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

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.

Best,

Dr. Yang

Most SMAS (deep plane muscle tightening) facelifts give a result in terms of turning back the clock by 10 years or more. However, having the surgery does not stop the ageing process, so you will develop more skin laxity over the jawline as you continue to age.
There are a number of skin-tightening lasers such as Thermage, SkinTyte and Ultraformer III that improve skin laxity with minimal or no down-time, and these can be used to slow down the ageing process, and delay the need for further surgery. These however need to be continued for ongoing improvement.

Than you for your question.  If the surgeons only  perform a face lift  without SMAS the possibility of having a temporary result is higher.  If the SMAS is lifted and the fat is lifted with it the results are more permanent.

Some lifting procedures seem to last longer when associated with other helpful procedures that change the actual shape of the face and neck, like liposuction. Another biggie is chin augmentation really helps the jawline and eliminate jowls if the chin is weak. Associated laser resurfacing adds the appearance of perfect skin.
An isolated lift will relax 20% in the first few months. The fact is that skin stretches, if it didn't I would have exploded several times with my weight. There are variances in skin quality like after childbirth. An average is 8 to 12 years. The first place to show loose skin again will be under the chin, that's where it collects first in your 40's.
hope this helps,


J. Smythe Rich, MD
Facial Plastic Surgery
Columbia, SC

The moment you complete your facelift, you begin starting to fight gravity again.  So sometimes a recurrence of your jowls can happen. However with proper techniques we can keep the jowls from falling down for very long time. I do an extended sub-SMAS elevation that allows me to lift up the entire muscle layer and secure it in a position so that it does not drop. Proper technique and suturing can make a difference in how long the lift will stay up. No two people are the same and everyone heals differently, but deep lift techniques and proper suturing will give you the best bet at a long lasting lift.

There are various types of facelift procedures that can be helpful to different age groups. A mini-facelift working on SMAS and minimal scar can help a young patient with lower face sagging (early jowls). An older patient with sagging of the brows, midface and neck would require a full face and necklift. Jowls are sagging of the facial skin and underlying tissue over ligaments attaching the skin to the bones. They can never be corrected by just filling the face with fillers. A proper facelift procedure involving pulling the SMAS should be performed for best and lasting results. I personally in many among other techniques use the composite facelift technique in cases with predominant jowls, where a SMAS flap is elevated with minimal skin dissection, a very quick recovery and very long lasting result.
If the SMAS is elevated and tightened properly, jowls should literally be corrected permanently. This does not mean you will never get jowls again, but will definitely be the best approach to correct the jowls in a lasting and natural young looking manner. Nevertheless, a facelift procedure if performed correctly can be repeated in years to keep the skin tight and elevated. 
Hope this helps,
Ali Rıza Öreroğlu, MD FEBOPRASEuropean and Turkish Board Certified Aesthetic, Plastic and Reconstructive SurgeonIstanbul, Turkey