Is Lower Facelift Right for You? A Comprehensive Guide to Lower Face and Neck Surgery Options

By Dr Scott J Turner, Specialist Plastic Surgeon | Sydney & Brisbane

The natural ageing process affects facial structures in predictable patterns, with the lower third of the face and neck region often displaying the earliest and most pronounced changes. Tissue descent along the jawline, fullness under the chin, and the development of jowling represent concerns that many patients find particularly troublesome. While injectable treatments and skin-tightening devices offer temporary improvements for early-stage concerns, surgical intervention with lower facelift techniques provides more substantial and enduring correction for moderate to advanced facial ageing.

This guide explores who may benefit from a lower facelift, how it compares to other facelift techniques, and the factors that help determine the right approach for your concerns.

Understanding the Anatomical Basis of Lower Facial Ageing

The visible signs of ageing in the lower face stem from multiple interconnected changes occurring at different tissue depths. Understanding these mechanisms helps explain why surgical correction targets specific anatomical structures rather than simply removing excess skin.

Structural Changes Contributing to Jowl Development

Jowling occurs when facial tissues descend below the mandibular border, creating the characteristic fullness along the jawline that many patients find ageing. Several factors drive this process:

Fascial Elongation: The Superficial Musculoaponeurotic System (SMAS) is a fibromuscular layer that provides structural support for the overlying facial tissues. With age, this layer stretches and descends, carrying attached skin and subcutaneous fat with it. The SMAS connects to deeper facial muscles and serves as the primary target for surgical repositioning in SMAS facelift procedures.

Ligamentous Laxity: Retaining ligaments anchor facial soft tissues to the underlying bone and prevent descent. As these ligaments weaken over decades, they permit gravitational migration of previously supported tissues. The mandibular cutaneous ligament along the jawline plays a critical role in jowl prevention.

Volume Redistribution: Facial fat exists in discrete compartments that deflate and descend at different rates. The malar fat pad descends toward the nasolabial region while the buccal fat pad migrates inferiorly, contributing to fullness below the jawline where volume is unwanted.

Dermal Changes: Collagen and elastin degradation reduce skin elasticity, preventing tissues from maintaining their youthful position. Environmental factors, including ultraviolet exposure and smoking, accelerate these changes significantly.

Neck Region Changes

The neck presents unique ageing challenges due to the anatomy of the platysma muscle. This paired muscle runs from the clavicle to the lower face, and its medial edges separate with age, creating visible vertical bands. Deep fat accumulation, skin laxity, and muscle separation combine to produce the characteristic appearance often described as ‘turkey neck’ or neck banding. Effective lower facial surgery typically addresses these neck changes simultaneously through neck lift (platysmaplasty) techniques.

Who Is Suitable for Lower Facelift Surgery?

Appropriate candidate selection significantly influences surgical outcomes and patient satisfaction. At his Sydney and Brisbane clinics, Dr Turner assesses patients for suitability for a lower facelift based on specific patterns of facial ageing. Understanding these criteria helps patients determine whether this focused approach addresses their concerns.

Ideal Candidates for Lower Facelift

Lower facelift surgery proves most appropriate for patients presenting with ageing changes concentrated in the lower third of the face and upper neck. In contrast, the upper and mid faces remain relatively well-preserved. Ideal candidates typically demonstrate:

Established Jowl Formation: Visible tissue descent below the mandibular border creates the characteristic jowl appearance that the lower facelift specifically targets. Patients with early jowling may benefit from less extensive techniques, whereas those with moderate to severe jowl formation typically require a comprehensive lower facelift.

Loss of Jawline Definition: The smooth, continuous transition from cheek to jaw that characterises youthful appearance becomes disrupted as tissues descend. Lower facelift repositions these structures to recreate mandibular border definition.

Neck Skin Laxity: Excess skin along the neck and beneath the chin responds well to lower facelift techniques, particularly when combined with platysmal repair. Patients with significant neck redundancy benefit from the extended access provided by lower facelift incisions.

Platysmal Banding: Visible vertical bands in the neck indicate platysma muscle separation, which a lower facelift addresses through muscle repair techniques (platysmaplasty).

