Jowls? Best Treatment? Need Second Opinion (photo)

I'm looking for a 2nd opinion. I'm wondering what type of treatment I need to correct the roundness of my cheeks and the (jowls?) they're beginning to form that remind me of droopy every time I look in the mirror. I'm only 35 yo but these things make me look older. The surgeon I saw told me that face and neck liposuction would provide the best results, but the procedure comes to a hefty price tag of nearly $6K. Any other tx that could yield comparable results? Thank you for reading!

Doctor Answers 7

Treatment of jowls

I fail to see how liposuction will fix the problem. This is standard early aging of the face. The soft tissues under the skin migrate downward and connections between the skin and deeper structures become creases in the process. In this photo the crease is a jowl. The ideal maneuver would be to put the tissue back up where it used to be rather than remove it. In very early cases we camouflage this by putting injecting a filler in the crease.

You might look into non-surgical approaches like ultherapy as well but do your homework before committing to any procedure.

My response to your question/post does not represent formal medical advice or constitute a doctor patient relationship. You need to consult with i.e. personally see a board certified plastic surgeon in order to receive a formal evaluation and develop a doctor patient relationship.

Los Angeles Plastic Surgeon
5.0 out of 5 stars 2 reviews

Facial volume loss

You are beginning to experience loss of fatty volume in your face which is a characteristic change with aging. A full face photo would be more helpful to decide exactly what is best to help you restore a more youthful shape to the face. I can not evaluate or comment on your neck as a profile view is needed. However you are showing volume loss at the jawline in an are we call the pre jowl sulcus. The fatty volume remains behind this area making the marionette lines appear deeper. A facelift can certainly make this better and I prefer a deep plane SMAS lift to achieve the needed elevation in this area.

I am not a fan of removing volume from the face, as I mentioned the problem with aging is volume loss. Buccal fat and liposuction of the face may yield a short term benefit but may require volume correction as you age.

A relatively inexpensive alternative to surgery is volume augmentation of the prejowl sulcus. This can be done with hyaluronic acids such as juvederm but my preference for this area is sculptra.

Seek out a board certified plastic surgeon to evaluate you and review your options. I hope this was helpful. Good luck

Robert W. Kessler, MD, FACS
Corona Del Mar Plastic Surgeon
5.0 out of 5 stars 129 reviews


It is difficult to truly evaluate your concern without other pictures.  From what I can see, I don't believe you neck is the problem. Your soft tissue of the cheek is descending over a fixed point in the jowl region.  A less costly treatment, facial fillers such as hyaluronic acids or facial fat grafting would lessen the shadowing effect and yield a good result.  

Joseph C. Berardi, MD
Scottsdale Plastic Surgeon
4.5 out of 5 stars 14 reviews

Liposuction of the jowls/jawline do great under local!

Your jowls/jawline would do great under local anesthesia for liposuction and would run around $2500 for the procedure and $750 for the op room =$3250 is a good estimate. It would make a big improvement and is easy to undergo. Sincerely,

David Hansen,MD

David Hansen, MD
Beverly Hills Dermatologic Surgeon
4.7 out of 5 stars 42 reviews

Fill below the jowl for a youthful look

We know with certainty that the hallmark of aging is loss of facial fat. The fullness in the neck will respond to suctioning, however suctioning the cheek can be aging and removal of the buccal fat can be a regret as well. We suggest fill to the groove below the jowl, either an HA filler or fat for a smoother look without risks.

Peter E. Johnson, MD
Chicago Plastic Surgeon
4.0 out of 5 stars 42 reviews

Early jowling in the thirties

Thanks for the photos, I have a couple of options to consider.  The removal of buccal fat from inside your cheeks is simple procedure under local anesthesia that may reduce the fat volume in your cheeks nicely.  I am not a fan of liposuction of the face because of resulting contour irregularities that may be hard to correct.  A more aggressive approach to the jowling is using a minimal access cranial suspension (MACS) technique to suspend the cheek fat.  Best of luck with your research.

Randy Wong, MD
Honolulu Plastic Surgeon
4.8 out of 5 stars 36 reviews

Liposuction should work.

Liposuction is a very versatile technique that allows one to remove fat from a wide area through small incisions. This is applicable to almost all areas. Your fullness of the jowl and cheek areas should be amenable to this type of treatment. Sometimes to achieve a hollowing of the cheek we resect the fat pad, but this does not seem to be your problem. The cost for the procedure varies, but I would think that this should be available for less in most areas.

Rodney A. Green, MD
Cleveland Plastic Surgeon
4.8 out of 5 stars 24 reviews

These answers are for educational purposes and should not be relied upon as a substitute for medical advice you may receive from your physician. If you have a medical emergency, please call 911. These answers do not constitute or initiate a patient/doctor relationship.