Case Study: Addressing Jowls and Neck Laxity with a Lower Facelift

This case study documents one patient's experience with lower facelift surgery at Shire Facial Plastic Surgery in Chattanooga, Tennessee. Dr. James R. Shire, a double board-certified facial plastic surgeon who has focused exclusively on the face for more than three decades, performed the procedure. The patient sought consultation because her appearance had begun to look tired and no longer matched how youthful and energetic she felt. Her concerns included early jowling, neck banding, and deepening marionette lines, and her goal throughout was a natural, refreshed result that preserved her own facial character. This case may be useful for prospective patients who want to understand how lower facial aging is evaluated, what the procedure involves at a structural level, and what recovery and outcomes looked like in one individual case.

Case Snapshot

Procedure: Lower facelift and neck lift

Primary Concerns: Tired appearance, jowling along the jawline, neck banding, and deepening marionette lines.

Surgical Support: Repositioning of the deeper facial tissues beneath the skin to restore youthful contours and improve lower facial support.

Overall Goal: To create a more rested, youthful appearance by improving jawline definition, reducing signs of aging in the neck, and restoring natural facial balance.

Why the Patient Considered a Lower Facelift

The patient’s main concern was that her appearance looked more tired than she felt. She noticed early heaviness in the lower face, softening along the jawline, visible neck banding, and deeper marionette lines extending from the corners of the mouth toward the jawline.

These changes can affect how rested or energetic a person appears, even when they feel well. In this case, the patient wanted improvement in the lower face and neck without losing the natural character of her face.

Consultation and Surgical Goals

During the consultation, Dr. Shire evaluated the lower face, jawline, neck, and marionette line area. A defined jawline generally has a smoother transition from the chin toward the ear. In this patient’s case, early jowling had begun to soften that contour, while neck banding and lower facial laxity contributed to the tired appearance she wanted to address.

After reviewing her concerns and goals, Dr. Shire recommended a lower facelift with neck lift support. The plan focused on improving the areas most responsible for lower facial aging while preserving a refreshed, natural-looking appearance.

Procedure Performed

A facelift, also called rhytidectomy, is designed to improve visible signs of aging in the face and neck. The American Academy of Facial Plastic and Reconstructive Surgeons lists jowls, sagging facial skin, deepening folds, and loose neck skin among the concerns facelift surgery may address. A neck lift, or lower rhytidectomy, focuses more specifically on visible signs of aging in the jawline and neck.

For this patient, the lower facelift addressed the lower face, jowls, and neck area. During surgery, the skin was elevated and the deeper underlying facial structures were repositioned to a more youthful location. The surgery took approximately three and a half hours to complete.

This deeper-tissue support is important because a natural facelift result depends on more than skin tightening alone. Repositioning the supportive facial structures can help improve contour while reducing the risk of a pulled or over-tightened appearance.

Recovery and Early Healing

Recovery progressed smoothly. The patient was able to return to work after approximately two weeks and resumed her normal daily activities within one month.

As healing continued, the improvements in her jawline and neck became increasingly apparent. These recovery details reflect this patient’s documented experience only. Recovery varies based on anatomy, the specific surgical plan, individual healing, and the post-operative guidance provided by the surgeon.

Results

The lower facelift restored a more youthful contour to the lower face while preserving the patient's natural appearance.

Before Surgery

• Tired appearance despite feeling energetic and healthy
• Early jowling along the jawline
• Neck banding
• Deepening marionette lines
• Reduced definition between the jawline and neck

After Surgery

• More defined jawline
• Improved neck contour
• Reduced appearance of neck banding
• Softer marionette lines
• More refreshed and rested appearance
• Natural-looking facial rejuvenation

The patient was extremely pleased with her results and felt her appearance better reflected how she felt on the inside. Results from facelift and neck lift surgery are individual and should not be interpreted as typical or guaranteed.

View More Facelift Before and After Photos

Additional examples are available in the Facelift Before and After Gallery. Each case should be reviewed as an individual result, since facial anatomy, surgical planning, healing, and goals vary from patient to patient.

Why Patients Choose Dr. Shire

Dr. James R. Shire is double board-certified by the American Board of Facial Plastic and Reconstructive Surgery and the American Board of Otolaryngology Head and Neck Surgery. He has spent more than three decades focused exclusively on surgical and non-surgical procedures of the face and neck, which means every aspect of his practice is oriented around facial anatomy, technique, and long-term outcomes.

His approach to lower facelift surgery centers on repositioning the deeper structural layers of the face rather than simply tightening the skin. This technique is designed to create natural-looking, long-lasting results without the overcorrected or pulled appearance that patients consistently wish to avoid.

Patients travel to his Chattanooga practice from across the region, including North Georgia, Knoxville, and Nashville. Dr. Shire and his team provide individualized care throughout the consultation, surgical, and recovery process.

Dr. Shire's Approach to Facial Balance

Successful facial rejuvenation is about more than tightening skin. Dr. Shire evaluates how each facial feature works together to create overall balance and harmony.

For facelift patients, special attention is given to the relationship between the cheeks, jawline, neck, and lower face. By repositioning the deeper facial structures that have descended with age, he is able to create results that look refreshed rather than overcorrected.

His goal is to help patients look like a more rested and youthful version of themselves while preserving the features that make them unique.

Schedule a Consultation in Chattanooga

If you feel your appearance looks tired or older than you feel, a consultation with Dr. James Shire can help you explore your options.

During your visit, Dr. Shire will evaluate your facial anatomy, discuss your concerns, and develop a personalized treatment plan designed to achieve natural-looking rejuvenation.

To request an appointment, contact Shire Facial Plastic Surgery in Chattanooga through the consultation form or call 423-870-3223.