Is removal of jowl fat during SMAS facelift standard procedure? (Photos)

Question

Surgeon mentioned at consultation he would "remove fat (subdermal?) in the jowls" before anchoring SMAS (imbrication, not plication). Is this standard procedure? Could it be aggressive and cause uneveness in jawline? In my research l have not heard of this being done. I am 62, thin (haven't lost any weight) and have mild jowling.

George Marosan, MD · Answer

Thank you for your question and photos. Facelifts are customized to the patient's anatomy. Liposuction in the jowl area above the jaw line can create problems with grooving and too much defatting. Yes, you can pull up and reposition this jowl area fullness, but it will not be long lasting unless your surgeon divides the mandibular ligaments (see the crease in the photo, just in front of the "jowl"). It always looks great in the operating room, but there will be early relapse if the ligaments are not released. See a board-certified plastic surgeon for an in-person consultation/evaluation. Good luck.

Stephen Prendiville, MD · Answer

Thank you for your question. During a facelift, the portion of the jowl that sits in the neck will be removed with liposuction.  The portion of jowl fat that sits in the face is elevated with the SMAS and re-positioned.  Liposuction in the face is fraught with contour issues.  Sometimes, a portion of the jowl is related to the buccal fat pad, which can be reduced in size. For the photos shown, I would not recommend fat removal in the face.

Zoran Potparic, MD · Answer

Correction of jowls is one of the most important part of facial contouring. It should be incorporated in face lift procedure regardless of the technique. In same cases when there is no other indication for face or neck lift, liposuction with a small cannula may be sufficient. I hope this helps. Good luck.

Randal Haworth, MD, FACS · Answer

It can be standard in some hands, but it is not mandatory in every SMAS facelift — and in a thin patient with mild jowling, it should be approached very conservatively.
What Your Surgeon Likely Means
The “jowl” area can include:
True fat fullness (localized fat that bulges)
Descended cheek fat (tissue that has fallen into the jowl zone)
Redundant skin/SMAS laxity (often the main issue)
Some surgeons will do selective defatting or contouring in the jowl area to help smooth the jawline before tightening/repositioning the SMAS. Done gently, it can refine the result.
Your Concern Is Valid (Especially Because You’re Thin)
In thinner patients, aggressive fat removal can:
Create a hollow or “scooped” jawline
Increase risk of irregularity/asymmetry
Look less natural over time as aging continues and volume loss progresses
So yes — it could be too aggressive if overdone.
What to Ask at Your Next Visit (Very Important)
To protect yourself, ask:
Are you removing fat, or repositioning descended tissue?
How much will you remove, and in what exact layer?
Do you ever avoid defatting in thin patients?
Can you show before/after photos of patients with my build and mild jowls?
Bottom Line
Selective jowl contouring can be part of a facelift plan, but in a 62-year-old, thin patient with mild jowling, the priority is usually repositioning and tightening, not subtracting volume. If your surgeon’s plan sounds “aggressive,” it’s reasonable to get a second opinion from a board-certified facelift specialist.
Good luck!

Darryl J. Blinski, MD · Answer

Sounds like this option is specific for that surgeon. Best yo address this with him/her. I do not recommend that option

Is removal of jowl fat during SMAS facelift standard procedure? (Photos)

Answers (5)

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