Question : I live in Boston and I would like to know what you think is the best face lift technique for improving jowls.
Answer : This is a very important part of face lifting surgery. If you do not improve the jowls, the surgery is not really successful. It is important to have a vertical lift on the tissues of the lower face, especially the SMAS, the tight supporting tissue of the face that is really an extension of the platysma muscle covering the neck up onto the face. I do what is called an extended SMAS flap to accomplish this. Some surgeons do a bit more dissection forward under the SMAS to do a deep plane face lift. I do not think the added dissection adds much in most cases. Also, simply placing a few sutures in the SMAS under local anesthesia may not achieve a sufficient and long lasting lift. It is important to structure the operation to the needs of the patient. Not every patient gets the same face lift. Also, I often do some liposuction on the jowls at the time of the procedure.