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How do I get rid of my sagging jowls? (Photo)

Hello there! I'm only 23 and have sagging jowls. It runs in my family! I guess I thought I would be in my 50's before I got them, but that's not the case. I'm not sure what to do about it! I don't think I want to resort to plastic surgery, being that I'm only 23. But I'm extremely self-conscience about them. I'm getting married in August and was wondering if there's anything that would help? What's my best bet for improvement with invasive surgeries? Please help!! Clarissa

Doctor Answers (21)

Getting rid of sagging jowls at age 23

+2
Dear Godislove, I sympathise with you having to consider a facelift when you are so young. However you are not alone. The time when a facelift is required depends on the laxity affecting facial shape and is not based on biological age. This varies from person to person and tends to follow your genetics unless there has been significant weight loss, which accelerates the  aging look as a result of laxity. Your problem is not to do with skin elasticity, you don't have wrinkles, which people think are the reason for a facelift. But you have laxity with sagging, the proper reason for having a facelift.
A proper facelift, is one that properly corrects the internal support layer without any direct pull on the skin. Avoidance of skin tension on the incision is essential for a good scar, that is one that is invisible; but this is critical for a younger person having a facelift (under 40) because younger skin has more elasticity that tends to stretch the incision so the scar widens to be visible.
One doctor correctly pointed out the prejowl hollow, that is the significant hollow of the jawine between the jaw proper and the chin. This is a structural predisposition to showing jowls. For you to have a good result requires correction of the bone with a bone like implant placed at the same time as your facelift. Then you would have a good and lasting result.
Some other suggestions offered, (fat injections, skin tightening) are simply too minimal to make a worthwhile difference as they do not address the anatomical situation.


Melbourne Plastic Surgeon
5.0 out of 5 stars 18 reviews

Jowl Managrment

+2
I agree with the many other surgeon responses to your question. A 23 year old with jowls is not common. Have you experienced massive weight loss? In order to give you the best answer, it would be helpful to have more photos or a chance to examine you. Jowls are caused by a multitude of factors: relative skin excess, inadequate fat support, inadequate bone support. 
My approach to your problem would be staged: improve the bone support with cheek and chin implants; thicken the skin and fill depressions with fat grafting; remove redundant skin with face lift. The sequence of procedures will depend on your time frame. With your wedding around the corner, I would recommend staying conservative for now. 
Good luck and be well. 

Morgan E. Norris, MD, FACS
Houston Plastic Surgeon
4.5 out of 5 stars 18 reviews

Jowls

+2
Hello, pictures are not that good, but from what I can see, more than sagging jowls you have big cheeks, and a little fat in the jowl. There is a fat pad inside the cheek, it may be removed to diminish a bit your puffy cheek appearance, and maybe a little lipo to accent the border of your mandible. It can't be seen very well, but it looks like you have a small chin also, it can be augmented in three ways: an small chin implant, fat transfer, or with hialuronic acid fillers. Of the three, I like the chin implant better, it's easy to insert, and immediately will give you the beautiful contour you seek; and all can be done with local anesthesia and sedation. Talk to your plastic surgeon to evaluate your options. Good luck

Jose A. Leon, MD
Dominican Republic Plastic Surgeon
5.0 out of 5 stars 8 reviews

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Rare indication for upper facelift in a young patient.

+1
The picture in a 23 y/o s most unexpected.  I think the proper solution would be an upper facelift.  You could have this done without general anesthesia.

Vincent N. Zubowicz, MD
Atlanta Plastic Surgeon
4.5 out of 5 stars 10 reviews

Sagging jowls

+1
Dear,

In my opinion an anatomic chin implant will solve 80% of the problem. I have to say in my experience that chin implant surgery is maybe the noblest, simplest, most rewarding and less noticeable procedure in face plastic surgery. You will get an immediate more balanced face and defined jawline. Also your neck improves.
I said 80% of the problem because you do have sagging. 

Surgery should always be the last option even in Aesthetic. In case that surgery is the only or best choice so try to get the less invasive treatment with maximal result. 

