler from

Institute Hyalual along the contour of the lower jaw: above the jowl and under the jug (as a pillow, stiffening rib under the jig, see picture).

The procedure is best done using a cannula (25 G 50 mm). Good results are also obtained by bolus replacement of the lost volume under the puppet wrinkles, which can also be performed using the cannula technique. This volume will serve as an additional support and a stiffening rib for the fly.

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