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lift and peel FacialSurgery.com
Steven M. Denenberg, M.D.
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face lift and chemical peel
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This woman had a face lift operation and a chemical peel of the skin around her mouth.  But she also had another procedure, called a pre-jowl implant.  The jowl makes a bulge in the jaw line, and there usually appears to be a dent just in front of the jowl.  The face lift pulls the jowl's excess skin up and back toward the ear to smooth the jaw line, but the smoothing can be more effective if we put something underneath the skin to push out that dent at the same time.

That something is called a pre-jowl implant, and as the name suggests, it fills out the depression in front of the jowl.  The implant looks very much like a chin implant, but it is shaped so that it doesn't make the chin stronger from the profile view.  The face lift surgery tutorial contains a chapter devoted to the topic of pre-jowl implants (the surgery tutorials contain explicit photographs taken during surgery).

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All views of this lift and peel patient:
face lift and chemical peel
lift and peel
current: Right oblique
face lift and chemical peel

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Next: an example of the solid advice Dr. Denenberg gives patients on RealSelf.com.
Get that advice for your own situation by emailing your photos to Dr. Denenberg.

Questioner: Will a Septo-rhinoplasty Improve my Smile As Well?
I have always had a complex about my nose and wanted to get a rhinoplasty, I think I am financially and emotionally ready to start the process. Besides the obvious reasons of my dorsal hump and bulbous tip I also have a deviated septum which gives me breathing and congestion problems. I would like to know if this procedure would also affect my smile? As you can see my teeth barely show. If not, is there a procedure that the doctor can do in addition? Thank you!
(Questioner submitted photos)

Dr. Denenberg's answer: Not so sure working on your smile is a good idea
Hi. You do look like a good candidate for a rhinoplasty. You've got that hump, and the tip is wide, as you said. Also, from the profile view, a lot of the inside of your nose shows, and we would want to reduce the amount visible from the side. See my "Web reference" link for a morph showing potential changes to your nose, and an animation of the morph. I didn't make a frontal morph because your photos are sooo very tiny, but they do show the width of the tip of your nose. Be aware that work on the tip of the nose is difficult, and not every plastic surgeon has the skill to accomplish it with expertise. Be sure to see before and after photos of the doctor you choose. Seeing how he made changes for someone else is your only way to determine whether he has the skill to accomplish the changes you want for yourself.

Concerning your smile, I don't think working on your nose would change your smile in a meaningful way. Again, the photos are too small to have a good evaluation of your upper lip skin and how it attaches to your nose, and how things change with a smile, but in general, the smile is controlled by strong muscles, and the static position of the nose doesn't have much of an effect on it.

There *are* operations that claim to allow more of the upper teeth to show in a smile -- the "lip lift" operation comes to mind, but it seems to me that an operation like that would just be "something to try" rather than a solid, predictable solution, and you might be much better off leaving it alone. You don't want to be left with visible scars on you lip and no improvement in the feature you were concerned about.

Link to this question on RealSelf.com