Facelift (Lower Face Lift): Jowls, Techniques, Scars, Recovery and the Things Clinics Leave Out

What a facelift can change, what it cannot, how the depth of the lift affects both the result and the risk, and why teeth, jaw and neck are part of the plan.

A facelift, or lower face lift, repositions the deeper tissues of the lower face and removes excess skin. It restores the jawline, reduces jowls, lifts the corners of the mouth and brings back the oval shape of the face. It is performed through an incision in front of and behind the ear and is usually combined with a neck lift. It is performed under general anaesthetic. Most people return to social life at around two to three weeks, the final result settles over three to six months, and the scars fade over about a year.

A facelift is one of the most powerful operations in facial surgery and one where technique matters enormously. A lift that pulls only the skin looks tight and does not last. A lift that repositions the deeper layer looks natural and lasts much longer, but asks more of the surgeon. This guide explains the difference.

How the lower face ages

The lower face, from the base of the nose to under the chin, is best assessed together with the neck. The face is built in layers, from bone to skin. At certain points, strong retaining ligaments run from the bone to the skin and hold the tissues in place.

With time and gravity, the soft tissues move downwards and outwards. Where the ligaments hold firm they stay put, and between them the tissue sags. In the lower face this produces jowls: tissue spilling over the jawline beside the chin, sometimes called the "bulldog" look. The face loses its oval shape and becomes squarer. The corners of the mouth turn down, giving an unhappy or cross expression. In women, this can make the face look more masculine.

A strong, well-defined jawbone supports the soft tissues for longer, so people with a strong jaw often show these changes later. Noticeable sagging of the lower face and neck usually appears from around the age of 50, though this varies widely.

What a facelift is — and what it cannot do

A facelift lifts and secures the deeper layer of the face (the SMAS, which contains the muscles of expression) upwards and backwards. It then redrapes the skin over it and removes the excess. As a result:

• The jawline is restored and defined.
• Jowls are reduced.
• The corners of the mouth are lifted.
• The oval shape of the face returns.
• Loose, creased skin is smoothed.

When combined with a neck lift, the area under the chin and the neck are tightened too.

A facelift does not treat the upper face. Brows, upper eyelids and forehead need a brow lift or eyelid surgery. Deeper facelift techniques can include the cheek, or it can be treated with a midface lift.

It does not replace lost volume. Hollow cheeks and temples need facial fat transfer. Many facelifts combine lifting with volume.

It does not change skin quality. Fine lines, sun damage and pigmentation need skin treatments.

It cannot compensate for teeth or jaw position (see below). And it does not stop ageing.

In Dr Yıldız's words

"Teeth have a very large effect on the appearance of the lower face and the lips. In people whose teeth are not well aligned, however much we do to the superficial tissues, it will not be enough. To reach the desired result, the teeth may need to be treated first."

"Before surgery, the position of the upper and lower jaws and the teeth relative to each other is important. Some people need their bone structure corrected first, and should be assessed for jaw surgery. If the teeth are well positioned and only the bone is deficient, the bone structure can be supported with implants, filler or fat injection. A chin that sits too far forward or back can be corrected."

"Until recently, women wanted an oval face. Today a defined jawline, and to some degree a more masculine look, has become fashionable. But if the lower face is treated with too much filler, it becomes dominant, and an abnormal 'done' appearance appears, along with a harder, angrier and more masculine look."

"As men age, they look more masculine, so up to a certain point, their ageing may even be perceived as 'charismatic'."

The most important thing on this page: the depth of the lift

Facelifts differ mainly in which layer is lifted, and that decides how natural the result looks, how long it lasts and what the risks are.

Skin-only lift. Only the skin is lifted and tightened. The operation is simpler, but the result tends to look pulled and does not last, because skin stretches. It is rarely the right choice on its own.

SMAS lift. The deeper layer is tightened and repositioned, by folding, stitching or partially lifting it, without fully separating it from the tissues beneath. The skin is then redraped without tension. This gives natural, longer-lasting results with a lower risk to the facial nerves.

Deep-plane lift. The deeper layer is fully released from the tissues beneath it, including the retaining ligaments, and lifted as one unit. It can give the most complete and natural improvement, especially in the jowls, the fold beside the nose and the cheek. The branches of the facial nerve run through this area, though. Temporary weakness is more common, and permanent nerve injury, while rare, is possible.

The right choice depends on your anatomy, the degree of sagging and how you weigh result against risk. A surgeon should explain which layer they will lift and why, and be open about the trade-off.

A facelift should never make you look pulled, windswept or like someone else. The aim is to look like a rested, younger version of yourself.

Alternatives for early changes

Thread lifts. When sagging is mild, suspension with permanent or dissolvable threads can give a worthwhile improvement. It is more modest and less long-lasting than surgery, and threads can cause dimpling, visible or palpable threads and asymmetry.

