What are jowls?
Jowls are excess skin along the jawline and under the cheeks. They form when the skin and fat pads of the face sag, blending together the jawline and upper neck, giving the face a heavy appearance.
What causes jowling?
Jowling is a common occurrence as we age. This happens as collagen production decreases, which results in a loss of firmness and elasticity in the skin. Gravity also plays a role in pulling the skin downwards, causing it to sag. However, there are other factors that can accelerate the development of jowls, such as genetics, lifestyle, and environmental exposure.
- Weight loss and its accompanying skin sagging can lead to the formation of jowls. As we age, we naturally lose fat in our faces, causing the remaining fat pads to shift downwards, pulling the skin with it. This often results in a loss of volume in desirable areas such as the cheeks, and an increase in fat in undesired areas e.g. jowls, neck, and above the nasolabial folds.
- Muscular and bone changes. As we age, our muscles weaken and become less able to provide adequate support for our skin and fat. Additionally, bone mass can decrease, this typically begins after the age of 35, and can also contribute to jowls.
- The impact of lifestyle choices. Certain habits, such as excessive sun exposure, smoking, or frequent weight fluctuations, can exacerbate the appearance of jowls.
The best procedures to fix jowls
Effective jowl treatment begins with identifying the root cause. A skilled provider can evaluate your facial features and recommend the best course of action, which can range from face exercises to non-surgical treatments or even plastic surgery.
A multi-faceted approach will generally deliver better results than a standalone procedure. For example, combining dermal fillers with non-invasive skin tightening may produce the most optimal outcome.
Dermal filler can temporarily improve the appearance of jowls, especially in the early stages of volume loss and skin sagging. The filler can be injected into the cheeks or in front of the ears.
Another solution involves injecting fillers into the pre-jowl sulcus, the indentation that forms between the jowl and chin. This is a common area where bone loss occurs, and adding volume can help to restore a more youthful appearance.
Some practitioners prefer fillers that promote collagen production, these offer longer-lasting results (2+ years). Certain fillers can also be injected deep next to the bone to help accentuate the jawline. Achieving the best results with filler requires a thorough understanding of facial anatomy and precise injection technique, make sure to choose an experienced provider in this regard.
FaceTite utilises radiofrequency heat to firm the skin via collagen remodelling, effectively tightening the skin by 20 to 35%. It also liquefies excess fat that can be extracted via liposuction.
FaceTite typically takes around an hour to complete and is done under local anesthesia. It focuses on tightening the skin on the lower face and neck. After the skin has been treated, liposuction is used to contour the neck and eliminate stubborn fat. In a single session, you can achieve tighter skin, reduced fat, and a more defined lower face, jawline, and jowls. Recovery is also fast, taking just a few days.
With FaceTite, you will notice some immediate tightening effects. However, it may take up to a year to fully see the results, luckily, effects can endure for up to 5 years.
Ultherapy utilises ultrasound energy to heat the underlying dermal layers, tightening and raising saggy skin. This procedure is the only non-invasive process that has been granted FDA clearance by the American regulator for skin lifting on the neck, chin and eyebrows.
These ultrasound waves target the same deep dermal layers that plastic surgery would, creating a lifting and tightening effect without the need for incisions. This non-invasive treatment stimulates the production of new collagen and strengthens existing weak collagen, through the body’s regular healing process. As a result, there is no recovery time required after the procedure.
Ultherapy delivers focused ultrasound at a greater depth compared to other similar therapies. To minimize discomfort, most practitioners will also apply a topical numbing cream.
Gains from Ultherapy often persist even after several months. In a 2014 study, approximately 70% of patients still noticed improvements in their jowls three months after treatment.
A lower facelift is a surgical procedure that enhances jawline definition by removing jowls, reducing the visibility of laugh or marionette lines, and firming saggy cheeks.
Occasionally referred to as a mini facelift, the operation starts with a small incision in front of the ear extending down to the lobe. A lower facelift is typically carried out using local anesthesia and can raise saggy skin, tighten muscles and removes excess skin.
A facelift is often the best solution for treating drooping jowls. The recovery period is quick with minimal downtime and there is no need for surgical drains. Most patients are also able to exit the hospital on the same day. The incision site is discreet and scarring will not interfere with different hairstyles. The operation can also be paired with a neck lift to blend the neck and jawline seamlessly.
