Best Way to Treat Jowls, Nasal Labial Folds, Festoons? (photo)

I have lower facial sagging, jowls and nasal labial folds that I would like to eliminate. I believe all are due to aging and my pregnancy in 2006 when I gained weight mainly in my face and stomach. I am 44 years old, thin, athletic. A surgeon has recommended a mid-face lift, anterior neck lift with liposuction and lipo of the “fat pads” on my cheek bones. Are these procedures the best way/current standard to smooth my face and jawline?

Doctor Answers 27

Procedures for a natural look that lasts

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I mentioned in my book, “The Fine Art of Looking Younger,” is that if you are around the fourth decade, you start to manifest some of volume loss and facial descent changes. Basically, there are two parts of facial aging that people are becoming aware of: one is that there is loss of bone, muscle and fat and the skin gets thinner which is called volume loss with the face collapsing a little bit and the lines become little deeper; secondly, there’s looseness of skin and of the supporting tissue.

A nasolabial fold is an area that is often referred to as a parenthesis. Very often, the solution by a lot of surgical colleagues is try to do a mid-facelift. This means to lift the mid-face and the cheek area and go vertically upward to try to soften the nasolabial fold. This will create higher cheek fullness.

From my experience and in the past 20 years of different mid-facelifting procedures, I have found that some procedures tend to push the mid-face too wide. Others also look very good in the beginning where everything is high, but then eventually tends to descend. So you have to ask yourself also about how much this area bothers you.  

The one thing that I can’t determine from your photos is of course how the skin feels. When I evaluate a patient, I look at them and I move the skin to see how much movement there is. Basically, in lifting procedures there has to be something loose to lift. If something is not that loose, then I will not be able to move it very much. So you may wanna consider more conservative options related to the nasolabial fold.

On the other hand, I think the best procedure when it comes to jowls is some type of face lifting procedure especially when someone has very loose skin in the jawline. As the face descends and sags, we are able to successfully redefine the jawline by lifting the skin and soft tissue underneath called the SMAS. The SMAS is often referred to as a muscle by a lot of people who research face lifting, but it’s actually the tissue that supports the skin and has to be tightened. When you look at the mirror and you lift your skin in an upward and back direction, you can get an assessment of how loose and tight your skin is.

So before you proceed with a surgical procedure with a combination of other procedures, see if your surgeon really understands what your expectations are. Sometimes there’s a miscommunication where surgeons are happy with some type of improvement but the patient wanted something a bit more dramatic or didn’t want something so dramatic. So it’s critically important that you communicate with your surgeon and get more than one opinion before you commit to any extensive surgical procedure.  i hope this was helpful, and thanks for your question.

New York Oculoplastic Surgeon
4.4 out of 5 stars 80 reviews

What are the best options for treating my face

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You have a slight amount of fullness in the neck below your chin. You also have a small amount of muscle laxity in the neck which diminishes the definition of your neck and jawline. There is a slight amount of howling and your chin is slighlty retrusive. I see healthy, fit patients like yourself frequently. 

I would recommend a lower facelift and neck lift to address the muscle laxity in the neck and the jowling in the cheeks. I would be very cautious with liposuction as it would be very easy to over do it a create a crater appearance underneath your chin. I would also avoid lipocontouring of your jowels. A facelift will pull the jowels back into their natural position. 

In the mid face I think that you would get your most natural result with fat transfer. This creates a three dimensional, youthful appearance which is a great compliment to the lifting in the neck and lower face.

Make sure to consult with a couple of qualified and experienced surgeons. Good Luck!

Todd C. Miller, MD
Newport Beach Facial Plastic Surgeon

Jowls, nasolabial folds are improved with a a lower and mid face lift

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In my practice I often see women just like you- correction of your lower face would involve some liposuction of the neck with a lifting of the deep tissue of the face to improve your jaw line.  Nasolabial folds are natural and complete elimination of them are not advisable.  My young daughter has nasolabial creases.  Improvement of them to a more youthful appearance will involve lifting of the cheek tissue, called a mid-face or cheek lift.  I perform this through a lower eyelid incision but there are several approaches.  This mid-face rejuvenation combined with lower facial refinement will help you achieve all of your goals.

