36, how best to treat early jowling? (Photo)

Question

36 year old female concerned re: early jowling, deep nasolabial folds and overall tired appearance. Wondering if issues are best temporized with filler-- would cheek augmentation lift and correct these issues? If so, which filler has the best lifting profile? I assume I'll eventually require a mid face lift, but given that I'm relatively young I would like to hold off as long as possible.

Nima Shemirani, MD · Answer

I would recommend a combination of hyaluronic acid dermal fillers and Morpheus 8. I recommend Morpheus 8. Morpheus8 is a non-surgical treatment for full body skin resurfacing, skin tightening, and fat reduction of stubborn areas. It uses minimally invasive fractional radiofrequency energy (RF) to penetrate the skin deeper than other microneedling devices, triggering the skin’s natural healing response to promote skin tightening and lifting. Best of luck, Dr. Nima!

Rod J. Rohrich, MD · Answer

If one has true jowling, there is not a good non-surgical way to treat it
other than a surgical “Lift” and “Fill” facelift. This should be done
in the hands of a Board Certified Plastic Surgeon with
expertise in facial rejuvenation to
get the best natural looking results.

Robert M. Lowen, MD · Answer

Every patient presents with their own unique anatomy, so the same answer would not be right for everyone.  Age is certainly a factor, since the definitive treatment for jowling is a facelift, in my practice that would be an extended subcutaneous jowl lift that effectively resuspends the  descended tissues between the angle of the mouth and the lateral face.Some alternatives include simply reducing the bulging fat with liposuction or laser, e.g., Precision Tx.However jowling usually is not the first sign of facial aging. That is usually in the upper face, below the eyes, as tissue sags downward, the tear trough becomes more visible, and the upper cheek loses its round contour, and becomes fat deficient.Treatment at this stage is done best with fat grafting, replacing what has been lost to age and gravity, and in some cases just the appearance due to genetics.When a patient has a narrower face, fat grafting could be suggested to round out the lower face contour, filling in some of the contour between the jowl and chin point, as well as treating the jowl with either reduction or facelifting

Jason Emer, MD · Answer

I suggest a formal facial rejuvenation consultation.  There are a lot of options including fillers, skin tightening procedures, ThermiRF etc.  There are many lasers that can help the skin complexion and wrinkles, tighten skin and increase collagen long term.  A formal consultation is needed with an expert who can work with long term goals.

Toby Mayer, MD · Answer

The treatment for saggy skin and jowls is facelifting.  Loss of volume over the cheeks can be corrected for 1 to 2 years with fillers otherwise cheek implants will correct them permanently.

Todd C. Miller, MD · Answer

Hi Mickeya, jowling is best evaluated on a side profile rather than a profile. What I notice most in your front profile pictures is an overall loss of volume in the tear trough, cheeks, and nasolabial fold. Your chin does look a bit recessed however the anterior profile is not the best angle to assess this. From the pictures that you have provided I would start with fillers to re-volumize your face. You could consider fillers such as Restylane or Belotero in the tear trough, and Voluma or Juvederm in the cheek, and Juvederm in the nasolabial fold. Another options would be fat transfer. Fat can be used to revolumize the entire face. Correction of the jowls typically entails a face lift. I would follow up with an experienced facial plastic surgeon to determine the best treatment plan.

Andrew Pichler, MD · Answer

I concur with your concerns. It would be helpful to see a lateral (side) view of you. Fillers in the pre jowl area or as a more permanent solution a chin/jowl implant if you have recessive chin or just a pre jowl implant could help. Fillers to "lift" your cheeks could also be added.I would like to recommend a hands on consult to really evaluate your needs better.

Francis R. Palmer, III, MD (retired) · Answer

Hi, based upon the attached photos the cheeks are very flat anteriorly (in the front) making the face appear elongated.  The chin is weak which can make the mid-face appear somewhat top heavy and out of balance.  There is evidence of jowls which are the primary indicatiomn for sone type of a facelift procedure.  If you have "jowls" this is sagging facial tissues and an indication for some form of a facelift, not Cheek Augmentation.  I have performed many Cheek Augmentations over the past 25 years and the notion that Cheek Implants or dermal fillers to the cheeks will lift tissues is an urban myth.  Filler to the cheeks or cheek implants will not lift up the jowls.  The underlying SMAS layer, of the face, must be dissected, lifted, trimmed and re-sutured.  The excess skin is then removed and the facelift incisions closed.My most popular facelift is the minimally invasive, short incision facelift that has all the benefits of more invasive facelifts (traditional, mid-face and subperiosteal facelifts) but with these added benefits:very small incisionsminimal tissue dissection = less bruising and swelling = rapid recoverycan be performed in 90 minutes or less, with or without general anesthesiano incisions within the hair = no hair lossexcess fat can be removedexcess skin removedcheeks, chin and jaw line can be augmented with dermal fillers (I prefer Perlane) or facial implantsmost patients fly back home to parts all over the world in as little as 3 days post-opCombining cheek augmentation with your facelift would further feminize the entire face.  Chin augmentation would proivide harmony and balance to the lower face.  Hope this helps.

David Alessi, MD - Account Suspended · Answer

You are correct about the cheek fillers.  Voluma is a filler specifically indicated for filling around the cheek bones.  This can gently lift the face.  The correction isn't dramatic and you would also be best served with a Thermage treatment by an expert.  Seek out a board-certified surgeon.  Best wishes.

36, how best to treat early jowling? (Photo)

Answers (9)

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