Board-certified plastic surgeon and NYPS Group partner Dr. Jerry Chang answers some commonly asked questions regarding jowling. For those looking to treat jowls and get a more sculpted look in the jawline area, there are plenty of treatments available. Dr. Chang was recently quoted on InStyle.com in the article How to Get Rid of Jowls, According to Experts (instyle.com)
What are jowls? What part of the face is this referring to?
Jowls are the descent of skin and/or tissue past the jawline. Typically this is posterior/behind the smile lines around the lips. A youthful jawline has a sharp mandibular border that is usually oval or heart-shaped in women, and more strong and angular in men. A sharp jawline is a youthful look, when tissue descends it squares off the face and makes it appear aged.
What causes us jowls?
The easiest way I can describe what causes jowls is any combination of these three components:
The deepest component is the tissue and fat pads of the face, which can descend with age.
The mandibular septum is the support system on top of the tissue and fat pads, it holds all the tissue in place and weakens as we get older.
Finally, as we age skin loses elasticity and droops.
Anyone of these reasons can cause jowling, but it is typically a combination of all three.
Genetics affects the elasticity of the skin and the support system. Things that can make people age faster include smoking, sun damage, as well as massive/quick weight loss. Weight loss surgery and treatments such as Ozempic are now more common and often result in fast tissue loss causing droopiness.
How can someone tell if they have jowls?
When you look at the jawline it should be a sharp straight line from the chin to the angle of the jaw. Jowling is when that line is disrupted by drooping skin and/or tissue drooping beneath that line.
When do jowls typically start to sag? What age in women? What age in men?
As mentioned, jowling can depend on genetics. That being said, women can begin to develop jowls as early as the mid to late 30s, most commonly in the 40s. In men, jowling can start from the 40s to 50s. Rapid weight loss is another factor that can impact the age at which jowling develops.
What can be done at home to treat jowls? What ingredients / products are helpful?
There are some facial exercises that are promoted which may strengthen the muscular support system, as well as topical products to help with jowling, but in all honesty, I’m not sure how much help they do. Most of the time home remedies have limited results. Gua sha stones are trending right now, it is said to increase blood flow ad collagen production which may improve tissue and skin tone. However, data on all these things is really limited.
What in-office treatments can help treat jowls?
There are three categories of in-office treatment for jowling: injectables, energy-based non-surgical modalities, and surgical options.
Injectables are the mainstays for mild jowling: Fillers such as Restylane and Juvéderm can improve tissue volume of the face which may provide a slight lift. More commonly, fillers can camouflage the jowl to reshape a sharp jawline. Sculptra is another injectable option, it is not a filler but a poly-L-lactic acid collagen stimulator that helps restore the underlying structure of the skin.
Energy-based non-surgical modalities: Overall these deliver energy, such as ultrasound, heat, infrared, radio frequency, or laser, to stimulate collagen production and skin tightening. Morpheus8 is getting a lot of traction and offers good results – but of course, results may vary.
Surgical options: In-office liposuction is a surgical procedure that can be performed in an exam room under local anesthesia, it is suitable for mild fat descent but won’t work well for individuals with very loose skin. Threads lifting is a small, minimally invasive procedure that is currently gaining popularity, however assessment is necessary. It’s worth noting that thread lifts are a more temporary solution than surgery.
What surgeries are available to help treat jowls?
Surgery such as mini facelift or full facelift remain the only modality to treat prominent and severe jowling. It addresses all three components of the causes of jowling and can last 10-15 years. Facelifts can tighten, and re-suspend the internal support system tissue, and excise loose skin.
How does one pick the best treatment for them? How does someone decide which treatment to go for?
The best course of action is to get an accurate assessment to see the cause and extent of jowling. A thorough evaluation by a board-certified plastic surgeon or facial plastic surgeon, or mid-level provider overseen by board-certified plastic surgeons is recommended. You want to have your face properly assessed and receive the appropriate treatment. There is a very individualized treatment plan for each patient.
