Hi, there comes a time when the degree of excess facial fat or facial laxity ("Jowls") exceeds the ability of a non surgical option to provide reasonable results. It's important to keep all of the "heavily marketed" non-invasive procedures in the proper perspective. Non-invasive techniques typically shrink the skin several mm's. There are 25.4 mm's in one inch. The minimally invasive facelift described below can remove 2 to 3 inches of skin which equals 50.8 to 76.4 mm's or up to 25 times the amount of loose skin provided by non invasive techniques. That reality should always be front and center in the decision making for prospective facelift patients. It should also be noted that non invasive techniques have no ability to properly dissect, elevate, trim and re-suture the SMAS layer nor modify any existing fatty tissue making them one dimensional at best. I have performed many facial shaping procedures over the past 30 years using dermal fillers, liposuction, facial skin rejuvenation, non surgical skin tightening, silastic facial implants, SMAS facelifts/neck lifts and for the past 15 years have performed many minimally, invasive SMAS facelifts. While non smiling photos (full face) front and side would help in the evaluation, from the photos there appears to be a significant amount of excess fat in the face/neck, jowls are present and there is loose skin under the chin. If you have "jowls”, these are sagging facial tissues and the main indication for some form of a SMAS facelift. The underlying SMAS layer, of the face, must be dissected, lifted, trimmed and re-sutured (not merely folded or suspended with threads or sutures that will not last). The excess skin is then removed and the facelift incisions closed. My most popular SMAS facelift is the minimally invasive, short incision SMAS facelift that has all the benefits of more invasive facelifts (traditional, mid-face, deep plane, cheek lift and subperiosteal facelifts) but with these added benefits: very small incisions and no incisions extend or are placed within the hair.minimal tissue dissection = less bruising and swelling = rapid recovery ( several days instead of weeks or months with the more invasive type facelifts mentioned)can be performed in 90 minutes or less, with or without general anesthesiano incisions within the hair = no hair lossexcess fat can be removed from the face and neckexcess skin removed from the face and neckcheeks, chin and jaw line can be augmented with dermal fillers (I prefer Restylane Lyft) or facial implantsmost patients fly back home to parts all over the world in as little as 3 days post-op I combine facial shaping with every facelift procedure. When jowls are present, these should be done in concert and not alone or separately in order to create a naturally, more attractive face. Liposuction of the face and/or neck can reduce excess fat to further shape the cheeks, face and neck. Following my beauty principles, women look the most feminine, youthful and attractive with heart shaped faces. Heart shaped faces have cheeks that are full and round in the front. Cheeks that are flat or concave in the front can be augmented with precise placement of a dermal filler or by using silastic cheek implants (permanent enhancement) to create full, round cheeks that will feminize the entire face. Along with the minimally, invasive SMAS facelift described above, some of the excess skin below the chin can be removed using a small, curved incision under the chin. This along with skin removed in front and behind the ear will tend to reduce the skin excess by around 70% or more. If anterior platysmal bands are present or the maximal amount of neck skin is to be removed, a "formal" neck lift can be done. In this procedure, the face and neck tissues are elevated using a curved incision around the front (explained later) of the ear that continues in the crease behind the ear and then 3 inches into the posterior hairline. The tissue is dissected from that point all the way across the entire neck to the same position on the other side of the head in a dissection that is as long vertically as the entire neck. The Platysma muscles are tightened using a curved incision under the chin and each side is pulled upward and back again being tightened at a line behind each ear (under the tissues). Since the skin flap pull is up and back, this will pick up any tissue laxity along the jaw line or "jowls" which must be dissected and flattened out using a lower facelift (incision around the front of the ears). If this isn't done, pleats of excess skin will appear below each ear. This is an extensive surgery taking 4 1/2 to 5 hours with large incisions, requires placement of drains, possible hair loss and months of recovery.Hope this helps.