Lower facelift, neck lift or both? I've suddenly developed a rectangular face, jowls and my jawline is no longer defined (Photo)

My upper cheeks are starting to hollow, now my face has lost its once defined jawline, and I see jowls forming. Also my neck has thin crepey skin that wrinkles and ages me quite a bit. Am I ready for a lower facelift? Or would I be safe doing a neck lift alone? I hate the shape my face is becoming. I feel it makes me look masculine. I don't want to to waste money on fillers if I'd benefit more from a lower facelift and neck lift. Please advise. Thank you in advance

Doctor Answers 12

Lower Facelift, Neck Lift, Both?

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The early aging changes that you are seeing are very typical for the process of facial aging - loss of skin tone, loss of definition along the jawline, development of jowl, loss of volume in the upper cheeks, and skin laxity in the neck. A facelift can address all of these issues. The terms facelift, lower facelift, neck lift mean different things to different surgeons. Usually a neck lift will include a lower facelift and would simply be called a facelift. Facelift can and should also include the upper cheeks. Often autologous fat transfer is performed along with a facelift to soften add volume where it has been lost and provide an overall more natural appearance. 

You are correct in noting that fillers would be a wast of money to address the areas that bother you. While useful, fillers can provide small corrections to specific areas and in some situations add small amount of volume. Fillers certainly cannot "lift" your face yet too often they are used to achieve that purpose. This results in an exaggerated puffy upper cheek area which looks unnatural.

Lower facelift and neck lift

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These are two entirely different procedures. As the face ages, looseness in the lower face contributes to the looseness that is seen in the neck. As aging continues, the neck muscles start to separate in the middle of the neck leading to "bands" or " turkey neck" . A lower facelift will help the neck to some degree, but it will not treat the muscle separation in the middle of the neck. This will become visible again within the first 3-6 months unless a neck lift ( platysmaplasty) is performed at the same time. It is possible to do a neck lift without doing a lower facelift, however, this is something that is best determined during an in person consultation with a facial plastic surgeon who specializes in facial cosmetic surgery and performs these procedures at least weekly, if not daily. I would also suggest researching chin augmentation with fillers or an implant in order to improve the appearance of your neck from the profile. 

Mark Karolak, DO, FAOCO
Bridgewater Facial Plastic Surgeon
5.0 out of 5 stars 62 reviews

Facelift and Neck

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Hi Lapc77

Thanks for your photo's and your question. You look reatively young, however as we all know, once we don't like something there is little people can say, that would make us feel better about it.

You may benefit from a lower face and neck lift. The cosmetic procedure is similar to a mini facelift as it is performed with a short scar that runs in front of the ear, down to the ear lobe and tucked behind the ear. There will be no dressings or drains afterwards. This is performed as a day case, walk in-walk out procedure with minimal bruising and downtime.

For those who have excess fat under the chin but still have good muscle tone and skin, liposuction of the neck will be sufficient. If the skin has lost elasticity, removal of excess skin (Neck Lift Surgery) to tighten and tone the neck will also be required. Tightening of the platysma muscle (also known as platysmaplasty) will require a small incision under the chin away from direct view to gain access to the front edge of the muscles on the neck; they are sutured together with permanent stitches. The muscles of the neck are the foundations and building blocks of the neck and are fundamental to achieving a tight and toned result.

All the best

Lower face and neck lift plus fat grafting

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Based on your photos tightening of your neck and creating youthful, well defined jawline would mean a significant improvement. This can be easily achieved with neck/lower face lift. Additional fat grafting of the cheeks (possibly around eyes) would be my suggestion.

You should discuss your options with a board certified plastic surgeon with significant experience in facial rejuvenation. Good luck.

Zoran Potparic, MD
Fort Lauderdale Plastic Surgeon
5.0 out of 5 stars 22 reviews

Lower facelift, neck lift or both? I've suddenly developed a rectangular face, jowls

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Hi, I have performed facelifts for over 30 years and have performed many minimally, invasive type facelifts on women in their late twenties and early thirties that had early "jowl" formation. From the photos your cheeks are flat anteriorly (in the front), there is some excess fat in front of the cheeks, the chin is weak but I do not see evidence of jowls. These factors combine to create a rectangular shaped face.

