Facelift for jowls comes in several incision patterns because aging differs from patient to patient; further complicating things is that each of them has a different underlying anatomy. The general rule of thumb is to customize the surgery to achieve impressive, natural-looking results.
Jowls might be caused by several factors such as redundant skin, excess fat, soft tissue or fat atrophy (receding or disappearing), or cheek fat that has sagged to a significant degree. For some patients their jowling is caused by two or more variables, thus careful analysis must be done to achieve good results.
For most patients their jowl can be addressed by a SMAS facelift procedure in which the connective tissue below the skin is reshaped and tightened, creating strong framework and results that can last longer than a skin-only lift.
The length and position of incision greatly varies, although the general rule of thumb is to place it behind the hairline and/or “inside the ear,” or specifically within the natural skin creases. The idea is to hide the scars that no one can detect them even at a conversational distance.
SMAS facelifts not only reshape and tighten the jaw line, but also correct the appearance of nasolabial folds, or more commonly referred to as “laugh lines,” as it can elevate the corners of the mouth.
Another benefit of going deeper is the “favorable” scarring—i.e., fine flat scars that are barely imperceptible. Because most of the tension is on the SMAS layer, which carries the skin, the wound can heal without the unnecessary pull.
Skin-only facelifts, meanwhile, are often criticized for their thicker, wider scars because the skin receives most of the tension. Another downside is the short-lived results because the deeper structure of the face has not been tightened and reshaped.
Aside from loose skin, fat or facial volume loss might also contribute to the appearance of jowling, with the deep laugh lines further aggravating the aged look. In this situation, volumizers such as dermal fillers or fat grafting can be of great help.
The idea of combining SMAS facelift and volumizers is to address facial aging in a 3D approach, thus creating a more natural and more rejuvenated appearance without having to worry about the windswept or perennially surprised look.
Meanwhile, some patients can benefit from a minimal facial liposuction to correct the appearance of jowl, although the soft tissue must be tightened as well if they appear hanging. Nevertheless, it is crucial to preserve some fat to avoid the jaw line from appearing skeletonized.