What is the best way to tackle jowls after cheek filler and PDO threads didn't help? And should I remove buccal fat? (photos)

Thank you for your question. If you are a candidate, Kybella can be injected in to the jowls. It is considered an off-label use. Also, if you are a candidate, injecting a dermal filler along the jawline can be used to help support the jowl area, you are referring to. I would recommend seeking an experienced injector for an evaluation. Best of luck to you!

For unique cases where a variety of modalities could be used to treat the condition, I would suggest an in-person or virtual consultation to develop a custom and effective treatment plan. It is difficult to precisely define the best option without collecting the same information. I suggest reaching out to an expert for a consultation with surgical and non-surgical methods to get a comprehensive option. Best, Dr. Emer.

At around 40, the mid face begins to sag, leading to the jowls as you have seen.
Cheek fillers would not do much at all, as you have seen, as the sag seems to be coming from a deficiency around the outer/ lateral part of your face based on your pictures.
If you were to consider thread lifts, I would be suggesting barbed lifting threads, and these generally last around 12 months and offer some lift and collagen stimulation as the threads dissolve.
Your best options are likely dissolution of the fat around the jowls, but I would not be dissolving buccal fat, which is a different kind of fat, and which may give you a hollow, gaunt look that may not suit as you get older.
If you do opt to have fat dissolution of the jowls, please choose an experienced doctor as there is some important landmarks to consider to minimise risks. Fat dissolution in this age group may also offer the additional benefit of tightening the skin slightly, which can be important.

Thank you so much for your question regarding Kybella.  Kybella
is deoxycholic acid, a naturally occurring enzyme.  Kybella is FDA
approved to treat submental fullness, double chin.  In order to
achieve the best results, we recommend treating according to Kybella
template/
guidelines.  If you do not treat properly you run the risk of uneven
results. If you are worried about the swelling, I recommend receiving
treatments in the winter or when you have several days off in a row.  Of course I am not able to tell without an in person consultation if this is in fact the best treatment for you.  Your pictures make it appear that Kybella would be a reasonable option, but I recommend an in person consultation.
I recommend scheduling an in person consultation with a board certified
provider for a proper evaluation.   
Best of luck!

the jowl fat expands. the prejowl thins. what makes the most sense is to remove fat and bolster the prejowl. You have had a number of treatments that didn't work and your list contains more treatments that won't work, The internet is a great marketing tool but not always a great way  to discover truth.

If you take out buccal fat at 40 you may really wish you still had it at 50.