Voluma for jowls? (Photos)

I had 2 syringes of Voluma for pre-jowels. The Dr didn't inject it into my cheeks, he put it around my jaw line and near the pre-jowels. I still see where the jowels are. Is it normal to injection it that way? It still feels hard and red with out makeup

Doctor Answers 11

Your doctor likely placed the filler in the jawline to fill a space that causes jowls, and add definition

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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New York Oculoplastic Surgeon
4.3 out of 5 stars 70 reviews

Voluma for Pre-Jowl Area

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. 


Kouros Azar

Kouros Azar, MD
Thousand Oaks Plastic Surgeon
4.9 out of 5 stars 33 reviews


Thank you for your question and for sharing your photographs.  Sorry that you are having some concerns about your postprocedure appearance.  Based on your photos, there appears to be some improvement.  Voluma is a great product.  Beautiful and natural results can be achieved.  I would suggest that you see your injector for an in-person reevaluation to fully discuss your concerns and your goals and expectations.  Additional product may be required for optimal results.  Hope this helps and best wishes!

Christian N. Ford, MD
Cohasset Physician
5.0 out of 5 stars 30 reviews

Voluma for jowls

Yes, this is a common area that I inject every single day.  The pre-jowl area as well as the malar areas are key areas for Voluma to lift the skin and rejuvenate the face.  Please consult a specialist for the best cosmetic results.  Best, Dr. Green

Michele S. Green, MD
New York Dermatologist
5.0 out of 5 stars 76 reviews

Voluma for jowls?

Injection of the pre-jowls can help minimize or eliminate the marionette lines as part of what has become known as the "Liquid facelift". See the attached video for a demonstration of this concept.
Best wishes!  Harry V. Wright MD, Sarasota, Florida

Harry V. Wright, MD
Sarasota Facial Plastic Surgeon
5.0 out of 5 stars 32 reviews

Voluma in the Jowels

Thank you for your question. Yes, it is normal for physicians and injectors to place product in the pre-jowel sulcus to help with some lift to the area. And while I do see improvement, you may benefit from having additional product injected into your cheek area (especially laterally towards your ears), or even along your jawline, or posterior jawline. This can help to both lift the tissue, and to better sculpt and define your jaw. With Voluma, the area can look red and feel firm for at least a week or two - all of this is normal. It will soften up with time. Best of luck! 

Anthony J. Taglienti, MD
Smithtown Plastic Surgeon
5.0 out of 5 stars 18 reviews


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,

Ross A. Clevens, MD
Melbourne Facial Plastic Surgeon
4.7 out of 5 stars 116 reviews

Voluma for lower face

Hello, and thanks for your question and photos. At this point I think you would benefit most from Voluma placed into your cheeks to provide structure and lift, thereby softening the lines in the lower 1/3 of your face. In order to determine the best treatment plan for you, I recommend an in-person consultation with a board-certified dermatologist or plastic surgeon. Best of luck, Dr. Frucht.    

Corey Frucht, MD, PhD
Santa Barbara Dermatologic Surgeon
5.0 out of 5 stars 4 reviews

Voluma for pre-jowels

Thank you for your question and the photos. I do see that you have some noticable improvement in the after photos. Treating the pre-jowels typically requires a combination of treatments for the best result. Fillers can be used to smooth out the chin/cheek transition and in the cheek bone area to lift the cheeks back up which has the effect of reducing the jowel-sag, kybella or cool-mini can be used to decrease the fat in the double chin and Ultherapy cna be used to tighten and lift.  I find that most people need a combination of thses for optimal results.Sincerely,Dr. Quenby Erickson

Quenby Erickson, DO, FAAD, FACMS
Chicago Dermatologic Surgeon
5.0 out of 5 stars 30 reviews

Improving jowls with Voluma

Injecting into the prejowl sulcus is helpful for improving the look of the jowls. It doesn't make them go away, it just hides them a bit. I do see improvement in the after picture. Adding some to the cheeks can lift the jowls as well and that's another place filler can help jowls. If it still feels hard and red after 4 weeks, you need to see you doctor to get it looked at because this is not normal.

Steven F. Weiner, MD
Panama City Facial Plastic Surgeon
4.7 out of 5 stars 41 reviews

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