Sagging Jowls - Is a Mid-Face Lift Needed with Lower Lift?

I am 54, but look slightly younger. I don't mind the normal aging around my eyes, etc. but my sagging jowls bother me. My Plastic Surgeon says he would not recommend having a lower face lift without at least also doing a mid-face lift, as well as a brow lift. Now he has agreed he would feel comfortable doing the lift without a brow lift, but says he would definitely recommend a mid-face lift with the lower face lift. Is it really necessary to also have a mid face lift with a lower face lift?

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Is a midfacelift a necessary companion to lower facelift?

 If you have a localized laxity of the jawline (jowls, neck bands) and your midfacial area is not deflated or descended, then a necklift alone is ok. If you do have some aging of the midface though, it is hard to complete a neck lift in a region that would benefit from lifting and tightening. The transition zone would better blend with the midface lift added - but only if you need it. Browlift may lead to a nice result, but does not impact the result of a necklift at all. It is hard to answer this question without photos.

Baltimore Plastic Surgeon
5.0 out of 5 stars 28 reviews

At 54 do a standart facelift.

Generally at 54, a  standard facelift which takes care of cheek, midface, N-L folds, jowls, and neck makes better sense. It is not that much additional work and cost so why do it half way and then have to come back.   The best avenue for you is a roitine lower 2/3 facelift.   The brow is less important.  Good luck.


Zsa Zsa-there is no one size fits all when it comes to face lifting. If it does not make sense to you, you may need another opinion. 


Dr Siegel

Michel Siegel, MD
Houston Facial Plastic Surgeon
4.5 out of 5 stars 95 reviews

Facelift Techniques: Harmonious Facial Rejuvenation

Approaching facial aging with surgery should be an individual decision that is directed by you the patient. There should not be any stipulations, however if your problem area is jowling within the lower face then an experienced facelift surgeon should be able to correct this with a lower facelift. A mid facelift is more for cheek and lower eyelid aging. I would agree that facial rejuvenation should be approached ideally with correction of the face, cheek, eyelids and brow, rather than pieced together, because you want to set the clock back all at once...but if you do not want that, then maybe you should seek a second opinion.

Andrew P. Trussler, MD
Austin Plastic Surgeon
5.0 out of 5 stars 17 reviews

Combination or Lower Facelift Candidate

If your laxity is localized to the jawline, then you are more likely to be a candidate for a lower facelift. Consult with 3 experienced and expert board certified plastic surgeons to understand your options.

Kris M. Reddy, MD, FACS
West Palm Beach Plastic Surgeon
4.5 out of 5 stars 21 reviews

It all all depends on what YOUR goals are and not the Surgeons

As a surgeon our job during a consultation is to listen to your needs, examine your anatomy and come up a with a surgical plan to address all of your concerns. Naturally we will see all areas that need rejuvenation and we will advise you about all of them. It is never our job to tell you that you have to have a certain procedure. It is your face and you will have to live with the outcome (even "more younger" looking or not).

The formula of doing several procedures at once is slowly fading away as we strive to give more natural results for our patients. So staying conservative and even staging procedures out so one can see how the first one looks is a wise way to go.

There are certainly times however where not doing an additional procedure will compromise the results of another procedure and therefore we will strongly advise a patient to consider both if we feel it will truly lead to a better outcome.

Keep talking with your doctor and have them explain their rational for each procedure to you - it will be a very helpful thing to do.

Kamran Jafri, MD
New York Facial Plastic Surgeon
5.0 out of 5 stars 8 reviews

Lower facelift for saggy jowls

It really depends on what your ultimate goal of the procedure is. Jowls are typically treated with lower facelift. Midface lift typically repositions sagging cheek tissue.

Babak Azizzadeh, MD
Beverly Hills Facial Plastic Surgeon
5.0 out of 5 stars 4 reviews

Facelift Surgery at 54

It's is difficult to assess you without seeing some photos and clinical background.

As you clearly describe, I have no doubt that there are sagging jowls in your lower face. However, attending to your age (54) and  to the presence of jowls, I believe that it's important to assess if there are more signs of aging in your face and neck (midfacial sagging, naso-labial folds, marionette lines, neck saggging... ).

I believe that with all these symptoms together, the best  choice would be a facelift of the lower 2 / 3 of the face, most likely with a cervical lifting.

Both economically and personally, you must go through a very similar process (if we compare it to performing only a surgical lift of the lower third).

Enrique Etxeberria, MD
Spain Plastic Surgeon
5.0 out of 5 stars 7 reviews

Facelift Options

For simplicity, I also divide the face into midface, lower and upper face when talking with patients.  For jowls alone the lower facelift or standard facelift is the best.  That being said, there are times where a midface lift is very helpful in obtaining good facelift results.  This is especially true in a larger or rounder face.  Your surgeon is the one evaluating your face, however.  Consider their opinion and obtain a second opinion if that is what is needed for you to be certain of your decision.  Good luck!

Hannah Vargas, MD
Kansas City Facial Plastic Surgeon
5.0 out of 5 stars 23 reviews

These answers are for educational purposes and should not be relied upon as a substitute for medical advice you may receive from your physician. If you have a medical emergency, please call 911. These answers do not constitute or initiate a patient/doctor relationship.