What Can Be Done About Premature Jowls and Sagging Lower Face? (photo)

I recently had a PS tell my lower face complaints are in a "gray zone"; my deformities are noticeable but not dramatic enough to merit a lower facelift. He also said I would likely be unhappy with face/neck liposuction because of the potential for more loose skin. He said possibly Ultherapy but that he was never impressed with the results. Are there any possibilities for me? Through surgical or non-surgical means? I'm willing to do more than one procedure if it means good results over time.

Doctor Answers 26

A mini facelift can correct early jowling and neck laxity

Thank you for your question.  I do see early jowl formation, neck laxity, and sub-mental fat under your chin.

I do think a neck lift or mini lower facelift with defatting of the neck would achieve the result that you want.I do not believe that Ulthera we will give you the result that you want.

Laser assisted liposuction will remove neck fat and tight near skin but I do not believe it can safely improve the jowls.

Jowls and extra neck skin

Whether or not your extra neck skin and jowls is worth undergoing a facelift (or any correction) is a decision for you to make.  From your pictures, you would benefit from a facelift and defatting of the neck.  Non-surgical means would offer some correction, but in my experience are not worth the money paid for multiple treatments.  An in-person consultation and a thorough discussion of the risks and benefits of surgery should help you determine which solution is right for you.

Jason J. Hall, MD, FACS
Knoxville Plastic Surgeon
5.0 out of 5 stars 11 reviews

Early facelift options

Dear seekingPS,

  1. It sounds like you were seeing a knowledgeable and conservative plastic surgeon
  2. Liposuction would probably leave you with underwhelming results, loose skin, and possibly scarring
  3. I think a conservative necklift would look great where the excess fat and neck skin can be removed from hidden incisions...the jowl can be addressed through this approach as well

Best regards,

Nima Shemirani

Nima Shemirani, MD
Beverly Hills Facial Plastic Surgeon
4.9 out of 5 stars 74 reviews

Facelift for Early Jowls and Facial Aging

Frequently what you're told by a plastic surgeon is dependent on their experience and their methodology of dealing with the problem.  Personally, I think you are an excellent candidate for a facelift.  However, I use a modification of the MACS Lift which is somewhat similar to a mini lift but provides maximum results and significant longevity.  This methodology provides a more vertical lift and, without significant excess neck skin, can be done with a minimal post auricular incision.  The original MACS Lift was designed for people in their forties and early fifties.  Since then, I and others have modified it so that we use it for everyone, as it provides, in my opinion, superior results to the old style SMAS lift.  There are also other surgeons who have modified the standard SMAS lift for people with minimal facial aging.  I, therefore, suggest that you see someone who specializes in facial rejuvenation and has experience in rejuvenation people with earlier signs of aging.

Robert T. Buchanan, MD
Highlands Plastic Surgeon
5.0 out of 5 stars 6 reviews

Facial rejuvenation


Yeah, I would avoid the Ulthera treatment.  I did perform about 60 of these with decent results but it's definitely on the subtle side and in your case not a useful venture.

I combination of jawline tightening and reduction of the heavy loose tissue beneath the chin and jaw coupled with some volume of the midface and cheeks would be helpful.

You may be familiar with the info attached but I'll include it just in case.

Chase Lay, MD

Chase Lay, MD
Bay Area Facial Plastic Surgeon
4.9 out of 5 stars 75 reviews

Face/neck lift is the answer to excess neck skin and jowls.

Face/neck lift is the answer to excess neck skin and jowls. For 35 years I have told patients that they have a mirror and can decide when they are ready for surgery. Other minimal treatments are a waste of your money! See a very experienced facelift surgeon. 

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

How to Treat Early Signs of Aging

Based on your photos, you appear to be a good candidate for a facelift.  Your photos show early jowl formation, and neck laxity.  You would be wasting your time and money with non-surgical procedures.  Consult with a Board Certified Plastic Surgeon to discuss your options and concerns. Best wishes!

Robert E. Zaworski, MD
Atlanta Plastic Surgeon
4.9 out of 5 stars 60 reviews


From the photographs, it appears that neck laxity and jowling are present.  The best non-surgical option is ulthera; however, multiple treatments (2 or more) would be necessary and still not produce equivalent results to a lower face / neck lift, whereby fat is removed and tissues tightened. Good luck!

Jeffrey B. Wise, MD, FACS
Wayne Facial Plastic Surgeon
4.9 out of 5 stars 156 reviews

Face lifts

You can tried Thermage fist as a non surgical option to thigh the skin the result is limited but is a non surgical procedure otherwise  you need a neck lift.

Alejandro J. Quiroz, MD, FACS
Mexico Plastic Surgeon
4.3 out of 5 stars 116 reviews

Sagging Lower Face & Jowls


Thank you for your question and for providing photos.  I agree with many of the other plastic surgeons that you would benefit from a neck and face lift.  Liposuction would worsen the loose skin, and I am not a fan of Ulthera.  I recommend scheduling a consultation with a board-certified plastic surgeon to determine what your options are.  I think your result has the potential to look fantastic and take 10 years off of your neck.

Best of luck!

Ashley Gordon, MD
Austin Plastic Surgeon
4.9 out of 5 stars 35 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.