What do you recommend to help my eyes, neck and jowl? (photos)

Should I get both my top and lower lid lifted? Do you recommend a neck lift, would that also pull my jowls back? can this all be done in one surgery? Please help, I want the biggest bang for my buck. I live in Honolulu so I would even consider the west coast or Vegas for these surgeries to reduce the expense.

Doctor Answers 11

Help my eyes, neck and jowl?

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 Hi, I have performed facelifts for over 30 years and have performed many minimally, invasive type facelifts on women in their late twenties and early thirties.  From the photos your cheeks are flat anteriorly (in the front), there is excess fat below and around the cheeks, there is evidence of lower eyelid fat pockets, jowls are present, the chin is weak with excess skin in the neck.  These factors combine to create a rectangular shaped face. 

 Following the beauty principles outlined in my book on face and body beauty, 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.  Cheek augmentation with a dermal filler or using cheek implants for a permanent enhancement will create full, round cheeks that will feminize the entire face.

 A weak chin 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 that 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 an 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 facelift is the minimally invasive, short incision 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
  • no incisions within the hair = no hair loss
  • excess fat can be removed
  • excess skin removed
  • 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.  This can be combined with a lower Blepharoplasty.

Hope this helps.

Neck Lift

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Thank you for your question. I suggest that you move forward by consulting with a board certified facial plastic surgeon. The two main recommendations would be the necklift surgery to tighten your skin or Kybella, an injectable, to remove excess fat. The difference between the procedures may depend on your preference for cost, recovery time, invasiveness and level of permanence.

Best wishes,

Ross A. Clevens, MD
Melbourne Facial Plastic Surgeon
4.7 out of 5 stars 123 reviews

Facial aging and facial rejuvenation

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All great questions.  First we must understand that aging occurs in a variety of ways including loss of skin elasticity as well as loss of soft-tissue volume.  Second, we must also appreciate that everyone has their own particular ideas of what facial rejuvenation is.  These two issues together must be taken into account when deciding what facial rejuvenation procedures would be ideal.  My thoughts are that a face lift neck lift would be beneficial to rejuvenate essentially everything below your lower eyelids.  Fat transfer to the face will also be beneficial to help rejuvenate the volume loss and smooth out irregularities of contour.  I think lower eyelid surgery is most often needed when a face lift is done as extra skin is recruited into the lower eyelid-cheek junction.  I cannot tell from the current photos if upper eye lid lift is needed as well.  Sometimes fat transfer alone to the eyebrow, temple, and upper eyelid  is all that is needed.

All the best,

Dr. Remus Repta

Remus Repta, MD
Scottsdale Plastic Surgeon
4.9 out of 5 stars 170 reviews

Rejuvenation recommendation

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Aloha and thank you for the photos.  From the profile photo, your upper lids and brow are just fine.  The lower lids would benefit from a skin tightening with midface lift, and a SMAS facelift will take care of the neck nicely.  I suggest a one stage procedure with IV sedation.  Other options may be considered in consultation with a qualified surgeon, but please do not base your decision on cost alone.  Quite often, cheap surgery will end up costing more.  We would work with your budget, but don't like to cut corners to optimize your results.

Help my eyes, neck and jowl

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Aloha and thanks for your questions.

From the limited photos it is difficult to give specific recommendations; but it may be helpful to consider eyelid and face/neck-lift options. These can easily/safely be done at the same time. I'm not sure it would save any money to travel to the mainland; especially considering the amount of advance planning and close follow-up care generally needed. Also, if any complications would occur, it can become very difficult to address.

It would be best for you to visit an experienced board certified plastic surgeon for an in-depth consultation to review your options.

Mahalo, Dr D

Jowls, lower eyelid and neck - lower facelift and fat transfer

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Hi there. Thanks for your post. Based on a photo-only assessment, a lower facelift with fat transfer will address most of your concerns. If the underlying facial muscle layer (SMAS) is lifted in an appropriate manner, there will also be benefit in terms of rejuvenating the lower eyelid region especially when performed with fat transfer. This will also help the neck contour although it can usually be improved even more through a small incision under the chin. The upper eyes are often treated well by skin (eye bag) removal and sometimes a brow lift. These procedures can be performed at the same operation (and in fact, often are) - the exact plan can only be determined after an in-person consultation. Good luck!

Improving Eyes, Neck, and Jawline

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An upper eyelid blepharoplasty to remove exess skin, a lower eyelid blepharoplasty to remove the bags, and a facelift including the neck can be done to rejuvenate your face and reverse the physical signs of aging. All of these procedures can and should be done at the same time so you have anesthesia only once, a single recovery, and it will cost less.

Richard W. Fleming, MD
Beverly Hills Facial Plastic Surgeon
4.9 out of 5 stars 40 reviews

Treatment of facial aging with excess skin and jowls as well as lower eyelid fat and excess skin, etc.

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 Treatment of facial aging with excess skin and Jowls, as well as lower eyelid fat and excess skin, etc.  A mini lift will not give you what you want. A full facelift with removal of excess skin and fat as well as tightening the muscle layer is what you need. Your  lower eyelids need to remove excess skin and have the fat transposed into the lower eyelid Hollow.  I cannot evaluate the upper eyelid based on the photos you presented. See a very experienced facelift surgeon who can go over the pros and cons of different approaches to give you what you want andwho does natural looking faces. 

Toby Mayer, MD
Beverly Hills Facial Plastic Surgeon
4.8 out of 5 stars 36 reviews

Upper and lower eyelid surgery in addition to a face and neck lift

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From the limited photographs, it does appear that the eyelids  can get improvement with an upper and lower blepharoplasty procedure.  A full set of photographs are required to make a more formal determination.  A lower face and neck lift can accomplish tightening loose facial neck skin, removing fatty deposits in the neck, tightening the neck muscles in 3 locations and lifting the jowls. Both a blepharoplasty and a facelift procedure can be performed at the same time under the same anesthetic with the same recovery period.  For more information,  our current price list, and many examples of both procedures, please see the link and the video below

Facial rejuvenation

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Hello and thank you for your question. Based on your photograph, you may benefit from a mini facelift with a neck lift.  If good technique is used, this can be done with minimal scarring and can result in a natural look, not over-done look, with rejuvenation of your face.  Upper and lower eyelid blepharoplasty can be performed at the same time for a nice result.  Make sure you specifically look at before and after pictures of real patients who have had this surgery performed by your surgeon and evaluate their results. The most important aspect is to find a surgeon you are comfortable with. I recommend that you seek consultation with a qualified board-certified plastic surgeon who can evaluate you in person.

Best wishes and good luck.

Richard G. Reish, M.D.
Harvard-trained plastic surgeon

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.