Filler or fat. Adding definition to the jawline and chin can postpone surgery in people whose lower face is not heavy. Overdoing it makes the lower face dominant and "done", and can look harder and more masculine.

Chin or jaw support. Where bone structure is deficient, a chin implant, fat or filler can strengthen the jawline. Where the jaw or bite is significantly out of position, orthodontic or jaw surgery assessment may come first.

Who performs your surgery

Your facelift is planned and performed by Op. Dr. Feryal Yıldız, a specialist in plastic, reconstructive and aesthetic surgery. She qualified from Ege University Faculty of Medicine in 2013 and completed her specialist training at Istanbul University–Cerrahpaşa Faculty of Medicine in 2018. In 2017 she attended the New York University Hansjörg Wyss Department of Plastic Surgery and the private practice programme of Prof. Daniel C. Baker in New York, where she gained experience in facial aesthetic surgery and particularly facelifting.

[TO CONFIRM — Dr Yıldız to approve this wording]

Who this suits

A facelift suits adults with jowls, loss of jawline definition, downturned mouth corners and loose skin in the lower face and neck, usually from their late forties or fifties onwards. You need to be healthy enough for general anaesthetic, with any medical conditions well controlled.

Blood pressure. Because facelifts are usually done later in life, other medical conditions are more common. High blood pressure in particular raises the risk of bleeding after surgery, so it should be assessed and controlled beforehand.

Smoking and diabetes. Both affect the small blood vessels that nourish the lifted skin, delaying healing and making scars more visible. Stop smoking well before and after surgery, as instructed. Diabetes should be well controlled.

Teeth and bite. These should be assessed, and corrected first if needed.

Realistic expectations matter most: a fresher, younger version of your own face.

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Scars

The incision starts in front of the ear, often following its natural contour, runs around the earlobe and behind the ear, and, when combined with a neck lift, continues into the hair or along the hairline at the back. There is often a short incision under the chin for the neck.

The scars are permanent, but the face heals better than most parts of the body, and they usually fade to fine lines within about a year. They heal less well in smokers and people with diabetes. Careful placement also protects the hairline, the sideburn and the shape of the earlobe, so that the scars can be hidden and the lift does not reveal itself.

The operation and the first weeks

A facelift is performed under general anaesthetic. It usually takes three to five hours, longer when combined with other procedures. Most patients stay one night, so that bleeding can be checked in the first hours.

After surgery, the face and neck feel tight, swollen and numb, and bruising can spread down the neck. Discomfort is usually moderate and controlled with painkillers.

After surgery:

• Keep your head raised, including while sleeping, for the first one to two weeks.
• Wear the dressing or garment as instructed.
• Avoid turning or bending your neck sharply. Turn your whole body instead.
• Keep your blood pressure controlled, and avoid straining, bending and heavy lifting.
• Avoid strenuous exercise for about four weeks.
• Wash your hair only when and how you are told.
• Avoid hair colouring and heated styling tools until you are cleared.
• Protect the face and scars from sun.
• Do not smoke.

Contact the clinic urgently if you notice rapidly increasing swelling, tightness or pain on one side of the face or neck. This can signal bleeding under the skin, which is the most important early complication and may need a return to theatre.

[TO CONFIRM — Dr Yıldız's usual hospital stay, drain use, and dressing protocol]

The recovery timeline

Days 1–3. Swelling, tightness and bruising are at their peak. You stay overnight for monitoring, then rest at home with your head raised.

Week 1. Swelling is easing. Stitches are removed from around days five to ten.

Weeks 2–3. Most people return to social life and work. Residual bruising can be covered with make-up, and hair can hide the scars.

Weeks 3–6. Light exercise resumes, then full exercise when cleared. The face may still feel firm or lumpy in places.

Months 3–6. Swelling fully settles, and the final result appears. Numbness of the cheeks and ears gradually improves.

Up to 12 months. The scars mature and fade.

How long it lasts

A well-performed facelift that repositions the deeper layer gives a long-lasting result, often around ten years or more. The face continues to age afterwards, but it will look younger than it would have without surgery. Skin-only lifts fade much sooner. Sun protection, a stable weight and not smoking help preserve the result.

Risks and complications

No operation is risk-free, and a page that leaves this section out is not worth trusting. The recognised risks of a facelift include:

Haematoma. A collection of blood under the skin is the most common significant complication, usually in the first 24 hours, and may need a return to theatre. The risk is higher with high blood pressure and in men.

Facial nerve injury. Weakness of part of the face, affecting the smile, lip or brow. It is usually temporary. Permanent injury is rare, and the risk is higher with deep-plane techniques.

Skin loss or delayed healing, particularly behind the ear. It is much more likely in smokers and people with diabetes.

Visible or widened scars, a shifted hairline or sideburn, or a pulled-down earlobe.

