What is the best (and longest-lasting) facelift technique to lift heavy jowls?

Hello.  Thank you for your question.  This is a very complex question.  It would require a textbook chapter to describe the differences in all of the various facelift techniques, and I am certain that you will get varying opinions on which technique is the best or provides the longest lasting results.  The reality is that there are no randomized clinical studies or evidence to support one technique over another.  However, every surgeon likely has their own opinion on which technique works best in their hands.  Experienced facelift surgeons may very well incorporate all of the techniques that you described, in addition to others, depending on the anatomy and goals of the individual patient.  The bottom line is that all properly performed facelifts involve the same basic principles, including elevation of the skin, lifting and suspending the SMAS and platysma to recontour the jawline and neck, followed by redraping and trimming of the redundant skin.  The various facelift techniques primarily differ in how the SMAS is managed (plication, imbrication, SMAS flap, deep plane, MACS).  All of these techniques can provide good, long-lasting results when properly performed by an experienced facelift surgeon.  The longevity of any facelift result likely depends more on patient factors, such as skin and soft tissue elasticity, genetics, body weight, body habitus, underlying skeletal anatomy, sun exposure, smoke exposure, etc., than it does on the specific technique used.  The exact same procedure can be performed on 10 different people, and the longevity of the result will vary in each one.  A facelift simply turns back the hands of time for the patient, and they will continue to age in their own unique way from that point on.  I would recommend that you schedule a consultation with a board-certified Facial Plastic Surgeon with extensive facelift experience and allow them to assess your individual anatomy, concerns, and goals in order to determine the best treatment plan for you.  I hope this information is helpful.  Best of luck.

You ask a very difficult
and complex question. As the various options imply, there is no firm consensus
on what the best facelift technique is, and the skill of the surgeon in
performing the technique is ultimately more important than the actual technique
used. That being said, in my own firm opinion, techniques that actually release
and move tissue will last longer and have a more natural result than techniques
that rely on stitches (e.g., MACS lift, imbrication, plication). There is
universal consensus that the deeper tissues (i.e., SMAS) contribute in a major
way to the aging process, and that jowls are caused more by relaxation of the
SMAS and overlying subcutaneous fat than by skin relaxation. An extended high
SMAS technique and the variation of the deep plane facelift that I perform share
the objective of elevating the midface in addition to the jowls and lower face.
A standard SMAS lift does not raise the deeper tissues over the cheek. In terms
of duration of the result, my patients return for a second procedure after
about 12 years, on average, and that includes about 200 patients on whom I have
done 2 facelifts. However, due to the inherent loss of elasticity with age,
which is highly variable among patients, there is always some relaxation in the
first 6 months, and a 70-year-old patient having a facelift for the first time
will not get the same duration or as complete an elimination of jowls as a 50-year-old
patient.

Thank you for your question.  Firstly most of our patients will have their main concern as the lower facelift, jowl and neck area. I have pioneered a revolutionary local anaesthetic facelift known as the ‘Concept™ Facelift’. 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 main benefits of the Concept Facelift would be: minimally invasive as it is a short scar facelift, significantly less risk under local than general anaesthetic, full recovery in matter of days rather than months and fresh, youthful and long lasting results.I advise all our patients to have a one to one consultation with a Surgeon to discuss and address your concerns and can provide you with information about which surgery is best suited to the look that you want to achieve.Good Luck with your procedure! 

Hi Heartsease,Sometimes the reasons jowls seem to reappear is because the surgeon didn't address the front of the jowl as well as pulling the SMAS behind it.There are a number of areas that need to be treated and a comprehensive approach is the key.

