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.

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. 

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.

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.

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. I have largely replaced suspension thread with PDO monos. PDOs tend to last 9-14 months. Our team has a special method of thread application known as ‘vector lifting.’

This group of injectables can treat mild to moderate cases of jowls by increasing the collagen production in key areas. 2-4 sessions are required for best outcomes.

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.

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.

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.

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.

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.

A jowl lifting cream does not exist, however topicals including retinol & antioxidants can help build & protect collagen.

Retinoids such as tretinoin 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.

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.