Hi, I have performed many facial shaping procedures and facelifts over the past 30 years, many of these on women who had jowls in the late twenties and early thirties. Developing sagging cheeks with premature nasolabial folds typically occurs when the cheeks are very flat anteriorly (in the front). Flat cheek lack the bony support needed to prevent sagging of the tissues off of the cheeks. IMHO, it makes more sense to attack the problem on three tissue levels.Add volume to the cheek bone using cheek implants. For woomen this means creating cheeks that are more full and round, in the front, that create heart shaped faces that are more feminine and naturally attractive. For men it's creating more angularity to the cheeks.Remove and excess fat that's blocking the most aesthetic shaped cheek possible.Remove any excess skin by dissecting, lifting and trimming the SMAS and excess skin. Jowls are sagging facial tissues and an indication for some form of a facelift. The underlying SMAS layer, of the face, must be dissected, lifted, trimmed and re-sutured. 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 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 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-opIn contrast, attempts to susepend falling fat and facial tissues up onto the cheek bone or lower eyelid will not last as it lacks the required two point hard fixation.Hope this helps.