Do they move outward or up next to the sides of the mouth and just hang? Would lifting that muscle cause the lower face to appear heavier?
Where Do Jowls Go when SMAS Muscle is Lifted and Tightened?
Doctor Answers 24
Depends on technique used
Jowls are composed of 3 main components:
1. Muscle / Fascia (SMAS)
3. Skin & it's attachements to the underlying tissues
There is also the pre-jowl sulcus (this is the crease that is present at the front of the jowls).
Depending on your anatomy, desired goals, desired degree of surgical invasiveness, time available for recovery, overall health, etc., your Surgeon should be able to offer you a technique that is best for you.
As a general overview here is what happens to the jowls during surgery with different techniques:
1. Deep Plane / Composite Facelift : in this procedure certain portions of the tissues are actually lifted up off the underlying bone and elevated as a unit. In addition dissection may go into the deeper layers of the jowl itself in order to remove fat, elevate the jowl or soften the pre-jowl sulcus.
2. SMAS Plication : in this technique the SMAS is actually folded up onto itself and sutured together (much like sewing a cuff on to the bottom of a pant leg). The jowl may be pulled in a superior direction, posterior direction or both.
3. SMASectomy : in this technique a portion of the SMAS is actually removed and the cut ends are sewn together. In most cases the direction of jowl elevation is posterior/superior - this allows for some softening of the nasolabial fold (cheek wrinkle).
4. Cranial Suspension : in this technique the jowls are pulled in a vertical direction, essentially straight up. I personally prefer this technique for most cases since it allows for nice volume restoration of the mid face ie. it helps create a "heart shaped" face.
As Dr. Mayer mentioned, a facelift should not add tissues to the lower third of the face but instead elevate / suspend them higher up in a position that is natural looking and more in line with where they once before before the aging process and genetics started to influence your facial appearance.
The Jowls are Elevated
The jowls disappear!
The jowls are composed of skin, fatty tissue and muscle. Typically in a facelift, some fat is removed, and as the muscular layer and skin are pulled up, back and tightened, the jowls flatten. Some of the tissue (fat) is removed, while some is tucked flat against the underside of the chin and the rest up. This allows for better definition of the jawline but does not add bulk to the lower face. In contrast, the lower face becomes more defined and youthful.
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SMAS Facelift Elevates Jowl Fat to Cheeks and Cheekbones
Jowls and Facelifts
Jowls are deposits of fat, muscle, and skin which descend below the jawline with age. Appropriate treatment of jowls depends on the anatomy of the patient. Typically, jowls are contoured and repositioned creating an improved jawline and facial appearance.
Jowls are generally made up of fat and lax skin. During a facelift, I sculpt out the fat in the jowl area so that the fullness is diminished to the proper degree. I then re-drape the connective tissue known as the SMAS to flatten and smooth the remainder of the jawline. The skin is then re-postioned in a backward direction, never upward, so that a natural, non-stretched appearance is obtained.
Vertical SMAS Lift is best!
In my mind, the jowl is soft tissue that used to be part of the cheek and the hollow underneath the cheek. Many SMAS lifts pull this tissue to the side (toward the ear). I call this the Nike Swoop look. Try pulling your jowls to the side and look in the mirror. Not Good!
But, if you smile and place your fingers at the top of the cheek to hold the tissue in place. Voila! The jowls are gone, you look smooth and natural. Hence the Vertical Lift!
The SMAS gets pulled into the face to where it was originally
Jowling is essentially tissue that has descended from the face to sit beyond the lower border of the jawline. When you do a SMAS facelift, this tissue is pulled up over the jaw and into the area where it used to be. Your face won't necessarily be fatter, it will have more of the youthful volume it use to have when you were young. Adding tissue into the buccal lower face area tends to make you look younger in fact.
This area can tolerate a lot of tissue without making you look fatter in the face. Facelifts tend to turn your face from the square look into the more v-shaped and youthful appearance.
It depends on what you are calling jowls.
Normally, surgeons call jowls the fatty masses on the lower jaw and below it. These are repositioned in the cheek where they used to be.
Having said that, your fat is higher than that and may only require liposuction at the time of facelifting.
Tightening the muscle will not cause the lower face to look heavier; it should do just the opposite if done properly.
Lifting the SMAS
James P. Bonaparte, MD, MSc, FRCSC
Head and Neck Surgery
practicing in Facial Plastic and Reconstructive Surgery
Assistant Professor, University of Ottawa
Ottawa, Ontario, Canada
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.