No Improvement in Jowls After S Lift? (photo)

Hi,I'm a 37 y/o woman. 2 years ago I was starting to develop jowls. Thermage/Ulthera were just a waste of money. June 2012 I had a thread face lift,it gave me hardly noticeable improvement(if any) and left huge lumps on my cheeks. End of November 2012 I went to another doctor who removed the threads and performed S Lift(skin and muscle).The lumps disappeared perfectly,but I still have a very noticeable jowls,it looks like my cheeks 'fell down'.Doctor says it's swelling,it will go away. Help!Thx

Doctor Answers 12

Swelling after S lift

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   The swelling may still be figuring into the picture at this time point.  If you are still unhappy, the lift can be modified with a more extensive facelift later.  I perform a shortscar facelift, but the level of suspension and undermining is the same as a full facelift.

Jawline indentation can't be addressed with a facelift, but it can be helped with other procedures

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Having issues with jowls at the age of 37 is a little bit unusual, but in my practice, the youngest patient I performed a facelift on is actually the same age. As a surgeon, I’m not going to disagree with you that Thermage and Ulthera are not worth the money. Unfortunately, a lot of people go for non-surgical treatments that are often oversold as the equivalent to surgical procedures. Ironically, a lot of surgeons will include these types of procedures in their practice to help people who don't feel they are ready for surgery.  From the 20 years I’ve been in practice, people come to me wanting to see real results, and not just small improvements considering  the amount of money they invest in these types of non-surgical treatments.

I hope during your consultations that there was a clear understanding about what the definition of your jowls are. A very common reason that something is interpreted as jowls has do with the anatomy of the jawline. In the jawline, there’s an area called the mandibular notch, which is an area that is a part of bone which tends to indent because of genetics or age. If there’s an unnatural indentation of the bone, then you cannot pull the skin tight enough to make it straight. In situations like that, I offer my patients non-surgical solutions such as Radiesse or fillers to help fill in that area, as well as more permanent solutions such as implants called pre-jowl implants to fill in that area.

One thing that is very important to understand is that the jawline and the relationship of the neck also depend on the teeth and the way the jaw, the mandible and the maxilla (the upper part of the jaw) meet. 

If you see an improvement from where you were, then it’s there is a real success. If you pull your skin or your jawline upwards and you can’t pull it any tighter, then you will most likely benefit from some type of augmentation along the jawline to soften the appearance of the relative jowling.

Your surgeon has told you that it is still early in your post-operative period. Surgical healing takes six months to one year, so there is no question that swelling can be a factor. In my practice, it is not unusual for me to see that, so I \ try to guide my patients on ways to help manage swelling. Sometimes they come to my medi-spa and my aesthetician will do some manual lymphatic drainage to help drain the fluid. Eventually, all the fluid does get better. I would suggest that you address with your surgeon your anatomy if that has not been discussed, and see if adding some filler at some point will help your jawline improve. I hope that was helpful, and thank you for your question.

Amiya Prasad, MD
New York Oculoplastic Surgeon
4.4 out of 5 stars 80 reviews

Dissatisfied after an S Lift

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Sorry to hear about your disappointment following an S-Lift. When I hear the term S-Lift I think of a minimally invasive lift procedure that lifts the skin and does not deal adequately with the underlying muscle. If the muscle layer was not adequately suspended you may benefit from a revision with more attention paid to the SMAS layer. I would consult with a couple of experienced and qualified facial plastic surgeons.

Todd C. Miller, MD
Newport Beach Facial Plastic Surgeon

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Jowl problem

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   There is no shortcut to good face work....especially if there is a jowl problem. Thermage, thread lifts, simple s-lifts etc. etc. etc. will not accomplish much except put wasted dollars in someones hand. You need a facelift with SMAS work and elevation to the muscles and facia. This need not be an ordeal. In my office we do all this work in 3 hours under simple and safe oral sedation and local anesthesia.

Jowls after face lift

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Usually a face lift that involves lifting of the deeper tissues addresses the jowls, and it is true that there is some swelling to be expected after the lift. If the surgeon only did an S lift that involved excision around your ear, the vertical pull will not be there to correct your jowls.  If the surgeon properly dealt with the deeper tissue to lift things vertically as well as toward your ear, then this does likely represent swelling and should improve.


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An S-lift is a mini lift which gives mini-results.  A full SMAS or High SMAS procedure will give a more predictable result.  Look for someone with extensive facelift experience

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

Jowls after face lift

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Thank you for your question about your face lift. I am sorry your efforts have been so disappointing.

  • Alas, my experience is that Thermage/Ulthera only work on thin skins.
  • Thread lifts - all the rage 10 years ago - don't work.
  • S lifts can work  - but again, in thin faces. However your swelling looks better at 2 months. You may see more improvement. Wait six months.
  • But you may find that the short cuts don't work for you and that the result you want requires the time proven SMAS face lift with liposuction. Hope this helps. Wish I had an easier answer for you.

Elevation of SMAS and liposuction would correct jowls.

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To get the most definitive correction of your jowls, cheeks and jaw line, the tissue needs to be elevated and firmly held in place.  This is best accomplished by a High SMAS facelift.  This would require a standard facelift incision which is very well camouflaged in the natural creases of the ear and along the hairline.  As you noted, you have tried Thermage/Ulthera, a threadlift and an S lift, all heavily marketed procedures which many feel do not deliver on their promises. Your best option would be to address this problem with the procedure most likely to correct it.  See a board certified plastic surgeon experienced in High SMAS facelifts.

S Lift??

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 An S lift is traditionally a very minor face lift. To correct your concerns I believe you most likely will require a much more major procedure. A combination of liposuction, fat grafting to the face and a more definitive facelift is most likely in order. You could even require removal of some of the buccal fat pad.  I have some examples in my photo section.


 It would be very useful to pictures of you when you where younger and to examine you. My suspicion is you had quite defined check bones and that the round face you have developed is hereditary. Consider a visit with an ASAPS Member in your area familiar with Facial Rejuvenation with Liposuction of the Face/ Fat Grafting to the Face and Deep Plane Rhytidectomy. They are experts in corrective cosmetic surgery. Best,



Gary R Culbertson, MD, FACS

Gary R. Culbertson, MD
Columbia Plastic Surgeon

Jowels after facelift

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liposuction of the jowels should be considered if not done  or maybe repeated.

the type of muscle tightening can also affect the improvement here.

Jed H. Horowitz, MD, FACS
Orange County Plastic Surgeon
4.9 out of 5 stars 116 reviews

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.