A pulled or unnatural look, if the lift is too tight or in the wrong direction.

Asymmetry.

Numbness of the cheeks and ears. It is usually temporary.

Prolonged swelling or firmness.

Hair loss around the incisions. It is usually temporary.

Infection. It is uncommon.

Recurrence. Gradual settling over time is expected.

Blood clots, and anaesthetic risks.

Further surgery, for any of the above.

Combining a facelift with other procedures

A facelift is most often combined with a neck lift. It is also commonly combined with a midface lift, brow lift, eyelid surgery, facial fat transfer for volume, a lip lift, or chin augmentation. Combining procedures lengthens the operation, so the plan balances what is achieved in one session against safety.

If you are travelling to Istanbul for surgery

Patients come to us from the UK, Ireland, Germany, France, the Gulf and elsewhere. Travelling for surgery is a reasonable decision, and it needs more planning than surgery at home.

Assessment. Skin, deeper tissues, jowls, neck, bone structure and teeth all shape the plan, and your blood pressure and general health are checked. This assessment must be made in person.

How long to stay. Plan to stay until stitches are removed and your face has been reviewed, typically about ten days. For international patients undergoing surgery with Dr. Feryal Yıldız, we recommend staying in Istanbul for at least one week after the procedure to allow time for early recovery and postoperative follow-up.

Flying. Keep your head raised, stay hydrated, walk the aisle regularly, and avoid heavy luggage.

Expect to go home swollen. Plan events and photographs for at least six weeks after surgery, and ideally three months.

Aftercare at home. Arrange who will review your healing once you are home. Health systems in your home country are generally under no obligation to provide routine aftercare or revision for private surgery performed abroad, though they will treat a genuine emergency.

Revision terms in writing. Agree in advance what happens if the result needs further treatment: who performs it, where, and who pays.

Your records. Take home your operation note and your discharge instructions.

Choosing a surgeon

Check the qualification, not the adjective. Ask which specialist register the surgeon is on, in which country, and verify it independently.

Ask which layer they lift, SMAS or deep plane, and why that one for you. Be cautious of skin-only lifts.

Ask about the risk to the facial nerves with their technique.

Ask whether you also need a neck lift, midface lift, volume or chin support, and whether your teeth or jaw affect the plan.

Ask to see results at a year or more, including with the hair tied back.

Ask how they manage bleeding risk and blood pressure around surgery.

Ask who will be operating on the day.

Be wary of pressure. Time-limited pricing, a decision expected on the day, or surgery packaged with sightseeing all suggest that commercial priorities come before clinical ones.

Frequently asked questions

What is a lower face lift?
Another name for a facelift. It lifts the tissues of the lower face to restore the jawline, reduce jowls and lift the mouth corners, and is usually combined with a neck lift.

What is the difference between an SMAS facelift and a deep-plane facelift?
An SMAS facelift tightens and repositions the deeper layer without fully releasing it. A deep-plane facelift fully releases and lifts it. Deep plane can give a more complete result but carries a higher risk to the facial nerves.

What is a mini facelift?
A lift with shorter incisions and less dissection, suited to early jowling. It gives a more limited, shorter-lived result than a full facelift.

Do I need a facelift or a neck lift?
If you have jowls as well as neck changes, you usually need both, and they are commonly done together.

Where are the scars?
In front of the ear, around the earlobe and behind the ear, continuing into the hair or hairline when combined with a neck lift. They usually fade to fine lines within a year.

How long does recovery take?
Most people return to social life at two to three weeks. The final result appears at three to six months.

Is a facelift painful?
Most people describe tightness and soreness rather than significant pain, controlled with painkillers.

How long does a facelift last?
A lift that repositions the deeper layer often lasts around ten years or more. The face continues to age, but it will look younger than it would have without surgery.

What is the best age for a facelift?
There is no fixed age. Most people are in their late forties to sixties, when jowls and neck changes become noticeable.

Can threads or filler replace a facelift?
For mild sagging, threads or careful filler can help and may postpone surgery. They cannot match a facelift once jowls and loose skin are established, and too much filler makes the lower face look heavy and "done".

Will I look different?
You should look like a fresher, younger version of yourself, not like someone else. A pulled or windswept look is a sign of the wrong technique or too much tension.

Can it be combined with other procedures?
Yes. It is most often combined with a neck lift, and also with eyelid surgery, a brow or midface lift, fat transfer, a lip lift or chin augmentation.

Arranging a consultation

If you are considering a facelift, the useful next step is a proper assessment. That means an examination of your face, neck, bone structure and teeth, an honest answer to which layer should be lifted and why, and a clear explanation of the scars, recovery and risks.

You are welcome to contact the clinic to arrange a consultation with Op. Dr. Feryal Yıldız. There is no obligation to proceed, and you should not be asked to decide on the day.

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