Jowl Treatments, At A Glance
- Best Results1-3 sessions
- Treatment RecoveryImmediate
- Procedure Time20-40 minutes
- Skin SpecialistNurse injector, dermatologist
- Duration of Results2-4 years
- AnaestheticNil required
- Back to Work Immediately
The term “jowls” refers to sagging skin between the jawline & the corner of the mouth. Everyone develops jowls with maturity. It happens because your skin becomes thinner and less elastic over time. Additionally, there is bone resorption of the jawline that can worsen jowling. Fillers can provide volume replacement to the area, whilst energy-based devices can potentially tighten loose skin. In mild to moderate cases of jowls, mono or suspension threads may provide a short term solution.
FactsFacts on treating Jowls
- Jowling is due to loss of elasticity & skin support, including bone resorption
- Treatments are aimed at increasing elastin, collagen & hyaluronic acid
- Dermal fillers help support the skin by replacing loss volume
- Hyaluronic acid & collagen stimulating fillers are most widely used
- Laser resurfacing can improve skin quality with collagen contraction
- Thermage, Tempsure, Pelleve & Ultherapy can increase collagen production
- Surgical approaches are best for severe jowls
- Combination fillers, threads & energy devices can treat mild to moderate cases
What causes jowls?
Advancing age, genetics, environmental factors & weight loss all contribute to jowls.
Age. With this comes a decline in the supporting structures of the skin, namely collagen & elastic fibres. Importantly loss of bone occurs in the early 40s, leading to shrinking of the jawbone (mandible). Treatments such as dermal fillers, lasers & heating devices target this cause & rebuilds new collagen.
Genetics. Patients who have genetically thicker bundles of collagen tend to age less.
Environmental factors such as UV, smoking & pollution can contribute to jowl lines. Avoiding these triggers can reduce ageing & improve the quality of your collagen.
Weight loss. When you gain weight, skin stretches. Conversely rapid weight loss can lead to sagging of the overlying skin, giving rise to jowls.
How do you get rid of jowl lines?
There are many options for treating sagging jowls or reducing how saggy or droopy they appear. Nonsurgical procedures, such as radiofrequency, lasers, & peels, can change the composition of the collagen. Dermal fillers can be used to camouflage hollow areas around the jowls. Thread lifting is a temporary procedure that can improve mild to moderate cases of sagging & jowls.
Surgical procedures, including, face & neck lifts, can tighten your skin and make it look less saggy.
How can fillers improve jowls?
Fillers can help decrease jowls by displacing volume & providing counter traction with vectors. Sounds complex? It’s actually an easy concept to understand. Place your finger a point just below the earlobe. Now gently push back & upwards. Creation of a new jawline angle can help reduce jowls in most patients.
Another displacement vector is the cheekbone. Volume displacement can create lift. Another method is to create new lines from the angle of the jaw to the jowls, taking care NOT to add volume to the jowls. It’s all about smooth transitions & transformations. In the majority of cases, strategic use of collagen stimulating fillers can give a good improvement to the jowls.
Can lasers help tighten skin?
Lasers target the upper layers of the skin, improving skin quality & textural changes such as sun damage, pigmentation & wrinkles. Ablative laser resurfacing will also contract & stimulate collagen, indirectly improving the appearance of mild to moderate jowls. Severe jowls will not ‘lift’ with lasers nor energy devices.
If skin quality is good, lasers are not advisable. There are far more efficient & cost-effective ways to treat jowls without associated downtime. Dermal fillers can initiate collagen stimulation whilst gentle radiofrequency (see below) can effectively tighten skin.
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What is HIFU treatment?
HIFU stands for High Intensity Focused Ultrasound. This treatment is delivered through a device called Ultherapy. HIFU delivers precise energy at different levels of the dermis through ultrasound guidance.
Focused energy results in neocollagenesis or formation of new collagen. Controlled heating can also cause immediate collagen contraction. Patients who have good quality collagen (minimal sun damage-elastosis) do best. Collagen can take up to 16 weeks to remodel. In summary, patients with lax skin with a thick dermis & little sun damage do best.
How can RF treat jowls?
RF or radiofrequency can help tighten skin. This treatment can be delivered with a needle through a treatment called RFM or radiofrequency microneedling. RF can also be delivered with contact plates & an applicator. Examples include Thermage, Pelleve & Tempsure.
IMO the most predictable results are from Tempsure, as it provides heating over a longer period of time. I have had 2 Thermage devices, and whilst this device could work in some cases, this device came with associated discomfort & consumables that pushed up the price of treatment. Consumables aside, the efficacy of all RF devices is reliant on the patient’s ability to contract & remodel collagen.
Is microneedling effective?
Microneedling is a great entry level treatment for mild jowls. This treatment is known as CIT or collagen induction therapy. Microneedles can be delivered via a pen, commonly known as Dermapen or Skinpen, rollers including derma rollers or even stamps, known as dermastamping.
A sensible depth starts at 0.2 mm, with a maximal depth of 0.3 mm suggested for this treatment. Home kits are available on eBay or Amazon. Just as long as you keep the needles short, & the passes accurate, there are very little side effects.
What is RFM or radiofrequency microneedling?
RFM is a superior method of CIT (collagen induction therapy). With tiny microneedles, energy in the form of radiofrequency is dissipated to deeper levels of the dermis. Our Genius RF system has the ability to penetrate deeper into the dermal layers, delivering precise energy at all levels. Controlled & precise heating of the dermis stimulates more collagen production over regular microneedling.
