Where Do Jowls Go when SMAS Muscle is Lifted and Tightened?
- Asked by hellofromteresa in Sacramento, CA
- 4 years ago
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?
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.
SMAS Facelift Elevates Jowl Fat to Cheeks and Cheekbones
The SMAS Facelift uses the deep tissues to move facial fat to its original youthful positions providing volume and highlights to the face. When properly performed by a very experienced facelift surgeon, the SMAS is used to carry jowl fat superiorly to the midface and cheekbones recreating the "heart" shaped youthful configuration that you had when you were younger, as evidenced in your old photographs. This recreates the high voluptuous contours of youth. It is best to let your Board-Certified Plastic Surgeon illustrate this to you by reviewing multiple before and after photographs. This tightening and elevation is also what creates the defined jawline after a beautifully performed SMAS Facelift.
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.
Web reference: http://www.shahfacialplastics.com/facelift.html
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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.
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.
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.
What are Jowls? and What Happens to them After a Facelift?
Due to anatomical attachments under the skin, the effect of gravity over many years produces a downward and forward migration of skin, fat and muscles of the face. The muscle that is sagging in the jowl area is called the "platysma" muscle. This muscle is actually enveloped by and therefore an integral part of the SMAS. So when the SMAS is repositioned, the platysma moves with it -- and the idea is to reposition it back where it used to be years earlier, which is in an upward and backward location. This repositioning does not make the lower face appear heavier. It actually does the opposite. It turns a rectangular, heavier-looking lower face into a more oval-shaped and narrower lower face.
If someone's lower face is looking heavier after their cosmetic procedures, it's invariably due to excessive use of fillers along the jawline.
Jowls Are Repositioned Back to their Youthful Location
The jowls are a combination of skin, fat, and muscle that forms as these tissues descend down along the jaw line over time. Most facelift techniques are focused on repositioning these tissues back to their original location. The SMAS is a layer of muscle and fat beneath the skin that is essential to correcting jowling. The SMAS is typically tightened and "lifted" into higher position so that it no longer sags down, creating the jowl. Without getting too technical, this can be accomplished using a variety of techniques (hence the wide variety of facelift types). Any excess skin will also be removed (with the incisions hidden around the ear). The end result is that the lower face will be less heavy and more youthful.
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.