What do I need to improve my sagging cheeks and jowls? (Photos)

From what I've read, my jowls can be addressed with a traditional SMAS lift technique, but this type of tightening wouldn't be as effective for improving my mid face issues (sagging cheeks resulting in deep nasolabial grooves and hollowness below my eyes). What would be the best procedure to improve my sagging cheeks? A deep plane technique? A cheek lift? If the best option is a cheek lift, what tissue should the elevated cheek tissue be anchored to?

Doctor Answers 7

What do I need to improve my sagging cheeks and jowls?

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Thank you for sharing your question. Based on your photos, you appear to be an excellent candidate for NovaThreads, a non-surgical lifting procedure. NovaThreads are absorbable PDO sutures that are inserted beneath the skin and are positioned to lift sagging tissue of the mid and lower face. The results last at least 6 months, at which point the procedure can be repeated. I have had excellent success in my practice using threads in tandem with dermal fillers to restore lost volume. I recommend consulting with a board certified specialist who will be able to evaluate you in person and discuss the best treatment options to address your concerns. 

Los Angeles Facial Plastic Surgeon
5.0 out of 5 stars 73 reviews

Face lift and cheek implant candidate

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When patients have a flat maxilla and a flat cheek profile, we place cheek implants in order to give volume restoration to the midface. Cheek implants are manufactured in large variety of shapes and sizes, and  are placed through an intraoral approach under general anesthesia as an out patient surgical procedure.
 In our practice, we perform a high-SMAS. facelift which accomplishes lifting the jowls, tightening the lateral face, tightening facial and neck muscles, the tightening loose facial and neck skin, and removing any fatty deposits in the neck. For many examples of both procedures, please see the link and the video below

William Portuese, MD
Seattle Facial Plastic Surgeon
4.8 out of 5 stars 158 reviews

Facial Aging and Lasers like Fraxel/Clear + Brilliant, RF like VIVA, Peels, Fillers, Skin Care, Face Lift, Fat Injections

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Sagging face needs volume with fillers or fat, skin tightening procedures or face/neck lifting, and lasers for complexion/fine lines. I suggest you see an expert for a formal consultation.  Best, Dr. Emer.

Jason Emer, MD
Los Angeles Dermatologic Surgeon
4.8 out of 5 stars 207 reviews

What do I need to improve my sagging cheeks and jowls?

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Hi, I have performed facelifts for over 30 years and have performed many minimally, invasive type facelifts. From the photos your cheeks are flat anteriorly (in the front) and jowls are present. These factors combine to create a rectangular shaped face.

Following the beauty principles outlined in my book on face and body beauty, men look ruggedly handsome with angularity in the cheeks, chin and mandibular angles. "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 and subperiosteal facelifts) but with these added benefits:

  • very small incisions
  • minimal tissue dissection = less bruising and swelling = rapid recovery
  • 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.

Hope this helps.

Francis R. Palmer, III, MD
Beverly Hills Facial Plastic Surgeon
4.7 out of 5 stars 28 reviews

Mid facelift and deep plane facelift.

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The neck and jowl area can be addressed with a deep plane facelift with elevation of the SMAS and removing excess skin. You may be a good candidate for mid face lift via lower blepharoplasty approach. The cheek soft tissue could be elevated and anchored to the periosteum of the orbital rim and cheek bone. The lower lid could be refined for a balanced appearance. If needed, complimentary fat grafting could be applied for further refinements. 

Sean R. Weiss, MD, FACS
New Orleans Facial Plastic Surgeon
5.0 out of 5 stars 19 reviews

Mini facelift

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Hello and thank you for your question. Based on your photograph, you are a great candidate for a mini facelift.  This can be performed with almost no visible scars.  A SMAS plication can address your jowls. The most important aspect is to find a surgeon you are comfortable with. With good surgical technique, you could have an outstanding result. 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

Richard G. Reish, MD
New York Plastic Surgeon
5.0 out of 5 stars 174 reviews

Male facial rejuvenation

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A mid face lift wouldn't address the changes in the lower face/jaw line. If you don't feel ready for a face lift I think you can get substantial improvement with volumization of your midface and eyelid-check junction in addition to strengthening  of the jaw line to camouflage the jowls. Botox of the eyebrow depressors will improve the low set eyebrows. The neck can be addressed with liposuction or mini-Coolsculpt. You can also consider Ultherapy to further improve outcomes. 

Costas Papageorgiou, MD, FACS
London Oculoplastic 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.