The current RFM device I am using is an upgrade on the previous systems I have had, including the Intensif RF, & Infini RF.
What is thread lifting & can it treat jowls?
Thread lifting can help with mild to moderate jowling, however the longevity of threads is limited to 12-16*months at best. The most predictable results are with barbed or conical threads. PDO monofilament come in at a more reasonable price point.
Threads work by pulling on loose skin, they do not address other causes of jowls (such as volume loss). Careful consideration needs to be exercised when using threads to ensure one is a correct candidate for this procedure. Threads are frequently combined with other devices & treatments including HIFU, fillers & RF.
*Thread companies state threads last up to and sometimes beyond 12 months. I do agree that in some exceptional cases we do see longer lasting results. The majority of patients will have improvement for 3-6+ months on average.
Can fat dissolving injections be used to correct jowls?
Yes. Off label deoxycholic acid (trade name Kybella/Belkyra) can be used to treat jowls. This naturally occurring bile acid can help dissolve fat. It is used on-label as a fat dissolving agent for under-chin or submental fat.
This can be injected to the jowls with extreme caution. Downtime is about one week, with significant swelling seen. One session an give a 10-30% overall reduction in fat along the jowl area. Most patients require 2-3 sessions. There is a 5% risk that one of your facial nerves maybe damaged for up to 6 months. The risk benefit ratio of this procedure will need to be discussed in detail before contemplating injections.
What is the best treatment for moderate to severe jowls?
A deep plane facelift gives the most predictable results, followed by a short scar face lift. In some cases, if there is excessive skin, a neck lift (with or without associated liposuction) is performed at the same time. I do perform short scar or mini S face lifts, however if you have significant jowls, I would recommend seeing a plastic surgeon who regularly performs deep plane lifting. Even with face lifts, jowls may not be completely corrected.
Does weight loss cause sagging?
Rapid weight loss & weight gain can result in jowls. This is because skin expands & contracts at a rapid rate. An analogy is a table & a tablecloth. The table represents dermal & subdermal components including collagen, elastin, hyaluronic acid & fat. The tablecloth represents skin. The table shrinks with weight loss (& age), whilst the cloth remains the same. The result? Excess skin & jowling.
Hence this is why I always simultaneously stimulate connective tissue when I debulk the masseters with Botox. Rapid deflation of bulk, with weight loss or in this case with muscle relaxants, can result in overlying laxity. Plan ahead.
How does one prevent or reduce the risk of early jowling?
Be sun smart, namely reduce UV induced breakdown of collagen & elastin. Antioxidants such as ascorbic acid, retinol, tocopherol, ferulic acid & green tea can protect collagen. Collagen stimulating topicals such as retinoic acid, lactic & glycolic acid can help. Procedures such as Pelleve, Ultherapy & Tempsure can stimulate your immune system to produce collagen.
Can anti-wrinkle injections worsen jowls?
Yes, especially in the context of facial slimming or masseter muscle reduction. Decreasing muscle bulk with Botox injections will result in a narrower face, however, may predispose to jowls. This is because there is too much skin with not enough bulk, resulting in downward & forward displacement. The solution? Provide counter traction at the angle of the jawline in an anterior-posterior position (front to back)- this can tighten skin without adding bulk. Chin augmentation & strategic fillers can also provide additional skin traction.
Masseter injections should be accompanied by a skin tightening plan. In most cases I prefer the use of RF (radiofrequency) to gently heat up & contact loose skin, in turn treating jowling.
Placed strategically, muscle relaxants can reduce the activity of muscles that pull the corners of the mouth downward. This can help with mild cases of jowling.
What is the best cream for jowls?
A jowl lifting cream does not exist, however topicals including retinol & antioxidants can help build & protect collagen.
Retinoids are derived from vitamin A & work at a cellular level to promote collagen formation. Vitamin C (ascorbic acid), E (tocopherol), green tea, botanicals & ferulic acid are all antioxidants that protect collagen from UV & environmental degradation.
At what age do jowls develop & how to tell?
In the majority of cases, early jowling develops in the late 30s to mid 40s. The onset is dependent on genetics, ethnicity, in addition to environment exposure to sun, smoke & pollution.
Early signs of jowling include loss of jawline definition. Youthful jawlines will have one two angles; from the ear down & a point towards the chin. Jowls often present as ‘steps’ or ‘tiers’ along the jawline.
Davin’s take on treating jowls
Probably the number one area of concern for patients in their 40s to 50s. In most there are multiple issues including age related laxity as well as bone & fat loss. In some cases, it is increased heaviness of facial fat that contributes to jowls. Elastosis or collagen breakdown due to UV & smoking is another common cause. Treatment will depend on the contributing factors.
Injectables including dermal fillers form the mainstay of treatment. My go to filler is calcium hydroxyl apatite. This builds up the jawline area & provides traction to support the skin. Chin augmentation also provides traction, whist fillers on the cheek bone can decrease downward descent of the cheek. There is no one cookie cutter treatment modality for jowls. In some patients, dermal fillers can be used, in others, tissue tightening with devices. In severe cases, either a mini-s face lift or a deep plane lift is best. Careful examination to determine the cause/s of jowls will dictate the best treatment/s. The majority will benefit from a combination approach.
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