Can Jowls Come Back After a Lower Face/neck Lift?

Is it true that jowls can reappear just a few years after a lower face/neck lift?  What long term results can be expected?

Doctor Answers 64

How long it lasts depends on the cause of the jowls, sagging or fat bulging

This is a great question.  Of course, we know that facelifts don't last forever, and the face will continue to age over time.  But you bring up an excellent point, which is important for people considering facelifts to understand prior to having a face and/or necklift surgery.

Why do facelifts last longer on some people and shorter on other people?

If a regular layperson understood what exactly a facelift is for, they may be able to better predict how long the facelift will last independent of the plastic surgeon selling them the procedure.

What is a facelift good for?

A facelift procedure is best used for "sagging" or deflation of the face, which is causing "excess" skin to sag below the jawline and the cheeks to also sag down the face.  When the lower face and cheeks are lifted upwards, there is excess skin which is removed along the incision and the face looks cleaner and the jawline looks smoother.  Essentially the facelift "takes the slack out."

When does a facelift not work as well?

There are some people who appear to have squaring of the jawline and "jowls."  However, upon closer inspection, these people may actually have full fatty bulges, and/or loss of bone structure or a "pointy chin" which both can appear to create jowls on either side of the chin.

If a person has "fatty jowls" and a full face with very few wrinkles and minimal to no "sagging" to speak of, mainly because their face is full, then a lower facelift may not last more than a couple of years or less for these people.  Why?  When the facelift is performed, the skin is tightened and it can flatten out the jowls because the skin is tighter.  However, over time as the skin relaxes, the full fatty jowls will restretch out the skin and the jowls will reappear.  Weight loss prior to face lift surgery is very important for these people.  A minimum of 15-20 lbs of weight loss will begin to show some facial deflation and some sagging of the cheeks and jawline.  If the patient can reach their ideal weight and maintain it, then the facelift should last the 7 years plus or minus a couple of years, that we want our patients to have.  

Bottom line is that patient selection is important when choosing the best candidates for a facelift who will both have a natural result but also a long lasting one.  If the surgeon is looking to operate on as many patients as possible, then some patients who are not good candidates will inevitably get operated on, and their results will be suboptimal, even though the surgeon performed the exact same steps for a face lift on the nice result as they did on the sub-optimal result.

Patient selection is the key.


Dr. Yang

New York Facial Plastic Surgeon
5.0 out of 5 stars 28 reviews

Lower facelift is a no-man procedure

A necklift does great things for the neck and modestly improves the jowl.

A cheek lift or mid-face lift works on the cheeks and jowl.

The combination of the two is a facelift.

A lower facelift is the jowl without the cheek. The only problem is the jowl should be lifted vertically and that involves working with the cheek.

Robert M. Freund, MD
New York Plastic Surgeon
5.0 out of 5 stars 27 reviews

Treatment of jowls with a lower face or neck lift

If done properly, a lower face or neck lift can produce a long lasting result. A lower facelift will identify the tissue that has sagged in the jowls and resuspend it to strong and firm tissue. This will create a clean jawline and a recontouring of lower face. You should expect this result to last for a minimum of 5 to 10 years. As you continue to age, all tissue will begin to sag. In time this area will sag along with the rest of your tissues.

Pat Pazmino, MD
Miami Plastic Surgeon
4.5 out of 5 stars 77 reviews

Lower facelift is not a good solution for jowls.

A lower facelift by itself is not really a good solution for jowls.  The lower facelift deals with aesthetic issues below the angle of the jowls.  Although jowls descent below this angle, the originate above it.  Usually a full facelift is indicated to correct the neck, cheek, and jowls.

Vincent N. Zubowicz, MD
Atlanta Plastic Surgeon
5.0 out of 5 stars 25 reviews

Recurrence of jowls after lower neck lift is multifactoral

After a facelift the skin can stretch again as we continue to age. Recurrence of jowls after a facelift is multifactorial, that is it will depend on your quality of skin(lax skin will stretch more,) the technique used(how much dissection and SMAS worked was performed and who is doing the procedure.

Sharon Theresa McLaughlin MD
Long Island City Plastic Surgeon

How to minimize jowls

The facelift technique you have will directly influence how quickly the jowls come back. Stringlifts and Minilifts are the first to go. Deeper techniques with SMAS adjustments and aggressive platysmaplasties all help.

There is an inherent difference in the thickness of the jowl tissue vs. the tissue right in front of it. While this is minimized with the performance of deeper facelifting techniques, it is not eliminated. Volume restoration in front of this thicker area can help to minimize the appearance of jowls, in addition to pulling smartly.

Heavier patients with heavier jowls usually see them come back more quickly after even a skillfully performed facelift.

Patients who have large yo yo weight gains often literally undo their surgeries.

The balance of a well performed facelift is a delicate one. Most noted facelift surgeons will pull smartly, but never cause freakish distortion of the ears that results from the novice surgeon whose only goal is to defeat the jowls.

Brent Moelleken, MD
Beverly Hills Plastic Surgeon
5.0 out of 5 stars 127 reviews

Yes, the jowls can return

Regardless of what type of facelift you have had done, you will start aging the minute it is finished. This includes gravitational descent of the cheeks which causes jowling. If the first procedure really addresses this well, the result is going to be longer lasting. Other factors such as your skin elasticity and weight profile also affect the longevity of your result.

Even if you never do the surgery again, you should always look better than if you never had it done. Hopefully, if you do consider redoing it, you won't feel the need for 10 years but no guarantees can ever be made regarding this. Just be sure to go to an excellent Board Certified plastic surgeon and check out many results before deciding where to have your surgery done.

Longevity of lower facelift

This question is made difficult by the myriad factors that impact on the outcome of lower facelift surgery.  These include the quality of the tissues, the extent of the problem, facial shape, age at the time of surgery, the type of operation, and the fact that patients continue to age after the surgery.  As a rule of thumb,  the majority of patients are not symptomatic of their jowls for 7-10 years.

Glynn Bolitho, PhD, MD, FACS
San Diego Plastic Surgeon
5.0 out of 5 stars 13 reviews

Treating jowels requires understanding the cause

Yes, jowels can return. The key to preventing them is treating them correctly in the first place. I think surgeons often try to pull too hard during the facelift in an attempt to flatten or lift jowels. I think jowels are related to deflation, or loss of fat, both in the malar pad above them and pre-jowel area in front of them.

I have had good success treating them by performing fat grafting to the pre-jowel area to build it up. Often proper treatment of a descending malar (cheek) pad is needed and I like a mid-face lift for that. By adding these two procedures I have found reasonable results in improving jowels. Of course as the other surgeons have mentioned, aging continues on in spite of our best efforts to stop it. I hope this helps.

Ivan Wayne, MD
Oklahoma City Facial Plastic Surgeon
5.0 out of 5 stars 47 reviews

Jowls and Facelift

As others have noted, jowls can be a perplexing challenge in Facelift surgery. "Jowls" can be likened to a fibro-fatty hammock that hang over the jawline, attached by deeper ligaments. Adequate treatment of more severe jowls requires a combination of aggressive liposuction along the jawline (but below the face), along with elevation of the SMAS in a deeper plane with vertical suspension. Techniques that rely simply in folding the SMAS on itself (mini-lifts, etc) are less likely to be effective, and have less longevity.

Treatment of jowls requires some degree of artistry and judgment: the only thing worse than an under-corrected Facelift is an over-corrected, exaggerated result.

Stephen Prendiville, MD
Fort Myers Facial Plastic Surgeon
5.0 out of 5 stars 74 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.