A lower facelift is a cosmetic surgical procedure that targets sagging and loose skin from the cheekbones down to the jawline. It’s designed to address jowling, a softened jawline, and the deep lines that run from the corners of the mouth to the chin (called marionette lines). Unlike a full facelift, which also treats the neck and mid-face, a lower facelift focuses specifically on restoring definition to the lower third of the face.
What a Lower Facelift Targets
The procedure zeroes in on the area between the cheekbones and the jaw. The main concerns it addresses are jowls (the pockets of sagging skin and fat that develop along the jawline), a less defined jawline, and deepening marionette lines. If your primary frustration is that your jawline has lost its crispness or your lower cheeks have started to droop, this is the procedure built for that specific problem.
A lower facelift does not typically address neck wrinkles or banding, forehead lines, or sagging around the eyes. For neck concerns, a full facelift or a separate neck lift is usually needed. The full facelift is a more invasive procedure that smooths and tightens the mid-to-lower face and neck together, with incisions extending further behind the ears.
How the Surgery Works
The surgeon makes small incisions along the hairline in front of each ear. Through these incisions, the skin and underlying tissue are lifted, repositioned, and tightened. Excess skin is trimmed, and the incisions are closed in locations designed to be hidden by the natural contours of the ear and hairline. When done well, scars are nearly invisible. Poorly placed incisions, on the other hand, can leave telltale signs like unnatural-looking earlobes, visible lines in front of the ear, or a pulled-back hairline.
There are two main approaches to what happens beneath the skin, and they differ in depth. The first technique lifts and repositions a layer of tissue just below the skin’s surface, a fibrous and fatty layer that acts like a scaffolding for your facial features. The surgeon tightens this layer by folding or stitching it into a new position without detaching the deeper ligaments of the face. This typically takes three to four hours under anesthesia.
The second approach, called a deep plane lift, goes further. The surgeon releases certain facial ligaments and repositions the deeper muscles and connective tissue as a single unit. Because it moves everything together rather than pulling the skin separately from the structures underneath, results tend to look more natural and last longer. The trade-off is a more involved surgery and slightly longer recovery. Your surgeon’s recommendation between these approaches depends on how much laxity you have and your facial anatomy.
Who Is a Good Candidate
Most people start noticing the changes a lower facelift corrects in their 40s: early jowling along the jawline, deeper nasolabial folds, and the beginning of loose skin along the lower face. Non-surgical treatments like fillers and muscle-relaxing injections can help with volume loss and fine wrinkles, but once there’s true tissue laxity and sagging, those treatments can only do so much.
Skin quality matters as much as age. Thick, elastic skin responds better to surgery regardless of how old you are. Thin, sun-damaged skin can still benefit, but the approach and expectations may need to be adjusted. During a consultation, a surgeon will assess your skin quality, degree of aging, facial anatomy, and overall health to determine whether you’re a good fit.
People who get the procedure earlier in the aging process, say in their 50s rather than their 70s, tend to get more years out of their results. As one Cleveland Clinic surgeon put it, the sooner the procedure is done once aging has occurred, the longer lasting and more natural the outcome tends to be.
Recovery Timeline
The first few days after surgery involve noticeable swelling and bruising, which typically peak around days three and four. By days four through six, swelling starts to go down, and light housework is often manageable if you feel up to it.
During the second week, some swelling and bruising linger, but many people feel well enough to return to work and start light activities like walking by around day 14. Sutures are removed anywhere from the end of the first week to the third week, depending on how your healing progresses.
Weeks three and four bring significant improvement. You may still feel some tightness and have residual swelling, but most outward signs of surgery have faded enough that other people won’t notice. By the one-month mark, most people are back to normal activities, including exercise, and are enjoying visible results.
How Long Results Last
Surgical results from a facelift can last up to 10 years for some people, though the range varies. Skin elasticity at the time of surgery is the biggest factor. Patients with more elastic skin at the time of the procedure simply get more mileage from it. Aging doesn’t stop after a facelift, but the clock has effectively been turned back, so you’ll continue to look younger than you would have without the procedure.
People who are older at the time of surgery tend to see the return of sagging and wrinkles sooner. This is one reason some surgeons recommend not waiting too long once aging changes become bothersome.
Risks and Complications
The most common side effects are swelling, bruising, and discomfort, all of which are expected and temporary. More serious but less common complications include hematoma (a collection of blood under the skin), infection, visible scarring, and skin necrosis.
Nerve injury is the complication that concerns most patients. A large meta-analysis of facelift studies found that overall nerve damage rates are low: about 0.66% for motor nerves (the ones that control facial movement) and 0.39% for sensory nerves (the ones that control feeling). Permanent nerve damage is rarer still, occurring in fewer than 0.1% of cases for both motor and sensory nerves. Temporary numbness or stiffness in the weeks after surgery is common and resolves on its own for the vast majority of patients.
Preparing for Surgery
If you smoke, you’ll need to stop at least four weeks before surgery. Smoking constricts blood vessels and significantly increases the risk of poor wound healing, skin necrosis, and other complications. Some surgeons will test your blood for nicotine byproducts to confirm you’ve actually quit, since patient self-reporting is notoriously unreliable on this point.
You’ll also need to stop taking blood-thinning medications and supplements (like aspirin, ibuprofen, and fish oil) in the weeks leading up to the procedure. Your surgeon’s office will provide a specific list and timeline. Pre-surgical blood work and a health screening are standard to make sure you’re safe for anesthesia.
Non-Surgical Alternatives
For people who aren’t ready for surgery or whose aging is mild, several non-surgical options target the lower face. Dermal fillers made of hyaluronic acid can restore lost volume along the jawline and smooth out marionette lines, though results typically last six months to a year. Muscle-relaxing injections can soften certain wrinkles and last about three months. Providers performed over 13 million minimally invasive cosmetic procedures in the U.S. in 2020, with the majority focused on the face.
The key difference is durability. Non-surgical treatments deliver short-term results that require regular maintenance appointments. A lower facelift is a larger upfront commitment in both recovery and cost, but it produces a more dramatic and longer-lasting change. Non-surgical options work best for early or mild aging, while surgery is better suited to true sagging and tissue laxity that fillers can’t correct.
Cost
The average surgeon’s fee for a facelift is $11,395, according to the American Society of Plastic Surgeons. That figure covers only the surgeon’s time. The total bill also includes anesthesia, the surgical facility, prescriptions, post-surgery garments, and any required medical tests. Depending on your location and the complexity of the procedure, the all-in cost can run significantly higher. A lower facelift that’s less extensive than a full facelift may cost less, but pricing varies widely by surgeon and region. Cosmetic facelifts are not covered by insurance.