Facelift For Sagging Jowls
There are a number of different ways to address jowling with aging. As we age, the soft tissue and skin of the lower face begin to descend. The mandible also reabsorbs causing an indentation of bone in the area that jowls form.
Fillers are temporary treatments which can work for early and milder jowling. Hyaluronic acids such as Juvederm and Restylane are a good option. More invasive options are surgical. A lower face lift is the best and most long-lasting treatment for jowling.
Done well by a skillful surgeon, a facelift can last up to 10 years. Because of the bone contour, sometimes a pre-jowl chin implant is also recommended in conjunction with a facelift to completely eliminate the appearance of the jowl. (Vito C. Quatela, MD, Rochester Facial Plastic Surgeon)
This crease results from a ligament that tethers the skin to the underlying jaw bone. As the tissues around this tether point descend, the crease becomes more noticeable. The best way to treat the descended tissues is to re-elevate them.
The superficial muscular aponeurotic system (SMAS) is a deep connective tissue layer that forms a continuous sheath within the face and neck. A facelift that lifts the underlying SMAS will re-elevate descended facial tissues and improve the appearance of the cheek-bone area (malar area) and jowls.
The SMAS elevation is performed separately from the elevation of the skin. After the SMAS is lifted, excess skin is removed.
In a patient with good skin quality this facelift should last 7-10 years. Additional procedures can be performed at the time of a facelift. Fat grafting can restore lost volume to the cheek-bone area, and can fill deeper creases around the mouth and nose (nasolabial fold).
Lasers and dermabrasion can be used around the mouth, and throughout the face, to treat wrinkles that are not addressed with the SMAS facelift. (Austin Hayes, MD, Portland Plastic Surgeon)
Facelift Results for Jowl Improvement
A facelift procedure in conjunction with dermal fillers would be the best approach to correcting jowls. The results of a facelift will restore lost volume in the face, lift sagging facial tissues and remove excess skin and tissue from the face resulting in a more youthful, rejuvenated appearance.
How to treat jowls
In my opinion the only effective way to treat the jowls is some type of surgery. Jowling is caused by fat deposits on the corners of the mouth and a long the jaw line, and as we age this area tends to drop more than other areas of the face.
Things like fillers and lasers do not tighten and lift this area appropriately. Surgery might involve liposuction, if the jowls are limited and only involve fat. However in many instances there is sagging skin, and some type of lower facelift or full facelift might be needed.
This would involve lifting the skin and redraping the deeper elements to provide a lasting effect. While it does involve surgery, the results are usually satisfying. (Kailash Narasimhan, MD, Sherman Plastic Surgeon)
There are several reasons the jowls appear, but they can be corrected with a facelift. You would do well with a short scar SMAS face lift or a MACS lift with neck lipo which would help in defining the jaw line.
A combination of these procedures would make significant difference. Fillers usually offer temporary solutions and act as a camouflage over a specific / limited period of time. They do not address the real problem. (Sameer Karkhanis, MS, DNB, India Plastic Surgeon)
The key components to getting a long lasting lift are a dissection deep to the “muscle” (SMAS) which frees up the major ligaments so the tissue can be moved vertically.
Aging in the facial skin is basically about gravity working over time on a thinner, less elastic skin. Gravity is pulling the tissues down and they need to be re positioned “up”. Most of our patients are very satisfied for 10-12 years- and then are still much improved from preoperatively. (Wayne F. Larrabee, MD, Seattle Facial Plastic Surgeon)
Facelift that addresses both skin and SMAS, and fat grafting to fill the volume loss around the mouth
The best way would be a facelift procedure that lifts BOTH skin and underlying muscle-fascia layer. There are multiple modifications to address the individual component. Fat grafting to fill the volume loss around the mouth has potential to be permanent.
Every surgeon tends to favor one way or another based on past experiences. (Johnny Mao, MD, FACS, Orange Facial Plastic Surgeon)
Both jowls and droopy skin can be effectively lifted and slimmed with a facelift including a cheekpad resuspension and SMAS plication.
Procedure to eliminate or improve the jowls.
A face-neck lift is the only procedure to significantly rejuvenate the jawline and reduce jowling
For best improvement in the jawline a lower face and necklift, neck liposuction and facial fat grafting are recommended. This will tighten the muscles in the neck and add volume you’ve lost as a part of your aging process.
When it comes to jowls, there is no substitute for a facelift.
The treatment for jowls is lifting them using an effective facelift procedure that elevates the deep “SMAS” layer. “Minilifts” or any lesser substitute is likely to be ineffective and a waste of time and money.