Dear Heartsease, The questions you ask are very valid and actually the answers to them are a little too complex to describe in this electronic arena, without photographs to even come near deciding which procedure would be the best for your needs. It is best if you could be evaluated by a Board Certified Facial Plastic Surgeon in person, to evaluate your face, jowls, tissue laxity,  bone structure, skin quality and together you could review each of these facelifting techniques to ascertain which would give you the best results for your face and your lifestyle. You may be pleasantly surprised that even a micro-invasive solution might  be possible for you but that would have to be determined after thorough evaluation of your face, if it would be appropriate for your particular type of facial "maturing". In addition to ThermiTight, the prototype, there are some more newly FDA approved devices that have just arrived from Israel after 8 years successful use there and also in Europe and Canada, finally arriving here in the USA. A select handful of surgeons who are experienced with these techniques have them at this point. It would be good to be evaluated in person and decide which route would be most effective for you. Best Wishes in your quest, Dr. Anna PetropoulosBoston's North Shore, Danvers, MA

More important than the facelift technique is the surgeon. An experienced facelift surgeon knows that each face is different and different techniques should be used to maximize the result for each individual. Some patients can get by with relatively simple techniques while others may need extremely sophisticated techniques to get the desired result. I'd recommend seeing a surgeon who specializeds in facial rejuvenation and can give you options that will maximize your result. For difficult anatomy, I prefer a high SMAS deep plane technique with subplatysmal contouring for those who need it. Andrew Campbell, M.D.Facial Plastic SpecialistQuintessa

Thank you for an interesting question.  There are a variety of different methods in lifting and rejuvenating the face, many of which you have mentioned.  In addition, each of these techniques can be modified or adjusted to meet your individual face.  It has never been shown in any study that one technique is superior to another, and good results can be obtained with many of the methods that you mentioned.  The common theme of all of these is that the deeper tissue is lifted as opposed to simply pulled, which can create a natural less operated look.Instead of focusing on the techniques, I would focus on the surgeon performing the procedure.  Look at the results and post op pictures, and meet with a couple of plastic surgeons.  You will likely get different approaches, and you can then get a feel for who you are most comfortable with.Best of luck with your face.Jeff Rockmore

It is easier to first mention that mini-lifts, MACS lifts etc. will not be the procedure of choice if you are seeking significant jowl correction with good longevity. In my opinion, the deep plane facelift will be superior to most superficial SMAS lifts. During deep plane lifting, the facelift surgeon will address ligaments (namely malar and masseteric ligaments) that resist re-positioning of the SMAS.

You are right.  It can get confusing as to which type of midface lifting will address the jowls in the best manner.The bottom line is the more aggressively the SMAS (deeper layer) is lifted the greater the effect and the longer the duration of the effect.  The direction of the lift should be more vertical.  Mini face lifts, thread lifts, purse string techniques will not give maximal lift nor duration of lift especially in somebody with heavy jowls.  You may also need to have liposuction in conjunction with the SMAS lift.  It is possible that the results you are seeing online post full SMAS face lifts are due to only partial treatment of the SMAS or improper direction of lift.   By focusing on the SMAS you are avoiding a pulled look as one gets when the skin is pulled to create the lift.Another issue I often come across is that patients expect their mid face lift to accomplish all the goals.  The face sags in three dimensions.  Surgical lifting only addresses things in 2 dimensions.  The third dimension is facial volume.  The cheeks deflate and the jaw line bone loses volume.  This needs to be addressed with fat injections or fillers for proper lifting of the jowls.Good luck in your search.  Avoid the branded face lifts and stick to the tried and true techniques on the SMAS.

Hello and thank you for your question. There are numerous types of facelift techniques.  The most appropriate technique depends on your individual anatomy.  If good technique is used, there should not be recurrent jowls after surgery. 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

You are correct that the SMAS is the cornerstone to a longer lasting facelift and to lifting the jowls.  This is because your SMAS is the support structure of your face and can be elevated and sutured and does not stretch.  Your skin is not a support structure but is a cover for the tissues beneath.   The SMAS can be lifted vertically/posteriorly to pull the jowl up off the jawline and to smooth/flatten it by plication/imbrication (which is the same thing and is typically done in patients with thin faces) or by SMASectomy, where a strip of the SMAS is cut out then the edges of the SMAS are sutured together by pulling the SMAS vertically/posteriorly ( typically done in patients with fuller faces to avoid bunching up too much volume in the cheek.)  Excellent results can be obtained by any of the techniques, although the MACS lift has issues with the purse string sutures breaking of being palpable under the skin.  Your surgeons experience is paramount so see a board certified plastic surgeon to discuss this in detail.