Satisfactory Upper Face Appearance: Patients whose brow position, eye area, and midface remain acceptable may achieve their aesthetic goals through focused lower facelift without requiring comprehensive facial surgery.

Non-Surgical Approaches

Injectable treatments, radiofrequency devices, and ultrasound technologies can produce modest improvements in skin quality and minor tightening effects. However, these treatments cannot reposition deep tissues, remove excess skin, or repair separated neck muscles. For patients with established jowling or significant neck laxity, non-surgical approaches often fall short of expectations.

Non-surgical treatments also require ongoing maintenance, with repeat sessions every few months to years—costs that may eventually exceed surgical fees while providing less correction.

Surgical Approaches

A surgical lower facelift is the right choice when jowl formation, loss of jawline definition, or neck banding cannot be adequately addressed with non-surgical methods. The decision involves weighing surgical effectiveness and longevity against recovery time and inherent risks.

Age matters less than the degree of change present. Some patients develop significant jowling in their early forties, while others maintain jawline definition into their sixties. The right time for surgery is when concerns cannot be addressed non-surgically, and you’re ready for the recovery commitment.

Distinguishing Lower Facelift from Other Facelift Procedures

The term ‘facelift’ encompasses several distinct procedures. Understanding how these techniques compare helps identify which approach best suits your concerns.

Lower Facelift Overview

A lower facelift targets the jawline, jowl region, and upper neck through SMAS manipulation and skin redraping. This focused approach suits patients whose primary concerns centre on the lower third of the face, typically including neck work to address banding and fullness under the chin.

Short Scar Facelift

The short scar facelift uses shorter incisions primarily in front of the ear, extending into the temporal hairline but not behind the ear or into the back of the scalp. This technique suits younger patients in their late thirties to forties with early to moderate ageing changes, particularly in the midface and early jowl formation.

Key Differences from Lower Facelift: Short-scar techniques incorporate meaningful SMAS manipulation—either via a high SMAS or a modified deep-plane approach—despite limited surgical access. The reduced incision length results in less visible scarring and shorter recovery periods. However, the technique sacrifices comprehensive neck correction in exchange for these benefits. Patients requiring significant neck work or those with advanced lower face ageing typically require more extensive approaches.

Best Suited For: Patients aged 35-50 with early jowling, mild neck laxity, and midface descent who prioritise minimal scarring and faster recovery over maximum correction.

SMAS Facelift

The SMAS facelift represents the foundational technique of modern facelift surgery. This approach directly addresses the SMAS layer through various methods, including folding and suturing, partial excision, or high SMAS elevation targeting the midface.

Key Differences from Lower Facelift: The term “lower facelift” often describes a SMAS-based procedure focused on the lower face and neck. The distinction lies primarily in scope—SMAS facelift can address midface concerns through high SMAS elevation, while a focused lower facelift concentrates on jawline and neck correction.

Best Suited For: Patients with moderate jowl formation, loss of jawline definition, and neck laxity who do not require the maximum correction that deeper techniques provide. Results typically last eight to twelve years.

Deep Plane Facelift

The deep-plane facelift involves dissection beneath the SMAS into deeper tissue layers, releasing the retaining ligaments that tether facial tissues. This approach enables more comprehensive lifting with reduced tension on the overlying skin, providing more natural-appearing, longer-lasting results.

Key Differences from Lower Facelift: Deep plane methodology provides more substantial correction than standard SMAS-based techniques. By releasing deeper ligaments, the surgery achieves maximum tissue repositioning. The method requires longer operative time and specialised expertise but offers superior correction for advanced ageing changes.

Best Suited For: Patients with moderate to severe facial ageing, significant midface descent, deep nasolabial folds, and substantial jowl formation. Results often persist for 10 to 15 years or longer.

Ponytail Facelift

The ponytail facelift takes an entirely different approach, placing all incisions within the hairline for complete scar concealment. This endoscopic technique focuses on the upper and midface—elevating the brow, tightening the outer eye area, and lifting descended cheek tissues.

Key Differences from Lower Facelift: The ponytail facelift does not address the jawline or neck—a fundamental distinction from lower facelift surgery. Patients with jowling or neck laxity require more formal facelift techniques. These approaches target entirely different facial zones.