Fillers are limited to improving the nasolabial and labiomandibular (smile and marionette) creases but do not provide lift. The fat pad under chin is treated at the same time using liposuction and tightening of the neck muscle.
The technique works to highlight jawline. You don’t need to look drawn tight (this is usually the patient’s biggest worry). There are different types of facelifts and you need to select an experienced surgeon that you trust.
It is a good idea to look at before and after photos too. (Eric Swanson, MD, Kansas City Plastic Surgeon)
Fillers may temporarily camouflage a marionette line if its not too prominent. s there is aging seen where a lower face and neck lift would be the ideal procedure in my opinion. (Raymond E. Lee, MD, Orange County Facial Plastic Surgeon)
Surgery to correct jowling
Correction of jowling is one of the principle reasons for facelift surgery. A well designed and executed facelift will correct the entire jawline including the jowls as well as the neck. I personally think that fillers should rarely be used to correct jowling.
This is because the jowling is not caused by volume loss in front of the bulge. Therefore attempts to add volume to this area usually just end up making the lower face appear puffier and sometimes square.
See a facelift specialist who can evaluate your anatomy and work collaboratively with you to come up with a comprehensive rejuvenation plan. (Sirius K. Yoo, MD, San Diego Facial Plastic Surgeon)
I have found the best approach to be a combination of lifting the areas where the tissue has sacked but also feeling well volume has been lost. A well performed face and neck left reshapes the tissue, rather than tightenting the skin and fat grafting techniques are now able to very accurately and elegantly replace lost volume. (James Murphy, FRCS(Plast), Manchester Plastic Surgeon)
This would involve tightening the deep muscle (SMAS) of the face both for better correction and well as a more long lasting result. Full skin redraping with excess skin removal completes the procedure. Another part of correction is treating the corner of mouth and marionette folds.
This could be done with an injectable filler (in the office even) or with fat injections. Either could be done as a stand alone treatment or as further enhancement to the facelift procedure. The first step is meeting with a board certified facial plastic surgeon for a complete examination and to discuss your options. (Mark Hamilton, MD, Indianapolis Facial Plastic Surgeon)
Facial shape restoration is most effectively achieved with a facelift and fat transfer with your own fat to the face. A deep plane facelift with manipulating the SMAS layer will re-suspend the soft tissues of the face which in effect improves the jowls you are concerned of.
The fat transfer you may think would detract from your aesthetic result, but in actuality, it can really make a big difference in softening the folds and regions where fat loss has occurred due to aging. (Joel B. Beck, MD, FACS, Bay Area Plastic Surgeon)
Fillers not the same as FaceLift.
Fillers no matter what anyone says are not anti-gravity procedures as a facelift is. So, using a small amount of Restylane to try to ‘lift’ a jowl just won’t work. What has to be done is a suspension of the deeper tissues of the face and perhaps a contouring of the soft tissue around the jaw line. (George T. Boris, MD, FRCS, Los Angeles Facial Plastic Surgeon)
We have found that just lifting the face without the placement of a prejowl augmentation will not completely correct the problem. Fillers can be used to assist, but the implants are permanent. Always get a consultation and be evaluated by a qualified facial plastic/ plastic surgeon. (James Shire, MD, Chattanooga Facial Plastic Surgeon)
The best fix for jowls is a facelift
While filler can be used to enhance the facial contours and can slightly improve the appearance of the jowls, only a facelift can truly repair the issue. During a facelift, a surgeon removes excess skin and tightens the underlying tissue that causes the formation of a jowl.
This procedure enhances the contour of the jawline and can greatly improve one’s appearance. I recommend you visit with a Board Certified Plastic Surgeon to discuss your options and to see if a facelift could be a good option for your needs. (David P. Rapaport, MD, FACS, Manhattan Plastic Surgeon)
As we age, several things happen. We lose fatty volume in our mid-face and we seem to gain volume in the lower face changing our facial shape from a youthful “V” to an older square.
Long-lasting treatment dictates that we re-shape the face to achieve this youthful appearance. To accomplish this facial rejuvenation a surgical approach is required. By lifting the skin (incisions around the ears) to get access to the underlying fat and muscle layer of the cheeks and neck (SMAS), the muscle layer is re-positioned and tightened and the fat is trimmed and/or re-positioned.
Often, fat grafting is used to re-fill the deflated areas of fat loss in the deep spaces of the mid-face. After the underlying “foundation” is restored, the skin is re-draped for a natural, non-operated, youthful look.
By lifting and re-positioning and not pulling with tension, a long lasting result can be achieved. Remember, we don’t stop the aging clock, we just turn it back. (Kevin L. Smith, MD, FACS, Charlotte Plastic Surgeon)