Voluma for jowls? (Photos)

Thank you for your question. You submitted several photos, and report having 2 syringes of Juvederm Voluma placed in the pre-jowl area. You say you still see jowls, and the areas are lumpy after undergoing this procedure, so you ask whether or not it is normal.
I can give you some perspective on how I evaluate patients like yourself, recommendations about what I would do in your situation, and hopefully give you a little explanation to what your physician was likely thinking when you had this treatment. A little background: I’m a Board-certified cosmetic surgeon and Fellowship-trained oculofacial plastic and reconstructive surgeon. I’ve been in practice in Manhattan and Long Island for over 20 years. I do a lot of injectable fillers in my practice, and in fact we do something called structural volumizing which uses a fair amount of thicker hyaluronic acid fillers such as Juvederm Voluma. I can give you a little understanding about the anatomy your doctor was trying to help you with, and explain what may be of value beyond what you had done.
A jowl is what most people describe as a lack of continuity of the jawline. When you follow from the chin back to the angle of the jaw, you’ll see a relative indentation with a bit of a sag, which is referred to as a jowl. That relative indentation is referred to as the mandibular notch, which is an actual notch in the bone structure that accentuates any sag or loss of tone and volume in the jawline. The strategy that indentation, is to fill it, which I think your doctor was trying to do. By filling that indentation, they are hoping for you to see an improvement in the overall appearance. Seeing your doctor who performed it and taking some photos would probably help you understand the level of improvement. I am sure that when you saw your doctor, the doctor did not say that your jowls will be eliminated, but typically will say the appearance of your jowl improved.
That said, the question arises if anything else can be done short of surgery? The answer is yes. We live in a time when we have a combination of numerous less invasive options to help people like yourself who may not even be a candidate for surgery. I can tell you a little about how we use Voluma in situations like yours. I mentioned, we do something called structural volumizing which is a different strategy where the filler is placed under muscles, and adjacent to the bone structure. That makes a lot of sense particularly in the pre-jowl area because that’s an area where you need volume at the bone level. Very often, it is a good, reasonable strategy to place the material just below the skin to blend the area. Very often, we do both areas because there is value in doing things in multiple levels.
In addition, we can actually place the filler like Juvederm Voluma in the chin. It appears in your photos that your chin is a little back. We often refer to it as a retrusive chin, which can further accentuate the pre-jowl area. We can place filler in the chin to increase its projection, so you can improve the pre-jowl area and the chin which is often enough to give you significant improvement. Beyond that, you can add filler at the angle of the mandible to further add some stretch and definition.
There are also non-surgical thermal energy devices that can help tighten the skin around the jowl area, and help define the jawline.
There are also minimally invasive approaches that use some surgical principles to vertically lift jowls. If we are talking about fillers as a solution for this area, then your doctor is on the right track. Additional filler will likely help further define this area. Even Botox® can be applied strategically to help the jawline. There are a lot of different ways to maximize the non-surgical approach for this type of issue. I think that although you may not be fully satisfied with your result, I think your doctor probably made an improvement, and now there’s probably room to further improve this area so you will feel better about your final result. I hope that was helpful, I wish you the best of luck, and thank you for your question.
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Yes, I often use Voluma in the "pre-jowl" area to lift and rejuvenate the face. It is not unusual to experience some redness and swelling post treatment. Both should diminish with time. Hope this helps. Kindly,Kouros Azar

Thank you for your question. The injectables will take 2 weeks to take effect. Voluma is a great way to counteract the appearance of jowls by increasing volume in the cheeks. Kybella is a very effective injectable for removing the submental fat that creates the double chin as well. 

Best wishes,