Lower Face Sagging - what non surgical procedures will help? (Photos)

Question

What procedures would you use on my lower face? I have had a mini facelift, and it did not address the jowl area. I would prefer to not have surgery at this time.

Kally Papantoniou, MD, FAAD · Answer

For lower face sagging and jowling, the best non-surgical plan usually depends on what is contributing most: skin laxity, volume loss, tissue descent, or a combination.

Options may include Ultherapy or radiofrequency-based tightening to stimulate collagen and improve mild to moderate laxity over time. Ultrasound and RF treatments are commonly used for non-surgical skin tightening because they heat deeper tissue layers and encourage collagen remodeling.

In some cases, carefully placed filler along the cheek, jawline, or chin can help restore support and soften the appearance of jowls. However, if there is significant tissue laxity after a prior mini facelift, non-surgical treatments can improve the area but will not replicate the result of surgery.

A consultation is the best next step so your provider can assess whether tightening, filler support, or a combination approach would be most appropriate.

William Portuese, MD · Answer

The photographs you presented a rather limited, but it does appear that you're a candidate for a lower face and neck lift procedure. This procedure. accomplishes, lifting the jowls, tightening  loose facial and neck skin, and tightening the neck muscles and three locations. Unfortunately, a mini lift only offers mini results. Study the before, and after photographs of your prospective facelift surgeon to ensure that you're getting natural results.

Nelson Lee Novick, MD · Answer

At least from the photos provided, it would appear that the use of a robust HA Contouring Filler placed in the region of the posterior angle of the jaw, as well as along the jawline would help to better straighten and define the jawline. This can be accompanied by the targeted use of small bolus amounts of Botox spaced along the upper and lower jawline and upper neck to further tighten the jawline and upper neck regions. Both procedures can be performed in one treatment session or in two separate sessions, if so desired. In experienced hands, each treatment approach typically takes no more than about ten minutes and usually engenders little to no significant post-treatment downtime. You would be wise to make sure to consult with an experienced, board certified cosmetic dermatologist injection expert.

Anna Chacon, MD, FAAD · Answer

Thank you for sharing your photos. Based on what I can appreciate, the primary concern appears to be mild-to-moderate jowling and loss of definition along the jawline, which is often caused by a combination of tissue descent, volume loss in the midface and temples, and gradual collagen loss in the skin.

One important point is that if a mini facelift did not fully address the jowl area, that does not necessarily mean non-surgical treatments won't help. It simply means that we need to identify which factors are contributing most to the sagging.

If you were my patient, I would likely consider a combination approach rather than relying on a single treatment:

1. Strategic Filler Placement (Not in the Jowls Themselves)
One of the most common mistakes is placing filler directly into the jowl area. Instead, restoring support in the cheeks, temples, and along the jawline can create a lifting effect and improve facial balance. Sometimes a surprisingly small amount of filler in the right location produces a more refreshed appearance than larger amounts placed in the lower face.

2. Biostimulatory Injectables
Products such as Sculptra can be excellent for patients who have experienced gradual volume loss and skin thinning. Rather than acting as a traditional filler, Sculptra stimulates your own collagen production and can improve facial structure over time while maintaining a natural appearance.

3. Skin Tightening Devices
For patients who prefer to avoid surgery, treatments such as ultrasound-based tightening or radiofrequency-based skin tightening can help stimulate collagen and improve mild skin laxity. These treatments are not a replacement for surgery, but they can provide subtle tightening and help maintain results.

4. Jawline Contouring
In some cases, carefully placed filler along the jawline can camouflage early jowling and restore a sharper mandibular contour. This is often particularly helpful when the jawline has lost definition despite previous surgical treatment.

Looking at your photos, I do not think you appear to need excessive volume. In fact, I would be cautious about overfilling, as that can create a heavier appearance and sometimes make the lower face look wider rather than more lifted.

My overall impression is that your best non-surgical improvement would likely come from a combination of collagen stimulation, targeted structural support, and skin tightening rather than simply adding volume directly where the sagging is visible. The goal is to restore support from above and improve skin quality while preserving your natural facial contours.

Laser Skin Solutions - Portland · Answer

Undergoing a mini facelift is a significant step, but it is not uncommon to find that localized structural laxity around the jawline and jowls persists or returns over time. A mini facelift primarily targets superficial muscular aponeurotic system (SMAS) tightening and skin redraping along the lower cheeks, but it often has limitations when it comes to heavy fat pockets or skin laxity directly over the jawline margin.Why Jowls Persist After a Facelift Gravity and Tissue Descent: Natural aging, volume shifts in the midface, and subtle ongoing skin laxity can cause tissues to descend over the jaw boundary, creating or recreating jowls.Structural vs. Skin Laxity: If the underlying support lacks structural firmness or if minor fat deposits remain in the submandibular region, surgical tightening alone may leave the jaw contour looking less defined than desired.Non-Surgical Procedures to Refine the Jawline and Jowls If you prefer to avoid undergoing another surgical procedure at this stage, several advanced non-invasive and minimally invasive treatments can effectively tighten, lift, and contour the lower face:Micro-Focused Ultrasound (Ultherapy): This device utilizes deep ultrasound energy to target the foundational layers beneath the skin, stimulating collagen contraction and lifting the jowls and neck without disrupting the surface.Microneedling RF (Radiofrequency): Combining mechanical microneedling with thermal radiofrequency energy delivers heat deep into the dermis. This helps tighten skin laxity, improve dermal density, and smooth the lower facial contours.Strategic Dermal Fillers or Neuromodulators: A skilled injector can use structural fillers placed near the chin or pre-jowl sulcus to camouflage the appearance of jowls and create the illusion of a sharp, continuous jawline. Additionally, neuromodulators can relax downward-pulling neck muscles to provide a subtle "Nefertiti lift."As an advanced licensed aesthetician at Laser Skin Solutions – Portland, I recommend scheduling a comprehensive in-person evaluation with a board-certified dermatologist, plastic surgeon, or specialized aesthetic provider. They can assess your post-surgical tissue thickness and help determine whether ultrasound tightening, RF microneedling, or targeted volume replacement is the safest and most effective next step for your goals.

Wutinan Sithipolvanichgul, MD · Answer

Based on your photos, I do see mild-to-moderate jowling and loss of jawline definition.
Since you have already undergone a mini facelift, I would be cautious about expecting significant improvement from skin-tightening treatments alone. Treatments such as ultrasound-based tightening, RF microneedling, and collagen-stimulating injectables may help improve skin quality and provide some degree of tightening, but results are generally more subtle than surgical lifting.
In my opinion, a combination approach is often more effective than relying on a single treatment for this type of concern. The most appropriate option depends on whether the primary issue is skin laxity, volume changes, or deeper tissue descent.
Wutinan Sithipolvanichgul, MD Member, American Society for Laser Medicine and Surgery (ASLMS)

Lower Face Sagging - what non surgical procedures will help? (Photos)

Answers (6)

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