Best Suited For: Patients in their thirties to early forties with early upper and midface ageing who want enhancement through concealed hairline incisions. Results typically last seven to ten years.

Face+ Signature Facelift

The Face+ Signature Facelift represents Dr Turner’s most comprehensive approach to facial ageing, combining multiple procedures into a single surgical session for complete facial correction. This technique addresses the upper face (browlift), eyes (upper and lower blepharoplasty), midface, lower face, neck, lips (lip lift), and volume restoration (fat grafting) simultaneously.

Key Differences from Lower Facelift: The Face+ Signature Facelift encompasses the lower facelift as one component within comprehensive facial correction. This approach suits patients with ageing changes affecting multiple facial zones who prefer addressing all concerns in a single procedure rather than staging treatments separately. The method requires a longer operative time (approximately 6 or more hours) and a longer recovery period than focused lower facelift approaches.

Best Suited For: Patients with comprehensive facial ageing affecting the upper face, eyes, midface, lower face, and neck who desire harmonious correction across all zones in a single surgical session.

Neck Lift as Part of Lower Facelift

All lower facelift procedures include neck correction as part of the surgery—the question is whether a traditional neck lift or deep neck lift provides the best results for your anatomy.

Traditional Neck Lift

A traditional neck lift addresses excess skin, superficial fat, and platysma muscle laxity. This approach suits patients with typical age-related neck changes, including loose skin, fat accumulation above the muscle, and visible neck bands. Results typically last seven to ten years.

Deep Neck Lift

A deep neck lift goes further, addressing structures beneath the platysma muscle. This includes removing deep fat deposits, contouring the digastric muscles, and reducing prominent submandibular glands when they create visible bulges along the jawline.

This technique suits patients with concerns beyond typical ageing—prominent glands, deep fat deposits, or inherited poor neck contour despite good weight and skin quality. Results typically last ten to fifteen years or longer.

Combining Lower Facelift with Complementary Procedures

A lower facelift is often combined with complementary procedures for comprehensive facial correction in a single surgical session. This approach allows single anaesthesia exposure and unified recovery while achieving balanced facial improvement across multiple zones.

Common additions include upper and lower blepharoplasty to address eyelid ageing, brow lift for descended brows, and lip lift for elongated upper lip. Facial fat grafting restores volume in depleted areas such as the cheeks, temples, and around the mouth, addressing the deflation component of facial ageing that lifting alone cannot correct.

The decision to combine procedures depends on individual ageing patterns, patient goals, and overall health status. Dr Turner discusses appropriate combinations during consultation, ensuring patients understand how each component contributes to the overall surgical plan and the implications for recovery duration.

Expected Longevity of Results

Well-performed lower facelift procedures typically maintain improvement for seven to fifteen years, depending on tissue quality, lifestyle, and genetics. The jowl region shows exceptional durability of correction. It’s important to understand that surgery doesn’t halt ageing—patients continue ageing from their improved starting point, remaining ahead of where they would have been without intervention.

Factors that can shorten longevity include smoking, sun exposure, and significant weight changes. Maintaining a stable weight, sun protection, and good skincare can help optimise the longevity of results.

Summary

Lower facelift surgery offers focused correction for jowling, jawline definition, and neck laxity—ideal for patients whose upper face remains well-preserved. Choosing the correct technique depends on the severity of your concerns:

• Early changes: Short scar facelift offers minimal scarring with faster recovery
• Moderate changes: SMAS facelift provides reliable correction for typical ageing
• Advanced changes: Deep plane facelift achieves maximum correction with longer-lasting results
• Upper/midface only: Ponytail facelift addresses brow and cheek concerns without jawline work
• Complete facial ageing: Face+ Signature Facelift combines all zones in one procedure

All lower facelifts include neck correction—either traditional or deep neck lift, depending on your anatomy.

Book a Consultation in Sydney or Brisbane

If you are considering lower facelift surgery, Dr Scott J Turner offers comprehensive assessments at his Sydney and Brisbane clinics. As a Specialist Plastic Surgeon specialising in facial aesthetic surgery, Dr Turner can evaluate your individual concerns and recommend the most appropriate surgical approach.

To arrange your consultation, please contact us or telephone 1300 437 758.