Options for Correcting Loose Jowls?

Jowls certainly are one of the main facial aging issues that leads people to seek a facelift, and jowls absolutely can recur after a face and necklift – especially if the ‘facelift’ is limited to surgery on the facial skin only. Not only may jowls recur, but they also may be incompletely corrected by a face and necklift, if the procedure performed is not appropriate for the nature of the ‘jowl’ problem. So carefully evaluate your surgeon’s ‘before and after’ photos for jowl area improvement.  

Like all aspects of a facial rejuvenation procedure, jowls require careful evaluation as to their nature and their specific treatment. Jowl fullness over the mid-jawline frequently is lower cheek fat that has descended due to increased skin and subcutaneous tissue laxity as part of the normal aging process, and that has increased in volume, which is also part of the normal aging process. Fat tends to atrophy (i.e. melt away) where you’d like it to stay – like high in the cheeks - and to increase in volume where you don’t want it, like in the jowl area, in the neck and above the nasolabial folds.

Skin-only facelifts have an inherently limited ability to improve jowls. Jowl fat is intimately associated with a deeper plane of facial soft tissue called the SMAS, so pulling on the skin does little to improve jowls. And skin is elastic, so as the skin stretches out, jowls recur. Jowl fat can be surgically removed during a skin-only facelift, but that form of treatment tends to skeletonize the jawline, which does not lend itself to a youthful appearance.

The most powerful means of correcting jowls is by advancing jowl-area fat back up over the jawline into the cheek. This can be accomplished by the High-SMAS face and necklift, which involves elevation and advancement of a tougher connective tissue layer below the skin called the SMAS. SMAS elevation (high in the cheek, hence the term ‘High-SMAS’ face and necklift) has positive effects on the peri-oral area (softening nasolabial folds, elevating the corner of the mouth, correcting marionette lines), pulls jowl fat back up into the cheek, and also tightens the area under the jawline – as it is continuous with the platysma muscle in the neck. And because the SMAS is made primarily of collagen, it had tensile strength and does not relax like skin does. The skin is carried passively with the SMAS, and all of the tension that holds the facelift is placed on the SMAS rather than the skin. So High-SMAS facelifts are closed without any tension on the skin, and the results are more natural-appearing and more long-lasting.

A ‘lower face and necklift’ implies skin elevation (and facial tightening with tension on the skin) to treat the jawline and neck, and I reserve this procedure for patients with relatively early facial aging changes. If patients have notable midface aging, peri-oral aging changes (nasolabial folds, downturn at the corner of the mouth, marionette lines etc), jowls, or significant neck skin laxity, they are best served by a High-SMAS face and necklift. When a skin-tension facelift is used to attempt to correct the peri-oral aging changes listed above, the result is a wind-swept, unnatural, surgical appearance that unfortunately is a permanent change.

I see many patients who think that they have ‘jowls’ but who actually have fat atrophy at the anterior jawline and posterior jawline – in other words loss of soft tissue volume in front of and behind the ‘jowls’, which makes the mid-jawline area appear fuller. Not only fat but also mandibular bone (the jawbone) atrophies in the areas where fat atrophies, which contributes to the hollowness that bookends what appears to be jowls. These patients have what might be termed ‘pseudo-jowls’, and this can often be very nicely corrected by means of structural fat grafting of the anterior and posterior jawline recesses. Some individuals have both atrophy at the anterior and posterior jawline and mild fullness of the jowl area, and for these patients conservative fat aspiration can be combined with fat grafting on either side of the jowls to restore a youthful profile. Many patients with this form of early facial aging can have a full, smooth and youthful jawline restored by fat grafting and fat aspiration only, putting off a more invasive procedure like a High-SMAS facelift until it is really needed for more advanced facial aging issues.

Necklifts don't address the jowl area.  All the correction is below the angle of the jaw.  An upper facelift will greatly improve or eliminate jowls.  Avoid the threadlift.  They don't work. I disagree with one of the other surgeons who recommended Thermage.  I don't think it works.

First, let's omit those things which are either unpredicable, ineffective, or just a bad idea. Thread lifts, thermage, or other skin tightening non surgical technologies. Let's just say they are not worth the money. That leaves you with two options for my practice. One is radiance, placed just in front of the jowl, which smooths the contours of the jawline without looking puffy or fat.

Immediate, no down time, effective, lasts at least a year, and might build up more duration as your body replaces it with collagen. Other option is a small surgical tuck up. Call it a minilift, jawlift, necklift, microlift. The name doesn't matter. What matters is that you consider a small, very focal surgery to help tighten the residual that you see. I have not been impressed with the laser lipo results.

A common complaint after a necklift is that the jowl area is often not improved. Jowls are a result of the descending cheek that naturally occurs with aging. A standard necklift does not address the jowls specifically.

Rather, a lower facelift is necessary to improve this area. Fillers may help to camouflage the area if the creases in front of the jowls (the "Marionette Lines") are not too prominent. However, fillers alone do nothing to correct the continual laxity of the jowls.

A Prejowl inmplant or Fillers / Fat injections could help with the looseness. The jowls occur for a number of different reasons.

What happens is that when you lose volume in the face, especially the cheeks and jawline area along with volume around the mouth, the jowls become more prominent. As an example, pinch the skin by your upper cheeks just inferior and lateral to the eye. Notice as you do this, that the jowls begin to rise a little bit. Now in front of your jowls is a depression and volume loss call the prejowl area. This area along the jawline and closer to the lips and in front of the marionette lines can be filled in as well.

Also, along the jaw in front of the ear can also be filled in and this can have an effect on the jowls decreasing. Sometimes people fill in the prejowl area with fillers and fat injections to reduce the appearance of the jowls through a camouflage type of correction. In terms of volumizing with fillers, you can also use fat injections for the same thing and you can add more volume with fat than you can, a lot of times, than with filler.

Fillers are quite a bit more expensive than fat for filling in volumes. Sculptra is another option in between fat and fillers. Sculptra can last over 2 years and some are finding more than that. Other options for the jowls include direct liposuction of the jowl area.

Thread lifts, in my opinion, don't work. They pull on the skin for a time being but relax and most of the time I don't think you get any long term improvement. The only time you get long term improvement is when you turn the thread lift into basically a facelift done in many traditional ways.

I hope that helps!

Yes, you can avoid surgery and still treat it with fillers. The key is to fill the areas between the jowls and your chin. The reason you notice the jowls is because of the depression between your jowls and chin called , prejowl sulci.

Any filler can be used to achieve this goal. You should try something reversible such as Juvederm or Restylane to see if you like the results. If you like it then you can try something longer lasting like Sculptra

Regards

The fat that hangs over the side of your jaw line or jowl is fat that did not appear out of thin air- this jowl was the fat that belong one to two inches higher on your lower cheek. With aging, this fat has sagged. Removing the fat with liposuction can make it better but at the cost of losing volume. We never want to lose volume. The ideal treatment is a vertical vector (lifting the tissues upward) midface lift. You have no need for a full facelift because you already had a neck lift.

Correction of jowls depends on the patient's individual anatomy.  

• A prominent depression in the prejowl sulcus (area before the jowl along the jawline) can actually contribute to this.  It is a normal phenomenom for bone loss to occur here.  Replacement of volume can help improve this in some patients.  
• Hanging jowls will likely need a lift procedure

Seek out an experienced facelift surgeon to help determine the best course of action.

The best thing for loose jowls is either a lower facelift or a full facelift. Sometimes the jowls can also be camouflaged with injectable fillers.