Fillers Applied in the Back of Jaw Bone?

Congratulations on your original thinking. It took aesthetic physicians a long time and a lot of work to appreciate and implement what you seem to have intuited on your own.

Over the last decade our understanding of how our skin ages has undergone a revolution. Whereas once the visible signs of facial and neck aging were attributed exclusively to skin laxity or looseness, today, we know that the sagging, drooping, wrinkling, textural alterations, etc that characterize the passage of time are a result of a number of anatomical and physiological events. These include loss in the quality and quantity of collagen and elastic fibers, largely due to years of accumulated sun exposure and other environmental damage; an increase in facial expression muscle activity (hyperkinesis);  loss of facial volume (due to decreases in fat, bone, cartilage and muscle); weakening of the retaining ligaments that suspend and hold the skin and underlying tissues in place; and the fragmentation and downward displacement--due to the effects of gravity--of the fat compartments that are responsible for giving fullness, smoothness, and youthful contour to the face and neck. The result of this gravitational pull on compromised, devolumized facial tissue is that the face loses its youthful triangular shape and takes on a more boxy look as the jowls and neck sag.

To illustrate what happens to our skin as we age, just Imagine a fully expanded dining room table covered with a beautiful, smooth table cloth that hangs just so halfway down each of the sides of the table. Now consider what would happen if you were to remove both leaves from the middle of the table. Not surprisingly, the table cloth that draped so beautifully now droops down to the floor. To restore the table cloth to its proper position, you wouldn't conclude that it had gotten too loose and proceed to cutting it down all the way around the table to shorten it. You would simply reinsert the leaves of the table and voila. However, for decades, physicians perceived jowls and turkey necks and sagging cheeks to be simple laxity (skin hanging) and merely cut away the "excess" tissue" as part of surgical facelifts, necklifts and eyelifts--often creating artificial, cadaverous, skeleton-like, overly pulled tight faces--giving rise to the obvious and much dreaded, "They've been done" look..

Unfortunately, despite the marketing hype to the contrary, many of the energy based, nonsurgical treatment modalities, such as radiofrequency, ultrasound and laser and light devices have not proven particularly effective, yielding results that are often subtle or minimal at best.  As evidence of this, one only has to look at how quickly today's supposed God's gift to nonsurgical rejuvenation energy-based device is replaced almost every day by the next purportedly most advanced, latest and greatest gizmo.

Today, fortunately, we do have several methods for nonsurgically addressing aging changes that have stood the test of time and that necessitate  little or no downtime. For muscle overactivity, we have neuromodulators, such as Botox, Dysport and Xeomin. For roughness, textural changes, skin dullness and mottled pigmentation, we have topical prescription medications, chemical peels, medical microneedling, etc. For fine wrinkles, we have fillers and for deeper furrows and volume loss, we have developed volumizing injectable fillers. And now, for sagging skin and apparent laxity, we have "The Nonsurgical 3D Vectoring Lift."

A vector describes a magnitude and direction of force. Aging skin is characterized by a negative downward and inward vector of sagging. To counter this, surgeons traditionally pulled skin upward and outward--i.e. using a positive vector. The key difference between the outcomes of traditional surgical correction and nonsurgical 3D vectoring, both of which lift upwards and outwards, is the Nonsurgical 3D Vectoring Lift's additional corrective dimension of ‘forward projection’. This 3D effect is the result of volumizing with the use of injectable agents designed for this purpose, such as Radiesse, Voluma, Restylane SQ, and Stylage XXL.

The Nonsurgical 3D Vectoring Lift is predicated upon the fact that the face and portions of the neck differ in their degree of mobility. The region directly in front and behind the ears is a fixed, denser, relatively immobile area, in contrast to the mid-cheek region (hence the greater tendency of this region to sag with the passage of time). These anatomical differences are exploited in the Nonsurgical 3D Vectoring Lift by making the fixed areas serve as anchoring points for the mobile tissues.  In determining the positive vectors for the mid to lower face, the tissues that require lifting are identified by pulling the skin directly in front of the ears in a direction perpendicular to the area that requires correction. If the pulling results in lifting of the desired tissue, then the vector has been correctly identified and is then marked in accordance with 3D vectoring protocol. A similar approach is used in the region of the angle of the jaw or in back of the ear when dealing with neck laxity. So the idea of injection at the angle of the jawbone in this instance is right on the mark.