Following the beauty principles outlined in my book on face and body beauty, women look the most feminine, youthful and attractive with heart shaped faces. Heart shaped faces have cheeks that are full and round in the front. Cheek augmentation with a dermal filler or using cheek implants for a permanent enhancement will create full, round cheeks that will feminize the entire face.

A weak chin creates an imbalance making the nose appear larger, the mid face top heavy and the lower face look short that de-emphasizes the lips and allows early formation of a double chin. Chin augmentation using a chin implant will add projection to the chin creating harmony and balance to the lower face. I have found that placement of a silastic chin implant, through a small curved incision under the chin (also allows excess skin removal) to be very safe, quick and highly effective.

If you have "jowls” these are sagging facial tissues and an indication for some form of a SMAS facelift. The underlying SMAS layer, of the face, must be dissected, lifted, trimmed and re-sutured (not merely folded or suspended with threads or sutures that will not last). 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 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 general 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-op
I combine facial shaping with every facelift procedure. When jowls are present, these should be done in concert and not alone or separately in order to create a naturally, more attractive face.  In your case, chin augmentation, cheek augmentation with liposuction of the nasolabial fold area would rate a more shapely face.

Hope this helps.

Francis R. Palmer, III, MD
Beverly Hills Facial Plastic Surgeon
4.7 out of 5 stars 28 reviews

Double Chin Treatment / Laxity-- SmartLipo/VASER/ThermiRF, Botox, Venus Legacy, Kybella, CoolMini

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I find that younger patients benefit from VASER/ThermiRF to this area with ultherapy to follow or kybella as an alternative.  there is really no need for a neck/face lift with proper fillers, skin tightening and liposuction at a younger age.  Best, Dr. Emer.

Jason Emer, MD
Los Angeles Dermatologic Surgeon
4.8 out of 5 stars 207 reviews

Lower Facelift vs Neck Lift

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Thank you for your question and photos. 
Lower facelift and neck lift mean different things to patients and surgeons. They are general terms that don't have defined meanings. To me, a neck lift focuses on removing lax skin and excess fat from the neck and provides modest improvement in the jawline with the effect really designed to contour the neck. A lower facelift does the same plus allows elevation of the jowls which helps define the jawline and correct sagging tissues in the lower face. Neither procedure addresses the upper face or loss of volume you are describing in the cheek area. Therefore a lower facelift with reflation of the cheek area, fat transfer, would be an option which would probably address all of your concerns. All of this would be predicated on you having a formal consultation with a board certified plastic surgeon who can perform  thorough exam and history and recommend what they feel is best for you
Best of Luck

Lee A. Gibstein, MD
Miami Plastic Surgeon

Who is a Facelift Candidate

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A person’s age is best guessed by the appearance of their face. If you feel that your face does not reflect how young you feel inside, you may be a candidate for a facelift.
During your #consultation, your skin texture and elasticity, as well as your underlying skin structure and your facial bone structure will be evaluated. Based on this evaluation, your board certified plastic surgeons will create a custom surgical plan, detailing specific techniques and recommendations to meet your goals. In doing so, he or she should be sure to have a full understanding of what results you expect.
If you are not a #candidate, your surgeon can make other suggestions to address your concerns and objectives.

Patients who desire facial rejuvenation that is affordable, quick, and effective should consider the Lite-lift™. Like the Life-Style™ facelift, this is a modified facelift that can be performed in the office with a local anesthetic and improve signs of aging around the neck, jawbone and lower face. These procedures are not "Thread-lifts" or "String-lifts". We do not use the "barbed" sutures employed in these other lifting operations. The Lite-lift™ uses longer lasting techniques that are discussed below. Because the incisions are limited, there is less bruising, swelling and healing time for most patients. Many patients can be back to work in one to two weeks looking rested and more youthful.

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

Face and neck lift

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Your changes desired are very subtle but a neck lift alone will not treat your jowl area. If you do not want fillers, then consider a lower face and neck lift. It's best to see a qualified surgeon for consultation.

Brian K. Machida, MD, FACS
Ontario Facial Plastic Surgeon
4.1 out of 5 stars 24 reviews

Lower facelift versus a neck lift

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 In our practice, a neck lift involves removal of fatty deposits above and below the platysma muscle and the platysma plasty to give more jawline definition. There is no skin removal with a neck lift. When patient's have  inelastic skin in addition to poor definition  of the jawline, a lower face and neck lift is required to tighten loose skin. For many examples and more information regarding both procedures, please see the link and the video below

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