Procedure to Fix Jowl Area?

I would like to know what procedure would be best to fix the jowl area and how long would I need to wait.

Also where the lump is in my cheek that the dr. said could be a nicked salivary gland there is now a feeling of a piece of string inside my mouth whenI run my tongue along the inside cheek that runs from the corner of my mouth to approximately, the side of my ear. I think it has to do with the salivary gland. It doesn't hurt at all. Just wondering how this would be fixed.Thank you.

Doctor Answers 11

Canthoplasty is seldom adequate to fix the lower eyelid after surgery

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Dear Hannah

I agree with the others. You need better doctor resources.

The canthoplasty is general not up to the task of fixing the lower eyelid after over aggressive lower blephaoroplasty. The correct approach involves recruiting more cheek skin into the lower eyelid which is done with a vertical midface lift and then lengthening the lower eyelid with tissue from the roof of the mouth. Look at my website for information about these types of procedures:

Regarding the lump in the face, it would be nice to have this issue diagnosed before proposing a fix. I think that an appropriate assessment is warranted. If your surgeon was a facial plastic surgeon, they should be able to assess you and make an appropriate diagnosis.

Since your doctor is not sure if you have an injury to your salivary duct, I would recommend that you see a facial plastic surgeon or otolaryngologist who can make this diagnosis. Australia has few fellowship trained oculoplastic surgeons however the top guy is Alan McNab in Victoria.

Beverly Hills Oculoplastic Surgeon
4.9 out of 5 stars 26 reviews

Jowl area correction after facelift

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Reviewing posts on the internet allows us to give general information to interested patients or potential patients. Apparently you have undergone 2 prior eyelid procedures and a limited facelift (MACS lift). From your description, your surgeon speculated on the cause of some of the issues you do not like.

The best advice I can give you is to seek consultation with one or more experienced surgeons in your area. Plastic surgeons could examine you in-person and evaluate all the findings and issues of concern. Based on such consultation, you may get a better picture of what your next steps would be. An oculoplastic / ophthalmologist might be best for your eyelid concerns. Those issues sound corrective rather than cosmetic.

I wish I could give your more specific and helpful online advice, other than - schedule a second opinion visit(s).

Sutton Graham II, MD
Greenville Plastic Surgeon

Lots or issues requires an expert

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Obviously, you should have less fullness in the jowl area after surgery, not more. It is concerning me that you have fullness in the jowls, a lump in your cheek, a string-like feeling inside your mouth, and on top of that, your eyelids are pulling down more. Since your concern is mainly the jowl, there are several ways to correct that depending on what the cause it. It could be an accumulation of fat which would be liposuctioned or perhaps the whole flap needs to be pulled and re-draped. This would require another facelift.

The string feeling may be from a thrombosed vein - a vein that has a blood clot in it.

If the canthopexy didn't help (assuming it was done properly), you may need lower eyelid reconstruction with a hard palate graft to get your lower lids back into better position. Unfortunately, the lower eyelids will only get worse over time if they are not corrected and can cause problems with dry eyes, scratching of the cornea, and possibly eye infection since the eyeball is over-exposed.

My suggestion is to find a very experienced and qualified doctor who can address each of your issues. With each surgery, your correction may get more and more complicated. Unfortunately, about 1/2 of my practice now involves corrections and repairs of previous cosmetic surgeries done elsewhere.

Jonathan Hoenig, MD
Beverly Hills Oculoplastic Surgeon

Facelift woes

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It's difficult to answer your questions without seeing you in person or having access to your operative record so I'm not quite sure how to address your jowl concern. Threadlift procedures have fallen out of favor as of late since they don't last. Facial fillers can sometimes be used for small touch ups. Most jowls require some sort of facelift procedure, but again a physical exam is necessary. With regard to your "lump", the explanation your surgeon gave you is perfectly reasonable. Also, there may be a retained stich on the inside of your cheek that is giving you that strange sensation. Hope this helps you.

Elan B. Singer, MD
Manhattan Plastic Surgeon
4.8 out of 5 stars 26 reviews

Addressing Jowls with a Facelift

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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

Jowl correction

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I am unclear of your question. Did you have some sort of a suture suspension lift of the face?  That would make sense if you feel a string in your cheek.

Steven Wallach, MD
New York Plastic Surgeon
4.2 out of 5 stars 30 reviews

Jowl Correction

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Jowls are a combination of the descent of soft tissue of the face, skin, and muscle coupled with the loss of bone in front of the jowl (prejowl sulcus).  Correction of jowls often involves reshaping the jowl, lifting the jowl, and augmenting the prejowl sulcus if necessary. 

The video below explains the anatomy of jowls and the treatment.

Anil R. Shah, MD
Chicago Facial Plastic Surgeon
4.8 out of 5 stars 181 reviews

Surgery to correct jowls

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A facelift or cheek and neck lift is the appropriate surgery to correct jowls.  Properly done you should have a smooth youthful jawline with no signs of surgery.

Facial Surgery to Correct Jowling

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Jowling appears as sagging tissues along the jaw line about a 1-1.5in. lateral from the center of the chin. It is usually pronounced because of ligaments just in front of them on the jawline. These ligaments keep the tissues tight to the bone and thus you see a depression then the jowl. Jowls are due to the sagging of the deeper tissues layers in the face but primarily the SMAS (superficial muscular aponeurotic system).

There are many ways to correct jowling. Each method depends on the severity of the jowling and the severity of facial and neck excess skin. In younger patients with less excess skin and mild to moderate jowling a MACS (minimal access cranial suspension) which utilizes 2 or 3 long loops of sutures around the SMAS to tighten and elevate is a good lift.

With more pronounced jowling, excess skin and worsening of the nasolabial folds I prefer to use an extended SMAS lift. In this lift the SMAS layer is lifted off of the deeper tissues then lifted in a vertical direction. The excess face and neck skin are then elevated in a more oblique direction.

A thorough examination by a plastic surgeon is necessary

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There are several options available to treat the “jowl” area of the face. Of course, it depends upon the severity of your physical findings. The options range from simple soft tissue injections to face and neck lifts procedures. A thorough examination is necessary to determine what modality may serve you the best, especially since you have had a previous face and neck lift procedure. The “lump” in your cheek can be assessed at that time to diagnose the problem and establish a treatment plan.

I would recommend that you see a board certified/eligible plastic surgeon experienced in face and neck cosmetic procedures.

I hope this helps.

Stephen A. Goldstein, MD
Englewood Plastic Surgeon

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.