Once the proper vectors are marked, the volumizing agents are injected in a series of radiating bands that serve as support struts to the skin and that impart the necessary 3D outward projection--the lift--that distinguishes and defines this nonsurgical approach. The high viscosity and elasticity of the volumizing fillers serves to hold and re-support the overlying tissue and restore more youthful contours.

Although volumizing fillers are reabsorbed over time, they do promote new, native collagen synthesis, which may continue to provide structure, firmness and improved skin quality while continuing to lift tissues. A typical Nonsurgical 3D Vectoring Lift of the face takes about fifteen minutes to perform. Bruising and swelling tend to be minimal, and most people can return to work or social activities immediately following treatment.

Yes radiesse can be used to enhance the contour of the jawline. It can be injected in the pre jowl sulcus and in some situations the angle of the mandible. This is not a substitute but and alternative to facelift surgery.

My first assessment is that I would prefer to see you in person in order to make a full assessment of your situation.  You may actually be having some masseteric hypertrophy that is giving you more of a square face than you’d like. But I do understand the jowling concept and how a liquid lift and volume enhancement of your upper face and lateral malar region can actually improve your jowling.  Without seeing you I have some concerns as to whether or not your assessment of what the treatment outcome would be may have some flaws in it.  However, Radiesse® can be placed in almost any tissue plane. The concept of having volume enhancement laterally to alleviate the dependent jowl region does not hold a lot of probability that you will be satisfied with its injection there, however. Of course, again I would be able to answer with more accuracy if I could see you in person.

In my opinion, injected fillers behind the mandible (jaw bone) will not do anything for your jowls.  Your jowls are present because of sagging of the lower face.  The most effective procedure for this is a facelift.

Fillers such as Radiesse can be injected in front of the jowl, in the pre-jowl sulcus.  The injected filler is placed right next to the bone, similar to silicone implants that were used for this purpose.  This can improve your appearance and camouflage jowling.  If your jowling is mild to moderate, this can work very well.   

Dear Ling Ling,


Radiesse can be placed in the cheek bone as well as along the jawline to remove the jowls

It looks great and will get the result you are looking for if your anatomy is right for the treatment


Best regards,

Nima Shemirani

     Radiesse to the jaw area can give a slight lift to the jowls, but I stress the word "slight".  If you are expecting anything more, then you need something else.   

The answer is yes.  Radiesse is a great product to fill and lift a sagging jaw line. It can be used in the jaw, cheeks and pre auricular area to lift and reshape the face

We do use it in the temple areas too. Although many of these areas are considered "off Label" We have had good success with the treatments.

Hi Ling Ling,

You were ahead of your time years ago about filler use in the temples.  Today you are right on about the use of volume to correct signs of aging.  The "semi-saggy" jowls that you refer to are usually the result of loss of volume of the surrounding areas of the face including bone of the mandible and midface, fat pads, and sometimes even muscle.  The use of a "thicker" filler such as Radiesse along the jawline can help to camouflage the jowl area.  

The most important aspect of your treatment will be choosing your injecting physician very carefully.  Goodl luck and be well.

Dr., P

Hi Ling.  While we always caution our patients about the amount of "lift" they can get from fillers, we usually find that injecting the cheeks aids in the jowl area.  We recently sent out our newsletter with information about a "Perlane Lift" and you can see the before and after pictures associated with a patient that had this procedure at the link below.  It definitely helped her with saggy jowls.

Yes. Radiesse can be injected into the temples, cheek, in front of the ears, and in the jawline.  Lips NO