Hi, I have performed many SMAS facelifts for over 30 years and have performed many minimally, invasive SMAS facelifts. From the photos your cheeks are concave in the front, there are signs of "malar bags" on the cheeks, jowls are present and the chin is very weak. These factors combine to create a, long, thin, rectangular-shaped face. The reality is, there are many different ways to perform a facelift from incision length, incision placement, level of tissue dissection (skin only, SMAS, Deep Plane, Subperiosteal), different degrees of tissue undermining, how to lift and support (imbrication versus plication of the SMAS layer), how much excess skin to trim, is excess fat going to be reduced and finally will the overall shape of the face be made more feminine or masculine (while avoiding the over pulled, windswept appearance). Price is determined by the reputation, location and experience of the Facelift Surgeon. In my humble opinion however, there are some basic requirements that must be met in order for a facelift to be "effective", yielding "aesthetic pleasing" and "naturally attractive" results. These include: 1. Some type of incision either curved around the front (preferred) or straight in front of the ear. This is how excess skin is removed which is not possible with an incision behind the ear alone. If you have so little excess skin on the face that "none" needs to be removed you are not a candidate for a facelift in the first place. 2. The facelift must address correction and softening of the "jowls" using a long lasting and effective technique. If you have "jowls” these 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. 3. Facial shaping must be combined to properly shape the cheeks, chin, jaw line and lips for feminizing or masculinizing the face as the case may be. In my experience when evaluating the face, it's key to determine the following: Are the cheeks, chin and lips the ideal aesthetic shape? Are "jowls" present and is there excess fat and skin in the face and neck. Once these factors are determined, the proper aesthetic plan can be determined to make the face balanced, (for women) feminine and more naturally youthful and beautiful (while for men creating a more chiseled, angular and handsome face). Nasolabial folds are caused by two factors: 1. When there is an excess amount of mid face fat, gravity pulls the fat layer towards the nose and mouth with aging to create nasolabial folds and jowls. 2. Another significant contributing factor is the presence or absence of sufficient cheek bone volume in the front of the cheeks and face to support the cheek tissues. When the front portion of the cheeks are flat or concave, this lack of bony support allows the cheek tissues to sag off of the cheeks towards the nose and mouth creating nasolabial folds and jowls. Often both factors are at play when significant nasolabial folds are present in the face. Following my beauty principles, women look the most feminine, youthful and attractive with heart shaped faces. Heart shaped faces have cheeks that are full and round in the front. When the cheeks are concave or flat in the front, cheek augmentation with a dermal filler or using silastic cheek implants for a permanent enhancement will create full, round cheeks that will feminize the entire face. The dermal filler can also be used to soften the edges of the malar bags as there is "no" treatment to remove them. When the chin is weak, this creates an imbalance making the nose appear larger, the mid face top heavy and the lower face look short that de-emphasizes the lips and allows early formation of a double chin. Chin augmentation using a chin implant will add projection to the chin creating harmony and balance to the lower face. I have found placement of a silastic chin implant, through a small curved incision under the chin (also allows excess skin removal) to be very safe, quick and highly effective. "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.