Why do some facelifts appear "Joker-like" and show large salivary glands sticking out on the side of the neck?

Why are some patient's faces pulled back so tightly during a facelift that their mouths tend to stay open or have a "joker-like" expression? Is the surgeon simply inexperienced or is the surgeon compensating for more sagging that will occur naturally with age? I have see photos that look painful due to the "tight" appearance of the skin; do some clients request this look or is is most likely due to inexperience on the surgeon's part in calculating the facelift? How is the lift calculated?

Doctor Answers 14

Why do some facelifts appear "Joker-like" and show large salivary glands sticking out on the side of the neck?

There are actually three issues that you have described: "joker-like" expression, "tight appearance", and large salivary glands.  

A so-called "joker-like" look is often termed Joker lines or a cross-cheek depression by experienced surgeons.   This is a situation, that should be noticed before surgery,  where the patient has an indentation from the sides of the mouth that extends to the ear.  A  facelift, without simultaneous volume augmentation (e.g., fat transfer, filler), can exacerbate the joker lines and make the person look "done" or "pulled".

A "tight" look can arise by a number of ways but is typically the result of a surgeon not re-positioning and tightening the muscle layer (SMAS layer) well or artistically enough, and he/she will then over-tighten the skin to compensate, creating a "tight", un-natural and pulled look.

Large submandibular glands can become more visible after a neck lift.  It is not uncommon to have these glands reduced in size to minimize their visibility.

The attached link provides more information.

I hope this helps.


Orange County Facial Plastic Surgeon
5.0 out of 5 stars 60 reviews

Joker lines

Some face lift techniques are more prone to these and some patients faces are more prone to this.  Good luck.

Steven Wallach, MD
New York Plastic Surgeon
4.1 out of 5 stars 24 reviews

Over pulled lift

The short answer is that it is likely a combination of the surgeon's aesthetic and the patient's demand. While most surgeons will pride themselves on achieving a natural looking result and most patients request this there is most definitely a group of patients who demand "super tightness" and want people to notice their lift. They will find surgeons who offer this type of result.

Michael L. Schwartz, MD
West Palm Beach Facial Plastic Surgeon
4.7 out of 5 stars 9 reviews

Poor technique

If wide subcutaneous undermining and heavy pull is performed the joker look is obtained. Most surgeons now do less undermining and more deeper SMAS modification to retain a natural look. I hope this helps. Good Luck!


Hello and thank you for your question. The simple answer to your question to carefully evaluate before and after pictures of the surgeon you are choosing and make sure you like what you see.  If good technique is used, a facelift can be done with minimal scarring and can result in a natural look, not over-done look, with rejuvenation of your face.  The most important aspect is to find a surgeon you are comfortable with. I recommend that you seek consultation with a qualified board-certified plastic surgeon who can evaluate you in person.

Best wishes and good luck.

Richard G. Reish, M.D.
Harvard-trained plastic surgeon

Richard G. Reish, MD
New York Plastic Surgeon
5.0 out of 5 stars 80 reviews

Joker faces

There might be many reasons for the overpulled look.  These patient might be repetitively unhappy, and end up seeking multiple procedures and multiple revisions to their faces, or their doctors are doing a very tight skin closure or are doing more horizontal instead of vertical pull. You can't really comment on pain based on the look of tightness and it may not be painful. Lifts are marked pre op to determine proper pulls to deal with problem areas. True salivary submandibular glands can become more evident in thin liposuctioned necks  but I'm not sure that's what you're looking at.

Brian K. Machida, MD, FACS
Ontario Facial Plastic Surgeon
4.1 out of 5 stars 22 reviews

Joker facelift

Facelift techniques that produce pulling  of  tissue more back than up can create this look.    The most natural facelift creates mosly upward lift,  which also creates natural neck improvement at the same time. I prefer the deep plane technique to achieve this.     

Matthew Bridges, MD
Richmond Facial Plastic Surgeon
5.0 out of 5 stars 20 reviews

Over pulled look

Thanks for sharing your question. I can appreciate your concern.

The redundant salivary glands are secondary to the plication technique on patients that have excess tissue. In those patients excision is better for the final outcome. 

Personally I do not think that over pull is a good technique because it is difficult to predict when to much is too much. Adequate pull or minimmaly overcorrected should be a better approach. At the end the bottom line is do you like the outcomes your plastic surgeon is giving you on patients followed for a year. If that is the answer then pick that surgeon.

Finally, make sure that you have a consultation with a board certified plastic surgeon.

Wishing you the best in your journey

Facelifts and Salivary Glands

The short answer is that thinner necks or those patients with large submandibular glands will be more likely to have glands that show after a lift. The tighter skin appearance is another matter. The lift should contour the neck, lift the face and improve or eliminate the jowels in a manner that does not make the patient look pulled. Some patients are not happy unless they look overdone and other times it is seen when a surgeon uses a skin only approach.

Talk to your docter, review photos and ask to speak to previous patients.

Best of Luck

Dr. J

A. Dean Jabs M.D. Ph.D. FACS
Board Certified Plastic Surgeon
6430 Rockledge Drive
Bethesda MD 20817

Facelift results

Facelift results are going to depend on both the surgeon's skill, you definitely want to see a board certified plastic surgeon, and a patient's desired outcome. With the new facelift techniques available today, there is really no reason for a patient to look "pulled" and overly "done". Hope this helps.


Kouros Azar

Kouros Azar, MD
Thousand Oaks Plastic Surgeon
4.8 out of 5 stars 21 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.