Lower Facelift and Other Options for a 66-year-old?

At 66, what would be the best treatment for lower face? I have read so many negative articles about thread lift. Fillers will not be enough; I need a lift. Do I need a lower face lift or is there an easier way to fluff this area up?

Doctor Answers 24

Lower Facelift and Other Options

Jowls certainly are one of the main facial aging issues that leads people to seek a facelift, and jowls absolutely can recur after a face and necklift – especially if the ‘facelift’ is limited to surgery on the facial skin only. Not only may jowls recur, but they also may be incompletely corrected by a face and necklift, if the procedure performed is not appropriate for the nature of the ‘jowl’ problem. So carefully evaluate your surgeon’s ‘before and after’ photos for jowl area improvement. 

Like all aspects of a facial rejuvenation procedure, jowls require careful evaluation as to their nature and their specific treatment. Jowl fullness over the mid-jawline frequently is lower cheek fat that has descended due to increased skin and subcutaneous tissue laxity as part of the normal aging process, and that has increased in volume, which is also part of the normal aging process. Fat tends to atrophy (i.e. melt away) where you’d like it to stay – like high in the cheeks - and to increase in volume where you don’t want it, like in the jowl area, in the neck and above the nasolabial folds.

Skin-only facelifts have an inherently limited ability to improve jowls. Jowl fat is intimately associated with a deeper plane of facial soft tissue called the SMAS, so pulling on the skin does little to improve jowls. And skin is elastic, so as the skin stretches out, jowls recur. Jowl fat can be surgically removed during a skin-only facelift, but that form of treatment tends to skeletonize the jawline, which does not lend itself to a youthful appearance.

The most powerful means of correcting jowls is by advancing jowl-area fat back up over the jawline into the cheek. This can be accomplished by the High-SMAS face and necklift, which involves elevation and advancement of a tougher connective tissue layer below the skin called the SMAS. SMAS elevation (high in the cheek, hence the term ‘High-SMAS’ face and necklift) has positive effects on the peri-oral area (softening nasolabial folds, elevating the corner of the mouth, correcting marionette lines), pulls jowl fat back up into the cheek, and also tightens the area under the jawline – as it is continuous with the platysma muscle in the neck. And because the SMAS is made primarily of collagen, it had tensile strength and does not relax like skin does. The skin is carried passively with the SMAS, and all of the tension that holds the facelift is placed on the SMAS rather than the skin. So High-SMAS facelifts are closed without any tension on the skin, and the results are more natural-appearing and more long-lasting.

A ‘lower face and necklift’ implies skin elevation (and facial tightening with tension on the skin) to treat the jawline and neck, and I reserve this procedure for patients with relatively early facial aging changes. If patients have notable midface aging, peri-oral aging changes (nasolabial folds, downturn at the corner of the mouth, marionette lines etc), jowls, or significant neck skin laxity, they are best served by a High-SMAS face and necklift. When a skin-tension facelift is used to attempt to correct the peri-oral aging changes listed above, the result is a wind-swept, unnatural, surgical appearance that unfortunately is a permanent change.

I see many patients who think that they have ‘jowls’ but who actually have fat atrophy at the anterior jawline and posterior jawline – in other words loss of soft tissue volume in front of and behind the ‘jowls’, which makes the mid-jawline area appear fuller. Not only fat but also mandibular bone (the jawbone) atrophies in the areas where fat atrophies, which contributes to the hollowness that bookends what appears to be jowls. These patients have what might be termed ‘pseudo-jowls’, and this can often be very nicely corrected by means of structural fat grafting of the anterior and posterior jawline recesses. Some individuals have both atrophy at the anterior and posterior jawline and mild fullness of the jowl area, and for these patients conservative fat aspiration can be combined with fat grafting on either side of the jowls to restore a youthful profile. Many patients with this form of early facial aging can have a full, smooth and youthful jawline restored by fat grafting and fat aspiration only, putting off a more invasive procedure like a High-SMAS facelift until it is really needed for more advanced facial aging issues.   

Raleigh-Durham Plastic Surgeon
4.8 out of 5 stars 118 reviews

Facelt is the best way to tighten up the neck and jawline

The only option for effectively tightening up the neck and jawline is by doing a lower Facelift. Fillers and threadlifts and lasers will all be a guaranteed waste of your money and time. Facelifts, when done by a skilled surgeon, are extremely safe, predictable and effective.

Jason B. Diamond, MD, FACS
Beverly Hills Facial Plastic Surgeon
3.7 out of 5 stars 14 reviews

Facelifts for a 66 year old

There are many names for a facelift - I prefer to call it a cheek and neck lift for example because many patients are afraid of a "facelift." However, that is probably what you need. Just don't fall for a mini procedure as it will not give much result and won't last. See many examples on my web site.

Richard P. Rand, MD, FACS
Seattle Plastic Surgeon
4.8 out of 5 stars 67 reviews

Lower facelift options and alternatives

With any surgical procedure, patients make choices. One of the most important is how good a result the patient wants. Most of our patients want to achieve the best result possible.

In almost all 66 year old women, there are many changes in the appearance that cause the face to appear to sag, the jowls to form, the face to lose volume, and neck to appear indistinct.

The most effective way to rejuvenate these areas, and to do so with the least amount of.artifact (the "done" look) is with an expertly done facelift and necklift. To do just the neck alone makes it impossible to do the beautiful restructuring of the face. It can also create a bizarre if the neck but not the face are rejuvenated.

