Hi, I have performed facelifts for over 30 years and have performed many minimally, invasive SMAS facelifts. From the photos the weight loss has reduced the mid face and lower face fat resulting in concave portions of the mid face, excess sagging skin, jowls and weak mandibular angles. These combine to create a very thin, elongated, rectangularly-shaped face. Following my beauty principles, men look chiseled and handsome with angularity in the cheeks, chin and mandibular angles. The hollows in the mid and lower face can be filled in with Sculptra. "Jowls” are sagging facial tissues and the main indication for some form of a SMAS facelift. The underlying SMAS layer, of the face, must be dissected, lifted, trimmed and re-sutured (not merely folded or suspended with threads or sutures that will not last). The excess skin is then removed and the facelift incisions closed. My most popular SMAS facelift is the minimally invasive, short incision SMAS facelift that has all the benefits of more invasive facelifts (traditional, mid-face, deep plane, cheek lift and subperiosteal facelifts) but with these added benefits: very small incisions and no incisions extend or are placed within the hair. minimal tissue dissection = less bruising and swelling = rapid recovery ( several days instead of weeks or months with the more invasive type facelifts mentioned) can be performed in 90 minutes or less, with or without general anesthesia proper SMAS Imbrication technique no incisions within the hair = no hair loss excess fat can be removed from the face and neck excess skin removed from the face and neck cheeks, chin and jaw line can be augmented with dermal fillers (I prefer Restylane Lyft) or facial implants most patients fly back home to parts all over the world in as little as 3 days post-op I combine facial shaping with every facelift procedure. When jowls are present, these should be done in concert and not alone or separately in order to create a naturally, more attractive face. Hope this helps.