Best Options for Jowl Reduction for a 32 Yr Old Female

I have a slight double chin and obvious jowls. The jowl on my left is visibly larger than on my right. Oddly, I'm quite thin and have been so all my life, but my cheeks have always been puffy and my nasolabial folds are deep (bad genes?). When I lay down on my back (second photo), the jowls totally disappear. Does that mean this isn't sagging muscles, but fat deposits? I don't want to admit that I need a face lift already at 32, so any/all options to get rid of puffy cheeks & jowls are welcome.

Doctor Answers 11

You don't need liposuction or a facelift

Given the photos, you have a common problem that occurs in your late 20s into your late 30s. This problem is volume loss. You lost your "baby face" which is primarily some of the subcutaneous fat layer. This has occurred in the sides of you chin often called the prejowl area. Fat or filler in this area is a minimally invasive way to resore the volume and effectively eliminate you jowl problem. Lipo in the neck or jowl would not correct the underlying problem. And you have hardly any fat in your neck to begin with so lipo could cause more problems. Radiesse, perlane, restylane or juvederm are all good options.

Jacksonville Facial Plastic Surgeon
5.0 out of 5 stars 3 reviews

Jowls at 32

Looking at your photos, I don't see significant lipomatosis or lipodystrophy of the face and neck You appear to have low midfave volume with poor cheek projection. I wonder if you are a runner or engage in regular high impact activity as I have seen this in such indiduals at an early age due to the shearing of the facial soft tissue with repeated impact. I also see this kind of midface soft tissue sagging in patients who have fluctuated their weight frequently with recent weight loss. This is due to soft tissue laxity and not necessarily excess fat or skin. I believe that liposuction of the jowls in this case can hollow the area unnaturally and I don't see anything to lipo on the neck from these pictures. A good option may be cheek implants with malar and submalar components. The deep prejowl sulcus can be treated with a prejowl implant or soft tissue fillers to minimize the step-off in this region. The cheek implats will establish good facial skeletal contour and lift the jowls without risk of contour irregularity seen occasionally with liposuction of the face. Use of soft tissue fillers and fat transfer for midface volume lift are extremely operator dependent and mistakes may be difficult to correct. You should seek a surgeon experienced in these modalities.

Edwin Ishoo, MD
Winchester Facial Plastic Surgeon
4.4 out of 5 stars 20 reviews

Liposuction Of The Jowls and Neck Not A Facelift Is Needed

It is fair to say at age 32 that you don't need a facelift. It appears that  liposuction of the jowls and the submental area should work nicely to give you an improved look. Your laying back indicates that it is largely fat that is the issue not extra skin. Jowl and neck liposuction provides a quick recovery and results that will be apparent within weeks after surgery.

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Liposuction of the neck and jawline works.


Of course, one would have to examine you, but it looks like you might really benefit by liposuction of the lower face.  This is a short scarless procedure with quick recovery, and the results can be dramatic.

George J. Beraka, MD (retired)
Manhattan Plastic Surgeon
4.8 out of 5 stars 9 reviews

Jowls aging, treatement options

jowls is the area sagging next to the chin.

it is fat deposit fat migrate down with gravity and give puffy appearance

the treatment is always medical with fillers or surgery.

fillers can help with filling the hollow areas and help smoothing the chin contour

surgery is indicated especially for more severe deformity and if we want to treat multiple areas in the cheek

fillers are recommended in early age ( young patients)

Jacques Haddad, MD
Montreal Plastic Surgeon
4.9 out of 5 stars 7 reviews

Treatment for jowls is 32 year old.

I can't give a firm recommendation without examining you but I think some lipo of the jowls with a small canula  and some filler or fat into the nasolabial folds and the prejowl sulcus (the indented are just medial to the jowls) would give a nice result.

By the way, thanks for the great photos!  They really illustrate why all marking needs to be done with the patient sitting upright!

Lisa Lynn Sowder, M.D. 

Lisa Lynn Sowder, MD
Seattle Plastic Surgeon
5.0 out of 5 stars 66 reviews

Re: Jowl Reduction and the Use of Radiesse for Non-Invasive Procedure

If you are concerned with the early onset of jowls,  one way to address it would be through the use of Radiesse, particularly if you are averse to any type of invasive procedure.

Radiesse works a little different from your average dermal filler since it can actually refine the contours of your face by creating a layer that can be shaped beneath the skin.

This layer is made of microspheres that are calcium based. Therefore the injection solution uses components that naturally occur in your body.

A good way to learn more is by seeing the experiences of actual patients. Here is a video that might interest you.



Sanusi Umar, MD
Redondo Beach Dermatologic Surgeon
4.7 out of 5 stars 30 reviews

Options for neck and jowl tightening

Neck liposuction can make a dramatic difference in facial appearance. This small-incision surgery allows recontouring of the neck with minimal downtime. Smartlipo can sometimes be used alone in this area to melt away small amounts of fat and tighten the skin and uses laser light, allowing finer resculpturing of the neck and jowls. This procedure can be performed as an outpatient without the need for general anesthesia allowing for a quick recovery.

If you are looking for nonsurgical solutions, Thermage® is a safe, non-invasive cosmetic procedure that helps smooth, tighten and contour skin for an overall younger looking appearance. It can be used to treat sagging skin, loose jowls, lack of definition in the jaw line, sagging neck skin (“turkey neck”), wrinkles and fine lines, and lack of definition in the lips. The treatment delivers natural looking results with little to no downtime —on all skin colors all in a single procedure. Fast and easy, you can even come in during your lunch break and return to work after! Thermage® uses radiofrequency technology to heat the deep, collagen rich layers of your skin. The heat helps tighten existing collagen and stimulate the formation of new collagen, which reduces sagging, renews contours, and improves the smoothness and texture of the skin’s surface. Comfort Pulse Technology, including a vibrating handpiece delivers enhanced patient comfort. 

Another nonsurgical option is Ultherapy, a new non-invasive (zero downtime!) treatment using ultrasound for counteracting the effects of time and gravity on your skin. The Ultherapy procedure stimulates the body’s own regenerative response to gently and gradually restore memory to the skin and stimulate growth of new collagen. A gradual tightening occurs, resulting in a natural lift of the skin over several months.


Michelle Copeland, MD, DMD
New York Plastic Surgeon
4.5 out of 5 stars 8 reviews

Large Jowls Nasolabial Grooves

It is difficult to make specific recommendations on the basis of one view of your face. However, liposuction of the lower face and neck, a prejowl implant, and fat or fillers for the nasolabial grooves should all be consiered.

Richard W. Fleming, MD
Beverly Hills Facial Plastic Surgeon
4.9 out of 5 stars 37 reviews

Double chin, jowls, and pre-jowl sulcus

The photograph shows a significant pre-jowl sulcus which is best treated with a pre-jowl implant. This will give added augmentation to the sidewalls of the chin so that it blends in well with the minimal jowls  that are present. A double chin and fatty deposits in the neck or best treated with a neck lift. Both procedures can be performed thru the same sub mental incision. A face lift is generally not required in somebody of 32 years of age. For many examples of chin implants, please see the link below

William Portuese, MD
Seattle Facial Plastic Surgeon
4.7 out of 5 stars 126 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.