Jowl remedy - any advice on what would help?

Question

Hello, I’m a 34 year old female noticing jowls and heavy marionette lines. I’ve never had Botox or filler and looking for a more permanent solution. Any advice on what would help.

Anna Chacon, MD, FAAD · Answer

Noticing jowls and marionette lines can be concerning, especially if you're seeking a more permanent solution. Here are several options to consider:

Non-Surgical Options:
1. Topical Treatments:
   - Retinoids: Prescription-strength retinoids can help improve skin texture and promote collagen production.
   - Peptides and Growth Factors: These can help to stimulate collagen and elastin production.
   - Antioxidants: Vitamin C serums can help protect against environmental damage and promote collagen synthesis.

2. Non-Invasive Procedures:
   - Radiofrequency (RF) Therapy: Devices like Thermage use RF to heat the deeper layers of the skin, stimulating collagen production and tightening the skin.
   - Ultrasound Therapy: Ultherapy uses focused ultrasound energy to lift and tighten the skin.
   - Laser Treatments: Fractional lasers can help to tighten skin and improve texture by promoting collagen production.

Minimally Invasive Procedures:
1. Microneedling with Radiofrequency: This combines microneedling with RF energy to enhance collagen production and skin tightening.
2. Thread Lifts: Special threads are inserted under the skin to lift and tighten sagging areas.

Surgical Options:
1. Facelift (Rhytidectomy): A surgical facelift can provide a more permanent solution by removing excess skin and tightening the underlying tissues.
2. Mini-Facelift: A less invasive version of a full facelift, focusing on the lower face and neck.

Lifestyle and Home Care:
1. Sun Protection: Always use sunscreen to protect your skin from UV damage, which can accelerate aging.
2. Healthy Diet: A diet rich in antioxidants, vitamins, and minerals can support skin health.
3. Hydration: Keep your skin well-hydrated with moisturizers and by drinking plenty of water.
4. Facial Exercises: Some believe that facial exercises can help to tone the muscles under the skin, potentially reducing sagging.

Consultation:
It's essential to consult with a dermatologist or a plastic surgeon to discuss your concerns and goals. They can provide a tailored treatment plan based on your skin type, the severity of the jowls and marionette lines, and your preferences for treatment methods.

Summary:
- Topical Treatments: Retinoids, peptides, antioxidants.
- Non-Invasive: RF therapy, ultrasound therapy, lasers.
- Minimally Invasive: Microneedling with RF, thread lifts.
- Surgical: Facelift, mini-facelift.
- Lifestyle: Sun protection, diet, hydration, facial exercises.

Discussing these options with a qualified professional will help you decide the best course of action for your specific needs and desired outcomes.

Nelson Lee Novick, MD · Answer

At least from the photos, the use of robust HA fillers would ( in the hands of an experienced, board certified cosmetic dermatology physician injector) easily and quickly address all of the problems you mentioned. Jowls and marionette lines, such as these (as well as more advanced cases) are treated daily in active practices.
So, let's get to the significant downsides of "more permanent" treatments. Clearly, more permanent solutions, such as expensive, invasive cosmetic surgeries-- that risk infection, scarring, and prolonged post-surgical downtimes (see all the complaints about these surgeries by members of Realself--were it not for the fact that WE are not permanent. This means that what might look nice now, in five or ten years, when we continue to age and lose fat, muscle and bone, we once again have all these cosmetic problems return (as well as others). So, that's really not permanent.
Now, let's take permanent fillers, another supposedly more permanent solution. Permanent fillers, simply because they do not have any means for dissolving them away, can translate into persistent or permanent problems if there is an unwanted or undesirable cosmetic result. What's more, these problems may not start immediately after treatment; they may in fact first appear five, ten or even twenty+ years later. 
On the other hand, the use of robust HA fillers can treat these issues and can be rather easily dissolved away should the need arise. And, what's more, their future use can be adjusted to address future changes age-related changes in the face. 
I hope this information helps and best of luck.

Jowl remedy - any advice on what would help?

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