Jowls, nasolabial folds, and neck sagging tend to develop around the same time, and this is due to anatomy. All three trace back to a single cause: facial fat shifts downward, skin loses its elasticity, and deeper structural layers gradually give way. A facelift is designed to address all three at once because it works at the structural level where aging begins.
Dr. Daniel Shapiro, MD, FACS, a board-certified plastic surgeon with more than 30 years of experience and Newsweek recognition as one of America's Best Facelift Surgeons, has built his practice on exactly this kind of comprehensive result. Read on as he breaks down the anatomy behind these changes and how a single procedure can address them all.
Three Signs of the Same Aging Process
These concerns may look distinct in the mirror, but they share the same origin. Cheek fat that once sat high gradually migrates downward. Skin thins and loses the elasticity that once held it in place. Deeper tissue layers relax and descend, pulling the surface along with them. The result shows up in predictable places:
- Jowls: Descended fat accumulates along and below the jawline, softening the jaw's once-defined contour
- Nasolabial folds: Falling cheek volume deepens the crease from the nose to the corners of the mouth
- Neck sagging: Loosened platysma muscle bands and excess skin gather below the chin and along the neck
Because all three stem from the same process, addressing them together tends to produce a more cohesive and natural result than targeting each separately.
What a Facelift Actually Corrects
The difference between a great facelift and an obvious one comes down to depth. Pulling skin alone creates artificial tension, producing the overstretched appearance patients most want to avoid.
Dr. Shapiro works at the level of the SMAS (superficial musculoaponeurotic system), the fibromuscular layer beneath the skin that connects to the underlying facial muscles and is central to how the face ages. Repositioning this layer lifts descended cheek fat back toward the cheekbones, restores definition along the jawline, and corrects jowling without stretching the skin. Nasolabial folds may also soften as the midface returns to its natural position, and the platysma muscle in the neck can be tightened through the same incisions.
For patients with more pronounced neck laxity, Dr. Shapiro may recommend pairing the facelift with a dedicated neck lift to fully restore the angle between the chin and neck.
When Volume Loss Requires a Separate Solution
A facelift repositions existing tissue. Patients with significant volume loss in the cheeks or around the mouth may find that nasolabial folds persist even after a successful lift, because the underlying deficit was not addressed.
Facial fat transfer resolves this by restoring volume to depleted areas, complementing the structural correction with added fullness. Dr. Shapiro evaluates each patient's anatomy individually and recommends only what is genuinely needed for a balanced, lasting result.
Comprehensive Facelift Results with Dr. Shapiro, MD, FACS
Correcting jowls, nasolabial folds, and neck sagging in a single procedure takes technical skill and the kind of aesthetic judgment that only comes with decades of focused practice. Recognized by Newsweek as one of America's Best Facelift Surgeons and an Adjunct Assistant Professor of Plastic Surgery at the Mayo Clinic in Rochester, Dr. Shapiro has spent more than 30 years developing both. To put that experience to work for you, contact Shapiro Aesthetic Plastic Surgery & Skin Klinic to schedule a consultation today.
This information is provided for educational purposes only and does not replace a consultation with a board-certified plastic surgeon. Outcomes, risks, and suitability vary from patient to patient.
