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

Thank you for your question. I understand you’d like to know the best and longest lasting method of treating heavy jowls, and you’re also questioning a number of different techniques including SMAS lift, SMASectomy, MACS lift, deep plane lift, etc. You’re also asking why people often have recurrent jowls even after full SMAS facelifts.You’ve certainly asked an interesting question, one that has been asked by people in this field for decades. The truth of the matter is the “best technique” does not exist, because there is so much variability to the human body. Before I explain this further, let me give you a little information about my background. I am a Board-certified cosmetic surgeon and a Fellowship-trained oculofacial plastic and reconstructive surgeon, practicing in Manhattan and Long Island for over 20 years. One of the areas I specialize in is facial aging, and I treat many patients, many of whom come from all over the world, for various facial aging concerns.I think the way face lifting surgery is marketed often confuses people, particularly because there are doctors who claim to do more complicated procedures that other doctors can’t - this is simply not the case. Every surgeon who performs face lifting surgery, and is properly trained and experienced, can perform all the procedures you mentioned in your question. In many cases, the procedures are customized even further because these doctors use their knowledge and experience to get the best out of the procedure and give the patient the best results possible.With regard to your question about why some people get recurrent jowls, this simply has to do with the limitations of face lifting and the factors related to facial aging. Facial aging is essentially volume loss and sagging. Volume loss refers to loss of bone, muscle, fat, and soft tissue; while sagging refers to the descent and weakening of the soft tissue of the face. This means that when you’re performing face lifting surgery, you’re lifting against a structure that has less volume and you’re lifting tissue that is less firm and more elastic.A colleague once likened the skin to taffy — it is extremely stretchable. Whether you go very deep or more superficial, you are essentially still lifting the foundation of the face called the SMAS. The challenge here is tissue quality, and there is an invariable amount of regression which the skin in the neck can stretch. When you turn your head up and down or side to side, the skin will stretch a little. The face will also stretch because of the normal movement from the expressions we make.What I always try to explain to my patients is if they are a candidate for a facelift, my first task is to reposition everything to where it should be. This doesn’t always mean that volume correction is not appropriate; volume correction can be done with the help of cheek or chin implants, or with the help of hyaluronic acid fillers and structural volumizing at the deeper levels of the face. In my practice, I will also sometimes perform a limited facelift combined with injectable fillers to simultaneously restore volume.It is important to keep in mind that face lifting is an art requiring a lot of finesse. There are so many variabilities, and each doctor will approach each case with their own personal style, so there really isn’t just one way to perform the best job possible. If that was the case, all doctors would be doing the exact same procedure.Ultimately, I think what you are dealing with is just the elasticity of the human body and the various ways that the face and neck area can be lifted. I recommend you meet with different doctors and specialists, and learn more about these different options, as well as the different anesthesia scenarios. Many surgeons who perform these procedures do have the appropriate experience and training needed to achieve great results, it is really just a matter of finding the right doctor whose style suits you best in terms of their approach to the procedure, the anesthesia method, and the mutual understanding of your cosmetic goals.I hope that was helpful and I wish you the 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!