Statistically, many patients are in a position where they cannot spend money on an initial surgery, then pay even more to redo unsatisfactory work.

So my advice to all patients is to do it right the first time. Choose an experienced facelift expert whose board certification, reputation and results you have researched.

Brent Moelleken, MD
Beverly Hills Plastic Surgeon
4.9 out of 5 stars 177 reviews

Lower Facelift, Under Local Anaesthetic

 Thank you for your question.

I have pioneered my Concept™ facelift which is suitable for men and women who wish to reduce sagging in the lower face (jowls) and neck and regain a more natural, rejuvenated appearance. The procedure is less invasive than a traditional facelift and there is less scarring, bruising and swelling for a significantly quicker recovery period. This innovative procedure combines the latest surgical techniques with the use of local anaesthetic to dramatically reduce the risks associated with traditional facelifts, while significantly reducing the bruising and downtime of your recovery, from months to a matter of days.

The marionette lines will be smoothed by tightening the skin however without tightening the muscle unfortunately the lines will still appear. A lot of my patients will have fillers or chemical peel to reduce these lines.

What are the benefits of the local anaesthetic Concept™ Facelift?

  • Minimally invasive as it is a short scar facelift
  • There is minimal bruising and swelling, especially when compared to traditional facelifts
  • As the procedure is performed under local anaesthetic, you can go straight home following the procedure
  • Full recovery in a matter of days rather than months
  • Significantly less risk than Facelifts performed under general anaesthetic
  • Fresh, youthful and long lasting results
All The Best

At 66, most people have significant skin laxity and jowls due to gravity and slowed collagen production.

At 66, most people have significant skin laxity and jowls due to gravity and slowed collagen production. While there are non-surgical options such as fillers or skin tightening lasers, these will most likely not be effective enough. Likewise, although it is impossible to say without seeing you in person, a “mini-lift” would likely not be enough either. I perform mini-lifts, which involve fewer incisions and less aggressive surgical techniques, most often on people in their 40s or 50s who are just beginning to see skin laxity or jowls. A full face and neck lift, which lifts and repositions the SMAS layer as well as re-draping the skin to recreate a more youthful and contoured appearance, would most likely be best for you. Please visit a board-certified facial plastic surgeon for a consultation to see what options you have. I hope this helps.

Jonathan Kulbersh, MD
Charlotte Facial Plastic Surgeon
5.0 out of 5 stars 66 reviews

Lower facelift for a 66 year old

The best treatment for someone who has lower facial laxity is a lower face-neck lift.  This involves removal of  fatty depositsin the neck, tightening the neck muscles and jowls, and gently tightening the skin.  For examples of our work , please see our facelift photo gallery on our website.

William Portuese, MD
Seattle Facial Plastic Surgeon
4.8 out of 5 stars 143 reviews

Lower face and neck lift to reverse signs of aging


There isn't a best treatment for all patients, as each patient is unique. Only after a comprehensive evaluation in-person, can a plastic surgeon advise what treatment may be best for you.

Facelift refers to aesthetic surgery of the neck and lower face (jowls). Even though patients are confused with many different face lift procedure terms, there are really only a few different types. These basic face lift types are the SMAS, deep, or composite. Face lift surgery may be combined with other cosmetic surgery such as a neck lift, fat transfer, or others.

The amount of tissue tightened or adjusted depends on the specific approach & the requirements of a particular patient. The minimal access or minimal incision lift that leaves a short scar is more appropriate for younger patients (less than 60) or patients with little/moderate skin aging. All of these types of face lifts are variations of SMAS lifts. Older patients or patients with severe & excess skin sagging will require a more traditional facelift procedure. By far, a majority of plastic surgeons who perform face lift surgery do a SMAS lift variation. This face lift type generally has the quickest recovery with great results.

There isn't one face lift type for all patients. Each cosmetic surgery is specific for each patient. Keep in mind, many companies or plastic surgeons may market face lifts by different names, which confuses patients. Speak to a plastic surgeon to determine which facelift is right for you.

Houtan Chaboki, MD
Washington DC Facial Plastic Surgeon
4.9 out of 5 stars 85 reviews

Facial rejuvenation at 66

Hello! You have not included a photo, so it is hard to say what would be best for you. Depending on genetics, sun exposure, prior procedures, all 66 year olds do not benefit from the same approach. Thread lift has gotten a "bad rap" and this is for a reason. Lifestyle Lift is similarly questionable as the level of surgical provider is not standard and might not be a Board Certified plastic surgeon. The best recommendation is to meet with a Board Certified Plastic Surgeon to investigate all of your possible options. There are more fillers out there which may give you the results you desire, balanced by cost, longevity of outcome, and degree of result.

Michele A. Shermak, MD
Baltimore Plastic Surgeon
4.8 out of 5 stars 50 reviews

Other options than lower face lift

  There are ALWAYS options offered by someone as an alternative to a lower face lift procedure.  They may not work at all or may be only mildly effective.  They may be costly, and they may be painful, but these options do exist and include radiofrequency units and ultrasound machines with fancy sounding names and websites.  Consider speaking to an experienced facelift surgeon who may successfully alleviate your concerns about having a mini lift procedure.

Lawrence Kass, MD
Saint Petersburg Oculoplastic Surgeon
4.8 out of 5 stars 131 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.