Can Jowls Come Back After a Lower Face and Necklift?

Q: Is it true that jowls can reappear just a few years after a lower face/neck lift? i know a few women to whom this has happened. They are older than I am, and had more jowling to begin with. I am not yet 50 with very little jowling and neck skin. Can I hope for a longer lasting result?

A: How long it lasts depends on the cause of the jowls: sagging or fat bulging.

This is a great question. Of course, we know that facelifts don’t last forever, and the face will continue to age over time. But you bring up an excellent point, which is important for people considering facelifts to understand prior to having a face and/or necklift surgery.

Why do facelifts last longer on some people and shorter on other people?

If a regular layperson understood what exactly a facelift is for, they may be able to better predict how long the facelift will last independent of the plastic surgeon selling them the procedure.

What is a facelift good for?

A facelift procedure is best used for “sagging” or deflation of the face, which is causing “excess” skin to sag below the jawline and the cheeks to also sag down the face. When the lower face and cheeks are lifted upwards, there is excess skin which is removed along the incision and the face looks cleaner and the jawline looks smoother. Essentially the facelift “takes the slack out.”

When does a facelift not work as well?

There are some people who appear to have squaring of the jawline and “jowls.” However, upon closer inspection, these people may actually have full fatty bulges, and/or loss of bone structure or a “pointy chin” which both can appear to create jowls on either side of the chin.

If a person has “fatty jowls” and a full face with very few wrinkles and minimal to no “sagging” to speak of, mainly because their face is full, then a lower facelift may not last more than a couple of years or less for these people. Why? When the facelift is performed, the skin is tightened and it can flatten out the jowls because the skin is tighter. However, over time as the skin relaxes, the full fatty jowls will restretch out the skin and the jowls will reappear. Weight loss prior to face lift surgery is very important for these people. A minimum of 15-20 lbs of weight loss will begin to show some facial deflation and some sagging of the cheeks and jawline. If the patient can reach their ideal weight and maintain it, then the facelift should last the 7 years plus or minus a couple of years, that we want our patients to have.

Bottom line is that patient selection is important when choosing the best candidates for a facelift who will both have a natural result but also a long lasting one. If the surgeon is looking to operate on as many patients as possible, then some patients who are not good candidates will inevitably get operated on, and their results will be suboptimal, even though the surgeon performed the exact same steps for a face lift on the nice result as they did on the sub-optimal result.

Patient selection is the key.


Dr. Yang