Where Do Jowls Go when SMAS Muscle is Lifted and Tightened?

Do they move outward or up next to the sides of the mouth and just hang? Would lifting that muscle cause the lower face to appear heavier?

Doctor Answers 28

Depends on technique used

Hello Teresa,

Jowls are composed of 3 main components:

1. Muscle / Fascia (SMAS)

2. Fat

3. Skin & it's attachements to the underlying tissues

There is also the pre-jowl sulcus (this is the crease that is present at the front of the jowls).

Depending on your anatomy, desired goals, desired degree of surgical invasiveness, time available for recovery, overall health, etc., your Surgeon should be able to offer you a technique that is best for you.

As a general overview here is what happens to the jowls during surgery with different techniques:

1. Deep Plane / Composite Facelift : in this procedure certain portions of the tissues are actually lifted up off the underlying bone and elevated as a unit. In addition dissection may go into the deeper layers of the jowl itself in order to remove fat, elevate the jowl or soften the pre-jowl sulcus.

2. SMAS Plication : in this technique the SMAS is actually folded up onto itself and sutured together (much like sewing a cuff on to the bottom of a pant leg). The jowl may be pulled in a superior direction, posterior direction or both.

3. SMASectomy : in this technique a portion of the SMAS is actually removed and the cut ends are sewn together. In most cases the direction of jowl elevation is posterior/superior - this allows for some softening of the nasolabial fold (cheek wrinkle).

4. Cranial Suspension : in this technique the jowls are pulled in a vertical direction, essentially straight up. I personally prefer this technique for most cases since it allows for nice volume restoration of the mid face ie. it helps create a "heart shaped" face.

As Dr. Mayer mentioned, a facelift should not add tissues to the lower third of the face but instead elevate / suspend them higher up in a position that is natural looking and more in line with where they once before before the aging process and genetics started to influence your facial appearance.

Take Care.

New York Facial Plastic Surgeon
5.0 out of 5 stars 11 reviews

Vertical SMAS Lift is best!

In my mind, the jowl is soft tissue that used to be part of the cheek and the hollow underneath the cheek. Many SMAS lifts pull this tissue to the side (toward the ear). I call this the Nike Swoop look. Try pulling your jowls to the side and look in the mirror. Not Good!

But, if you smile and place your fingers at the top of the cheek to hold the tissue in place. Voila! The jowls are gone, you look smooth and natural. Hence the Vertical Lift!

Robert M. Freund, MD
New York Plastic Surgeon
4.8 out of 5 stars 33 reviews

SMAS Facelift Elevates Jowl Fat to Cheeks and Cheekbones

The SMAS Facelift uses the deep tissues to move facial fat to its original youthful positions providing volume and highlights to the face.  When properly performed by a very experienced facelift surgeon, the SMAS is used to carry jowl fat superiorly to the midface  and cheekbones recreating the "heart" shaped youthful configuration that you had when you were younger, as evidenced in your old photographs.  This recreates the high voluptuous contours of youth.  It is best to let your Board-Certified Plastic Surgeon illustrate this to you by reviewing multiple before and after photographs.  This tightening and elevation is also what creates the defined jawline after a beautifully performed SMAS Facelift.

Daniel Shapiro, MD
Scottsdale Plastic Surgeon
4.8 out of 5 stars 107 reviews

The SMAS gets pulled into the face to where it was originally

Jowling is essentially tissue that has descended from the face to sit beyond the lower border of the jawline. When you do a SMAS facelift, this tissue is pulled up over the jaw and into the area where it used to be. Your face won't necessarily be fatter, it will have more of the youthful volume it use to have when you were young. Adding tissue into the buccal lower face area tends to make you look younger in fact.

This area can tolerate a lot of tissue without making you look fatter in the face. Facelifts tend to turn your face from the square look into the more v-shaped and youthful appearance.

Philip Young, MD
Bellevue Facial Plastic Surgeon
4.2 out of 5 stars 84 reviews

It depends on what you are calling jowls.

Normally, surgeons call jowls the fatty masses on the lower jaw and below it. These are repositioned in the cheek where they used to be.

Having said that, your fat is higher than that and may only require liposuction at the time of facelifting.

Tightening the muscle will not cause the lower face to look heavier; it should do just the opposite if done properly.

Toby Mayer, MD
Beverly Hills Facial Plastic Surgeon
4.8 out of 5 stars 34 reviews

The SMAS is a deep underlying sheath of connective tissue that lends the face its shape.

The SMAS, or superficial muscular aponeurotic system, is a deep underlying sheath of connective tissue that lends the face its shape. As we age, the SMAS descends due to gravity and the weakening of this tissue. A well performed SMAS facelift will reposition the tissue up and back, causing a more sculpted and youthful jawline. The jowls will essentially disappear, although if you have very fatty jowls then liposuction may be recommended as well. In any case, the lower face will not appear heavier after an SMAS facelift, nor will the jowls “hang.” There are many facelift techniques that can be customized to individual patients, so I recommend having a consultation to find out what kind of facelift is best for you. I hope this helps.

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

Where do jowls go after a SMAS facelift procedure?

As we grow older  the connective tissues within the face loosens and descends. Jowls result from this sagging tissue moving below the jawline. The best way to treat the descended tissues is to re-elevate them. The superficial muscular aponeurotic system (SMAS) is a deep connective tissue layer that forms a continuous sheath within the face and neck. A facelift that lifts the underlying SMAS will re-elevate the muscles and prevent the skin from sagging creating pouches around the mouth and jaw.  My speciality is the the SMAS facelift. I have performed thousands of this type of facelift.

Guillermo Koelliker, MD
Mexico Plastic Surgeon
4.7 out of 5 stars 36 reviews

The Jowls are Elevated

As we age the connective tissues within the face loosen and descend. Jowls result from this sagging tissue moving below the jawline. The best way to treat the descended tissues is to re-elevate them. The superficial muscular aponeurotic system (SMAS) is a deep connective tissue layer that forms a continuous sheath within the face and neck. A facelift that lifts the underlying SMAS will re-elevate descended facial tissues and improve the appearance of the cheek-bone area (malar area) and jowls. 

Austin Hayes, MD
Portland Plastic Surgeon
5.0 out of 5 stars 32 reviews

The jowls disappear!

The jowls are composed of skin, fatty tissue and muscle. Typically in a facelift, some fat is removed, and as the muscular layer and skin are pulled up, back and tightened, the jowls flatten. Some of the tissue (fat) is removed, while some is tucked flat against the underside of the chin and the rest up. This allows for better definition of the jawline but does not add bulk to the lower face. In contrast, the lower face becomes more defined and youthful.

Corey S. Maas, MD
San Francisco Facial Plastic Surgeon
4.5 out of 5 stars 13 reviews

Facelift, jowls

Jowls are generally made up of fat and lax skin. During a facelift, I sculpt out the fat in the jowl area so that the fullness is diminished to the proper degree. I then re-drape the connective tissue known as the SMAS to flatten and smooth the remainder of the jawline. The skin is then re-postioned in a backward direction, never upward, so that a natural, non-stretched appearance is obtained.

Patti A. Flint, MD
Scottsdale Plastic Surgeon
4.6 out of 5 stars 54 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.