Expert Doctor

Lower Facelifts

Posted January 30, 2017
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Karen Horton, MD

San Francisco, CA

Lower Facelifts

A lower facelift rejuvenates the face and essentially starts with the cheekbones and ends at the bottom of the neck. It does not address the upper face so it does not improve the eyes or the forehead. Sometimes a lower facelift involves a combination of liposuction and some soft tissue suspension.

A lower facelift and a neck lift are essentially the same because the lower face and the neck are continuous. One goes into the other. What bothers both women and men as they age are the eye region and the neck region. The advent of cellphones and selfies and constantly looking down has started to cause some drooping issues.

As people age, they lose volume in the upper face and develop hollows under the eyes and in the temple area. The lower face begins to descend so there is a downward vector of aging. A lower facelift or a neck lift resuspends the soft tissues to a position where they are more youthful. They also treat the jowls, resuspend any extra skin, and remove extra fat under the chin region.



The average patient for a neck lift or a lower facelift is someone in their 50s or 60s. They tend to be people whose bodies are physically fit. They have contoured everything else they can with a healthy diet and regular exercise. The one thing they notice when they look in the mirror is the neck because it is often the neck that really gives away aging. That is not something that diet or exercise or anything non-surgical can address. Some patients can start with nonsurgical options and others have to go straight to surgical choices. In the neck region, there are not many non-surgical options that are effective. There is skin care, Intense Pulsed Light, and some peels that can help with skin quality but it is usually best for patients to do the neck lift and not constantly spend money on treatments they will have to do multiple times.



SMAS stands for submuscular aponeurotic system and it is a connective tissue network of the muscles and the fats. Everything is basically continuous from the frontalis muscle in the forehead all the way down to the platysma muscle which can make bands on the lower neck. All of the facial expression muscles are interconnected. The SMAS is addressed by minimal access cranial suspension or MACS (minimal-access cranial suspension). It addresses the SMAS like a SMAS neck lift but it puts a per string suture in the most superficial layer of the SMAS to resuspend the SMAS. Instead of cutting it or placating it or folding it, the technique resuspends it to a fixed area and the upward vector and has a permanent resuspension.



There are many different techniques available these days. One technique focuses on the subcutaneous fat while another is a deep plane facelift that goes under the fat and right over the bone. Every five to ten years, plastic surgery changes as more doctors figure out exactly what happens when people age.



The most common risk when it comes to a facelift is hematoma which is a collection of blood under the skin and is a wound healing problem. For that reason, most plastic surgeons do not want to operate on smokers or anybody with high blood pressure because smoking and high blood pressure can predispose people to have wound healing issues.

Probably the most devastating complication with a facelift is facial nerve injury. The facial nerve comes out in front of the ear and splits into five major branches. It is the muscle that provides power to the muscles of facial expression. Some of the techniques go a little bit deeper into the SMAS and are at risk of injuring the facial nerve. A facial nerve injury can cause paralysis on one side of the face in the most extreme situations.

The most common branch of the facial nerve is called the marginal mandibular nerve and it is the branch of the nerve that goes to the lower lip. An injury to it can cause permanent damage to the facial nerve.

When a patient has a facial nerve injury from a lower facelift, the initial treatment is always going to be conservative. Usually a nerve injury is just a bruise. There can be swelling around the nerve but it tends to be temporary. The body needs up to a full year to recover. During the recovery, the muscles to the lower lips are weaker on one side so the doctor can inject some Botox on the other side to even things out as the nerve recovers. In the worst case scenario, there is permanent weakness on one side of the lower lip.



After any surgery with the face, there is going to be some social downtime. That means no going out, no working, or having dinner dates. The social downtime is two to three weeks because there will be some swelling and bruising. Patients cannot exercise for at least four to six weeks. It takes three months to a year for the swelling to go down, the scars to mature, and the final results to be visible.



When a person has a lower facelift or neck lift, the results are permanent. It is usually a one-time procedure without any need to have it redone.

If patients continue to have a lot of sun exposure or major weight fluctuations, it can interfere with the skin quality or the skin tone. Patients who put on a lot of weight will not ruin the results. If people lose a lot of weight from the neck down, their body tends to look fantastic. Losing a lot of weight from the neck up can make a person look older as opposed to heavier people whose face can still look youthful.



A lower facelift is a great procedure with lifelong results. Adding some non-surgical cosmetic treatments like filler or peels and IPLs can enhance the results and help the patient have a youthful lower face and neck for the rest of their life. In general, a lower facelift or a neck lift will give lasting results as long as it is performed by a Board-Certified Plastic Surgeon with proper training and experience.


Written by Cosmetic Town Editorial Team- MA

Based on an exclusive interview with Karen Horton, MD in San Francisco, CA

Article Last Updated on January 30, 2017