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 67

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

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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
4.8 out of 5 stars 34 reviews

Lower facelift is a no-man procedure

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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.

Return of the jowls

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Jowls can certainly return after a facelift.  The key is to perform the correct procedure.  Too many women have had Lifestyle Lifts which do not last or mini-lifts when a full facelift is required.  I personally will not perform the "wrong" operation if that will not produce a lasting result.  Lifestyle Lifts may not last more than six months.  The SMAS is appropriate in patients with jowls.  The trend toward minimally invasive procedures is a double-edged sword as some such operations may also produce minimal results.

Yes, the jowls can return

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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.

Treatment of jowls with a lower face or neck lift

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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.

Jowls and Facelift

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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.

Recurrence of jowls after lower neck lift is multifactoral

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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

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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
4.9 out of 5 stars 188 reviews

Recurrence of Jowls After a Lower Face Lift or Neck Lift.

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If you have a neck lift or lower facelift to correct you neck, jawline and jowls, the results will last a life time.  In other words, if we roll the clock back on your neck with a neck lift 10 years, you will always look 10 years younger.  The problem is that we cannot stop the aging process and the sagging will, at some point start to show up but your neck will always look better than if you did not have anything done.  If course, some maintenance, with good sunscreen, proper skin care and the fountain of youth; a good diet and routine exercise will help slow that aging process down.

Some surgeons would answer that it will be, on average, 10 years before your concerns like jowl need another lift if you want to keep the same look.

I hope that helps and if it does please give it and up vote at the top right by "report".  Thanks.

Best regards.

How does #DrMarcDuPere #Toronto plastic surgeon better adresses Jowls with a lower facelift?

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Thank you for your question Eva; it is an excellent one and will help many Realself customers with a little bit of clarification and education on the lower facelift technique.   

I am a 13-year experienced Toronto plastic surgeon and I trained with Drs Daniel Marchac and Gilbert Aiache in Paris, France and with Dr. Bruce Connell in Los Angeles. 

They are numerous techniques for #facelift and #necklift depending on your anatomy, your expectations and the surgeon's preferences; skin only versus muscle and skin - SMAS facelift - superficial versus deep planes, with or without fat grafting, short scar, MACS and traditional facelift, etc. 

The face refers to forehead, mid-face and neck, although most refer to a #facelift proper as adressing the mid-face and neck without the forehead.  Classic facelift addresses cheeks folds, jowls and neck bands and is done by lifting not only the skin but also the deeper muscle layers SMAS (see my blog for more details).  When I meet my patients in #Toronto and #Richmond Hill, I go over the pros and cons for those facelift and necklift techniques in details so you have a clear understanding.

A neck lift adresses the fat under the chin and the hanging muscle bands (aka chicken or turkey neck) with very minimal effect on the jowls.  That may explain why your friend has an early recurrence of the jowlings.

Now a lower facelift, in my hands, is a comprehensive necklift with an extended skin incision in front of the ear and a small SMAS lift; this will adress relatively well the jowls without the full facelift.  I call is also an extended neck lift. 

Yet, nothing will address better the jowls than the classic facelift, neckllift and SMAS dissection and vertical and posterior lift; this adds tremendously to the longevity of the results.  Fat grafting is highly beneficial for its #stemcell effect.

Keep in mind that no matter the procedure, aging is not stopped by a facial procedure...  Gravity, sun exposure, genetics and aging do go on...

I do discuss the SMAS and facelift technique on my blog: 

I hope this helps and it would be our pleasure to meet you at Visage Clinic in Toronto and Richmond Hill.


Best regards,


Dr. Marc DuPere, Toronto plastic surgeon

Voted TOP plastic surgery Clinic in Toronto for 2013 and 2014

Voted TOP Cosmetic Clinic in Toronto for 2014

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.