When it comes to eliminating jowls, a lower facelift or neck lift is the preferred option. While non-invasive devices may help tighten the skin moderately, surgery is still considered the best solution.
VASER liposuction utilises ultrasonic energy to turn fat into a liquid form, which is then suctioned out via a surgical tube. Compared to other liposuction techniques, VASER has reduced swelling, discomfort, and bruising, leading to a shorter recovery period. The energy waves selectively target fat cells without affecting the surrounding tissue.
VASER lipo offers a unique advantage, the ability to shrink the skin. It is a popular choice for older patients who do not want surgical incisions. VASER can create a defined jawline by removing fat and tightening the skin. Also, the extracted fat can be repurposed as a natural filler for the lips, nasolabial folds, and cheeks.
Facial Fat Transfer
Facial fat transfer involves taking fat from one part of the body and transplanting it to fill in the facial areas in front of the jowls. In some cases, there is tissue atrophy both at the front and back of the jawline together with diminishing volume in the jowl area. In such instances, a combination of removing fat in one area and adding fat on the sides of the jowls can help restore a youthful appearance. Fat grafting and fat aspiration alone can also be a less-invasive solution to rejuvenate the jawline in patients who are experiencing early signs of facial aging.
Facial fat transfer is deemed a safe procedure, but it does carry risks, such as hematoma, scarring, fat embolism, and the potential for facial fat necrosis.
More jowl treatments to consider
A thread lift is a non-surgical procedure where wires with small barbs or cones sit along the length and are inserted & attached to the skin, lifting saggy tissue. The threads are believed to promote the growth of natural collagen which can lead to increased skin tightness. This procedure works best for individuals with only minimal drooping.
The effectiveness of thread lifts is debated among medical professionals. Although advancements in the technology have been made in the last decade, there are still concerns regarding potential asymmetry, palpable stitches, and nerve damage.
Other doctors contend that thread lifts can provide stunning results when done by an experienced practitioner. The treatment is well-suited for the cheeks and jowls, delivering an immediate lift with minimal recovery time.
However, it's important to note that the results of a thread lift are not as long-lasting as what can be achieved through surgery. The strings will slowly disintegrate over a period of 6 months, though the increased collagen production may offer firming effects for up to a year.
Thermage utilises radiofrequency waves to tighten and raise skin in a non-surgical manner. The procedure can improve skin tightness, revitalize facial features, and boost the body's natural production of collagen.
This treatment is fast, taking less than an hour. During thermage, you may experience mild discomfort that can be reduced with a numbing cream. There is no need to take time off from normal activities as the procedure is not taxing on the body. Results may be noticeable immediately, however, full effects can take 3 to 6 months to completely develop.
Microneedling is a cosmetic procedure that involves the use of tiny needles to create small punctures in the skin. This stimulates the production of collagen, a protein that gives structure and support to the skin. With increased collagen, the skin appears smoother and firmer.
Microneedling can also be combined with radiofrequency (RF) technology for even better results. Devices with RF can remarkably improve the appearance of jowls. An RF device induces an anabolic healing reaction, leading to a significant increase in the production of collagen, elastin, and hyaluronic acid. Although the treatment is minimally invasive, patients can expect to experience some bruising and swelling for about a week.
Can topical skin care products fix jowls?
For those seeking to tighten their jowls, there are off-the-shelf skincare options available in addition to in-clinic treatments. While these products cannot provide a significant skin-tightening effect on their own, using retinoids and sunscreen can help stop jowls from worsening.
Adding antioxidants like vitamins A and C into your skincare routine can enhance collagen production in the skin. Retinol-based products, which contain compounds derived from Vitamin A, can reduce fine lines and wrinkles for a more vibrant young appearance.
To address jowling, use products that contain peptides and hyaluronic acid which enhance skin plumpness and elasticity.
Sources & Studies
Guillen Fabi, S 2015, ‘Noninvasive skin tightening: focus on new ultrasound techniques’, Clinical, Cosmetic and Investigational Dermatology, p. 47, viewed 30 January 2023, <https://www.dovepress.com/noninvasive-skin-tightening-focus-on-new-ultrasound-techniques-peer-reviewed-fulltext-article-CCID>.