42, is there anything I can do about my substantial pre-jowl pockets? (Photos)

Question

Dermal fillers / fat removal - Hi. Is there anything I can do about my substantial pre Jowl pockets? Have I lost volume either side creating this ‘pouch’? Or is this the result of sagging to this area? I feel it is fat not skin. I’m not keen on idea of surgery just yet. Would some kind of liposuctuon be effective ? Or fillers, chin or jaw fillers? My weight has fluctuated over the years. I am 42 but these have been forming since mid twenties

Hung William Song, MD · Answer

Hi, thanks for your question. Your concerns can be addressed without surgery. A combination of a Y_Lift and AutoCorre would be the ideal treatment. The Y_Lift is an innovative way to use safe Hyaluronic acid fillers to recreate the volume loss in the back of your jaw to pull the skin back. AutoCorre uses your own plasma and some fillers to stimulate natural collagen to tighten the skin and add volume where needed.

Anna Chacon, MD, FAAD · Answer

Thank you for your question. Pre-jowl pockets are a common concern and can result from a combination of volume loss, fat redistribution, and early skin laxity that becomes more apparent with age or weight fluctuations.

At 42, you're still a great candidate for non-surgical treatments, especially if you’re hoping to delay or avoid surgery. Here are a few effective options:

Dermal Fillers: Strategic filler placement along the jawline, chin, and prejowl sulcus can help restore volume, balance proportions, and create a more contoured appearance. This approach doesn’t remove the fat but blends and supports the area to reduce the visual dip or “pouch.”

Skin-Tightening Treatments: Non-invasive modalities like radiofrequency (RF) with microneedling, Ultherapy, or Morpheus8 can improve skin laxity and tighten the jawline contour.

Kybella or Deoxycholic Acid Injections: These can dissolve small, localized fat pockets but must be used with caution and precision in the jowl area to avoid excessive hollowing.

Chin & Jawline Enhancement: Enhancing the chin and mandibular angle with filler can improve overall facial harmony and mask the prominence of the pre-jowl area.

Liposuction or fat removal can be an option, but it's best suited for well-defined fat pockets and typically performed surgically. Given your interest in avoiding surgery, a combination of filler and non-invasive tightening might offer the most natural and satisfying result.

Randy Lindgren, MD · Answer

Based on your description, it sounds like the pre-jowl pockets you're noticing could be a combination of volume loss and some sagging in the area. Dermal fillers, especially when combined with biostimulators like Sculptra, can be an excellent non-surgical option to restore volume and address the hollowed appearance. These treatments can also stimulate collagen production, improving skin firmness and texture over time.
While liposuction may help if there is excess fat, I recommend starting with non-invasive treatments such as dermal fillers and threads, which can offer significant improvement. However, keep in mind that these injectable treatments are completely user-dependent, and results are highly influenced by the experience and skill of the provider. I recommend scheduling an in-person consultation with a qualified, experienced professional who specializes in facial aesthetics to determine the best approach for your unique needs.

John Michael Thomassen, MD · Answer

I would recommend a mini facelift.  This would allow the SMAS to be tightened near your jowl area to smooth this out and the excess skin removed.  No other procedures will achieve the natural results of a lift.

David Hansen, MD · Answer

A little liposuction with the micro canulas under local and the addition of FacetiteRF and Morpheus to tighten up the skin a lot is just what those jowls are begging for.  Only 1 day downtime and you look amazing. Cost is roughly $4750 and so worth it.

Nelson Lee Novick, MD · Answer

Although the photos provided do not allow for adequate evaluation, it does appear that the use of a robust HA volumizing filler for the cheeks, appropriately injected, would establish a more oval, heart-shaped face and Ogee Curve and secondarily improve the smile lines and likely the marionette lines to the sides of the mouth, as well. A robust HA contouring filler injected properly in the posterior cheek and along the jawline would further help to straighten and define the jawline. You would be wise to consult an experienced, board certified cosmetic dermatologist filler expert. You might be very pleasantly surprised that in about a thirty minute treatment session, you can have immediate results with little to no significant downtime. Hope this helps and best of luck.

Camille Cash, MD · Answer

You will likely have the best result from a combination of treatments.  FaceTite is an option which can melt fat and tighten skin.  This minimally invasive procedure uses RF technology and requires no general anesthesia.  Facial balance can then be addressed with fillers for a more complete result.  See my website or a provider near you to learn more.

Keera Kang, MD · Answer

Hi Claire88!I am sorry to hear you are concerned about your jowl area.Many of my patients have the same concern. But the reason for their sagginess is all different. So it is important to first analyze the patient's face, bony structure, skin laxity and so on before choosing the most effective treatment for him/her. So since I cannot do a thorough examination on your face I cannot give you the most accurate answer to your concern. But from the pictures, I see some sagginess and volume loss. There are actually many ways to address this issue and I think it depends on your preference now. 1. you could try filler around corners of your chin and cheek area to slightly lift the saggy jowl area2.you could try an energy based device to make the dermis of your skin tighter and this will improve the sagginess / and if that jowl pocket is fat then you could do a fat dissolving session with the EBD or try injections. 3.you can also try injections like skinboosters to stimulate collagen and elastin production leading to a slightly lifted/tightening look. 4.you could also try threadlifts (cog and monothreads)and so on.So there are many options you can choose from. So I suggest you visit a physician and get a consultation in person. Hope this helped. Good luck! and don't forget you are beautiful just the way you are :)

Kurt Kuhlman, DO · Answer

The "pouch" on each side of your mouth can easily be treated with a small amount of Kybella injected into this area. Kybella dissolves fat permanently. About 3 injections of 0.1 cc  Kybella on each side and then repeat this in 6 weeks should significantly reduce this pouch. This is very inexpensive because such a small amount is needed. However, your injector needs to be very skilled and experienced with doing this. You could also have  1 cc  of dermal filler injected along the marionette (just medial to the pouch) and pre-jowl sulcus.

Chris Atkinson, MD · Answer

I think you would be a good candidate for Morpheus8. It can decrease the subcutaneous fat and tighten the skin in that area. You could also do a bit of filler to decrease the appearance, but the results are less permanent and you will have to get more filler in the future.

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