Treatment for Jowls, nasal labial folds

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In our office, we review with you both surgical and non-surgical alternatives on every patient.  At 44, despite not seeing every view I need to see for a facial consult, I doubt those are your only alternatives.  A significant amount of rejuvenation can occur with skin care, photofacial & laser treatments, Ulthera for lifting and tightening, combined with botox and fillers.  Surgical facial options include laser liposuction of your neck and jowls and fat grafting before a mid-face lift. 

Best wishes!!

Best way to treat jowls and neck with surgery

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You will get various opinions. Surgeons will typically recommend surgery, while non-surgeons will recommend non-surgical techniques to improve the jowls, folds, and wrinkles. You may get great results with either approach.


You are still young and appear to have good skin quality and bone structure. Based on the information provided, you may consider a lower facelift, cheek lift, neck liposuction, and facial fat grafting (injection). Typically, I avoid liposuctioning fat from the face. Lastly, if you haven't already, you should consider non-surgical options such as facial fillers or other non-surgical facelift options to rejuvenate the face without surgery. Without a comprehensive evaluation, it would be difficult to provide more specifics.


Houtan Chaboki, MD
Washington DC Facial Plastic Surgeon
4.9 out of 5 stars 89 reviews

Treating Early Aging Changes

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Your photos  show evidence of looseness and sagging of the cheek soft tissues, creating deepened nasolabial folds, marionette folds, and jowling.  I also notice fullness under your chin in the front of your neck.  Although filler injection in the nasolabial and marionette folds can soften and camouflage these grooves as a temporary measure, the best approach is surgical with a short scar face lift focusing on elevating fat and skin upward in the cheek and reducing the fullness under the chin with liposuction and muscle tightening.  A chin implant could be considered if you are bothered by your slightly small chin.  I often use conservative liposuction in the jowl area to reduce the fullness there,  but never over the cheekbone area.  This combined approach should freshen the appearance of your cheeks and neck.

Richard G. Schwartz, MD
West Palm Beach Plastic Surgeon
5.0 out of 5 stars 32 reviews

Best Options for Early Aging

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After examining your profile, you certainly would benefit from a neck lift, chin enhancement and probably some fat grafting.

Personally, I would not recommend liposuction from the cheek areas.

If you are unsure about the proposed plan, visit another face specialist to obtain a second opinion.

Frank P. Fechner, MD
Worcester Facial Plastic Surgeon
4.6 out of 5 stars 48 reviews

Best options for facial rejuvination

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Facial rejuvination surgery can address the concerns you listed. Each surgeon has their preference for which procedures they feel are most appropriate. In my opinion a short scar facelift and Platysmaplasty (probably what your surgeon is referring to as an "anterior neck lift") would be and excellent way to achieve long lasting and substantial improvement in your lower facial features. The attached video explains the different incisions types that are used with lower facial rejuvenation surgery.

Thomas Buonassisi, MD
Vancouver Facial Plastic Surgeon
4.9 out of 5 stars 114 reviews

Most faces age synchronously so a complete facelift is usually recommended.

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The picture demonstrates symmetrical aging from the eyelids to the clavicles. Full facelift will collect all aesthetic problems observed. A mid face lift will do nothing to improve the neck.

Facial rejuvenation options

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Thank you for the question and the photos.  Facial aging and therefore facial rejuvenation involves skin, soft tissue (fat), ligaments, and to a small extent even bone.  There are low cost, low downtime treatments that offer mild results and there are higher cost, higher downtime, more definitive results.  Which option is best for you depends in part on how much correction you want to achieve and correspondingly how much money and downtime you want to invest.  Your best result will likely involve a face and neck lift plus or minus fat grafting and any peri-orbital (around the eye) rejuvenation that you may desire.

All the best,

Dr Remus Repta

Remus Repta, MD
Scottsdale Plastic Surgeon
4.9 out of 5 stars 173 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.