I think you will very happy with an anatomical chin implant. In case you don´t you can get a facelift late on but remember that facelift surgery  is a delicated procedure with possible complications or revisions even in the more experinced hands  than a simple chin implant. For me this is the most inteligent decision here for this young patient.

Good luck!

Andres Freschi, MD
Argentina Plastic Surgeon
5.0 out of 5 stars 1 review

Botox may help jowls in a 23-year-old person

+1
Botox injected into the DAO (Depressor Anguli Oris) muscle may decrease the downward pole on your mouth and improve the jowling.  You are too young for a facelift.

Brooke R. Seckel, MD, FACS
Boston Plastic Surgeon
5.0 out of 5 stars 37 reviews

I'm 23 years old, do I need a facelift?

+1
23 years old is very young to benefit from a facelift. From the pictures that you have provided, you appear to have some hollowing in the pre-jowl region as well as in the cheek. I would consider a non-invasive facial tightening procedure as has been previously mentioned such as ultherapy as well as a dermal filler to add some volume. Consult with a couple of experienced facial plastic surgeons to get a variety of options.

Todd C. Miller, MD
Orange County Facial Plastic Surgeon
5.0 out of 5 stars 16 reviews

Jowls at age 23

+1
You're right, it is unusual to have jowls at 23 years of age. This can happen in cases of massive or rapid weight loss, connective tissue disorders, or due to genetics like you said. Assuming there are no contraindications to treatment, at your age I would advise starting with non-invasive treatments. The first option would probably be Ultherapy to your face (and neck, if that skin is loose too). This is an ultrasound treatment that lifts and tightens, and has minimal risks. The results appear gradually and you don't see the effects until a few months after the treatment. While it's often called a one-time treatment, if you have good results and want to see more of an effect, you have the option of repeating it (just wait at least 6 months before repeating). If you want to see something more immediate, you can have fillers placed in the "pre-jowl" area, which is where you see that shadow in your photos. The jowling is more noticable because of the relative lack of volume in the area just in front of it, so if you fill this then the jowl would blend better and be less noticable. It may make the lower face look "heavier" in a sense though. It is hard to give real advice based on 2 partial photos and minimal history, and the recommendations may change once you are evaluated in person. In terms of surgery, the classic way to fix jowls is to have a lower facelift. Since it is February, and you are getting married in August (6 months away), I would say start with the Ultherapy, and in 3 months if you don't see enough improvement, consider doing fillers to the prejowls. It will give you enough time to see if you like the filler, and add more if needed (or dissolve it if you didn't like it) well before your wedding. You don't want to do treatments right before your big day because if you get any bruising or side effects, you want to give enough time for them to pass so that you are photo-ready.


Anita Patel, MD
Beverly Hills Plastic Surgeon
4.5 out of 5 stars 12 reviews

Best treatment for Jowls

+1
I would agree that because of your age that you are not yet an candidate for a facelift procedure.  There are, however, less invasive alternatives that will help minimize the appearance of the jowls.  Fillers in the pre-jowl area and along the chin can significantly reduce the appearance of the jowls.  Liposuction in certain circumstances can also reduce the jowling, however, care must be taken when liposuction on the cheeks is performed as this is a very unforgiving area.  I believe that fat transfers provide the longest lasting results.

Robert M. Jensen, MD
Medford Plastic Surgeon
4.5 out of 5 stars 21 reviews

Jowling at age 23

+1
Your jawline is disrupted by deep trough right in front of the jowl - an area called the pre-jowl. If this is not appreciated and treated, any procedure will be disappointing to you and your surgeon.
Appropriate options include inectable fillers, prejowl implant. I would discourage you from starting with a facelift as these other treatments will be more successful and are less invasive.

Frank P. Fechner, MD
Worcester Facial Plastic Surgeon
4.5 out of 5 stars 28 reviews

These answers are for educational purposes and should not be relied upon as a substitute for medical advice you may receive from your physician. If you have a medical emergency, please call 911. These answers do not constitute or initiate a patient/doctor relationship.