Chat with us, powered by LiveChat The Truth About Jowling: Causes And Treatment Glenn Vallecillos, MD, FACS

The Truth About Jowling: Causes and Treatment

by | Apr 6, 2023 | Face

What is Jowling?

Jowls is a term that refers to the lower fleshy part of one’s cheek when it falls below the jawline due to aging. Made of skin, fat, soft tissue and muscles, jowls disrupt the evenness and symmetry of the face while adding years to one’s appearance. Jowling is a natural phenomenon of the aging process that leads to sagging skin and volume loss. This is common among older patients resulting from skin laxity, descent of cheek fat, and volume loss in the structural components of the face. Overtime, the decrease in production and weakening of collagen and elastin contributes to skin laxity. The skin, fat, muscles and bones of a person’s face begins suffering from volume loss as early as a person’s late twenties.


Prevention is always the primary method to treating signs of aging. This includes wearing sunscreen daily and maintaining a healthy lifestyle. Smoking, tanning, excessive drinking, and poor hydration will contribute to premature aging signs such as jowling. But at the end of the day, aging is inevitable and the signs will show despite practicing the best skin care possible.

While there are many nonsurgical ways to address jowling like cosmetic fillers or laser resurfacing, the only permanent and definitive correction of jowling is surgery. The most effective procedure for eliminating the jowls is the dual plane face lift. Also known as SMAS, or superficial muscular aponeurotic system, the dual plane face lift restructures the neck and face by providing a definitive pull of sagging facial and neck tissues. The SMAS layer is tightened to hoist up the skin and eliminate the jowls. This stands as the best option for correcting both superficial and structural issues as the dual plane lift is performed on the underlying muscle layer as well as the skin. To do this, the sagging muscle layer beneath the skin must be pulled up before the skin layer. 

The advantages of this include addressing all layers of tissues rather than allowing the deeper sagging tissues to remain smushed while the skin layer is pulled. Furthermore, addressing both layers allows for a gentle pulling of the skin layer for a natural appearance because the skin doesn’t need to be pulled as tight. This minimized tension is also beneficial for scarring, as the incision lines are able to heal well and prevent disfigured scarring. And finally, the facelift is permanent since all sagging tissue, superficial and deeply structural, are lifted. The results are superior and long lasting.

Cost and Pricing 

The SMAS facelift typically costs around $11,000. For those seeking less invasive options or who are suffering from less severe signs of aging, fillers or laser resurfacing may be attractive temporary fixes. The pricing is based on the amount of filler used to address the treatment area, but these options are priced around $700 for one syringe of filler, and about $2,500 for laser resurfacing treatments.

How the Procedure Works

The SMAS facelift is performed under general anesthesia, with the procedure generally lasting 2 to 4 hours. Incisions are made in the hairline above and behind the ear. The surgeon then shifts and repositions the skin and SMAS muscle separately. After the skin is lifted a short distance to allow access, the SMAS muscle layer is lifted and tightened in a separate layer. Finally, the skin is placed back down and tightened, and then excess skin is removed. 

Aftercare and Recovery 

The recovery for a SMAS facelift takes about 2-3 weeks, with the patient wearing a compression garment, neck support and drain for the first 10 days. During this, the patient may experience temporary bruising, swelling, redness, pain and discomfort. Because the incisions are made tucked behind natural folds of the skin, scarring is minimized and naturally concealed as the patient recovers. Results are fully realized in two to three months and typically last about 10 to 12 years, some changes lasting even longer. In just one procedure, patients can remove years from their face and rejuvenate their appearance.

Am I a good Candidate?

When contemplating a facelift procedure, it is important that you choose a cosmetic surgeon that is knowledgeable about facial anatomy and understands the development of facial deformities. Many surgeons fail their patients by treating the jowls on a superficial level, neglecting the underlying soft tissue and muscle that can contribute to the jowling. Skin only facelifts will not produce comprehensive results, and tend to “give in” much sooner than the dual plane lift.

Similar and Related Procedures

A deep plane facelift is a more invasive facelift that goes past the superficial tissues of the face to address deeper structural components. The procedure primarily focuses on the repositioning of muscle and fat layers below the SMAS layer, rather than skin pulling and removal. This deeper technique allows for the treatment of a wider array of aging signs such as marionette lines and nasolabial folds. The goal of the deep plane facelift is to tighten the skin and muscles of the face, jaw, and neck as a single unit to create a rejuvenated, youthful but natural look. 

The deep plane facelift is performed under general anesthesia, and takes about 2 to 5 hours to complete. Just as in the SMAS facelift, incisions are made behind the ear and along the hairline for concealed scarring. The patient’s sagging skin and muscles are lifted together in one layer, releasing the ligaments between the skin and bone to allow access to underlying fat pads. The doctor is then able to go underneath to lift underlying fat pads and tissues. The results are a lifted look in the middle portion of the face especially, giving the appearance of added volume to the cheeks and face.

Risks and Side Effects

Side effects typically include temporary redness, swelling, bruising, and soreness. Scarring is also to be expected at the incision sites, but these are typically concealed by natural folds or contours of the face. Like any other procedure, facelifts run the risk of bleeding or infection, but these are rare and virtually nonexistent in the hands of a skilled physician.

If you are interested in getting a SMAS facelift to address jowling, or even just curious if the procedure may be right for you, feel free to call us at (310) 273-3007 with any questions you have. We will be happy to assist you and provide guidance to various treatment options, whether it concerns eyebrow divots or any procedure you are considering!

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Frequently Asked Questions

What is a SMAS facelift?

The SMAS facelift is the traditional facelift that addresses the lower 2/3 of a patient’s face to lift and reposition the skin and muscle tissues. The goal of the SMAS facelift is to reverse the appearance of sagging by correcting lost skin elasticity with tightening and excess skin or fat removal.

How much does a SMAS facelift cost?

 SMAS facelifts typically cost around $11,000.

How long will the results of a SMAS facelift last?

These facelifts typically last about 10 years.

What is jowling?

 Jowling is excess skin on the lower part of the face that sags as a result of aging.

Why do I have jowls?

With age and overtime, the skin loses elasticity and collagen resulting in the droopiness of the skin.

How can I fix my jowling?

The most efficient way to address jowling is through surgery to remove the excess skin and pull up the muscles allowing for a tightened look on the lower half of the face. This is done with a facelift, to literally lift the skin and face as the name implies.

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