Sagging is the manifestation of aging through a number of mechanisms. First, your skin and soft tissue lose volume, thereby causing you to "deflate" in certain regions of your face, therefore causing the redundant skin to sag. Second, the skin itself loses the tightness and elasiticity exhibited during youth because of sun damage and the loss of dermal matrix. Third, weight gain can result in fat being preferentially gained in areas that have sagged already. Fourth, some sagging in the jowl area may be related to overactive frown muscles that cause wrinkles and bulges around the mouth.
Several options for nonsurgical treatment of sagging jowls exist in my practice.
To tighten sagging skin without surgery, I routinely employ Aluma, a noninvasive radiofrequency soft-tissue tightening technology that is nonpainful and involves no down time. Treatments are performed every 1-2 weeks for 6-8 treatments and result in significant reduction of sagging facial folds, crepy skin, and wrinkles. The Aluma treatment causes collagen rearrrangment and realignment, providing tighening of the skin and underlying soft tissue. Positive changes continue even after completion of all treatment sessions, with improvement continuing over 6 months and lasting for 2-4 years. One or two extra treatments every subsequent year to maintain tightness is recommended.
As jowls may be simply the manifestation of the leftover of volume depletion in the face, I will also perform fillers (and/or fat grafting treatments) in the areas around the jowl to augment the surrounding "valleys" of the face that exists in front of the "peaks" of the jowl.
For sagging related to muscle-related wrinkles and bulges, I will also employ Botox to relax muscle areas that are overacting. Other wrinkles can also be significantly improved with fractional laser resurfacing.
Fat maldistribution in sagging areas can be strategically remove using minor liposuction performed under local anesthesia.
The above nonsurgical or minimally invasive treatments can be performed singly or in any combination to provide synergistic effects. In my experience, combination therapy can in fact provide dramatic results that would restore a jaw line to the the youthful look of yesteryear without going under the knife.
