McKeown Medical
167 Bath Street, Glasgow, G2 4SQ
Date posted — 21.10.24
One of the most commonly complained about features in the clinic is jowls. People, especially women, hate them – reminding them of their mother or other elderly relatives. People often think jowls are simply the result of gravity, but they are not! The process that results in the formation of jowls or sagging in the lower face is much more complex than simply gravity. In this article I want to help you understand what causes sagging jowls and what the best options are to treat jowls.
Jowls refer to the sagging or drooping skin in the lower cheek, typically along the jawline. This change in facial contour is often associated with ageing, and most people will develop jowls as they get older. However, some people develop them at a younger age and more severely than others.
You will hear that jowls are caused by ‘gravity’ or ‘loss of collagen and elastin from the skin’. These are, in my view, outdated views. The evolution of jowls starts with changes much deeper in the face – at the level of the bone. As we get older, the bones of the face are gradually reabsorbed, resulting in a loss of structural support for the overlying soft tissues. This allows the soft tissues – i.e. the skin and fat – to glide forward, collecting at the retaining ligament beside the chin and resulting in the fleshy pockets of tissue we associate with jowls.
There are a number of factors that contribute to how quickly people develop jowls in life, and to what extent they develop.
Understanding these factors can help in formulating the best approach to treating jowls in your particular case.
The basic underlying shape of your face is a strong predictor of how quickly or severely you may develop jowls as you get older. Since the loss of bone is the key factor undermining the process of jowl formation, it stands to reason that people who have a more delicate bone structure will develop jowls faster and more severely than those who have a stronger natural bone structure.
If, for example, you have quite a petite chin, naturally, this can look quite delicate and feminine when you are young. However, as you age and bone is lost, it predisposes you to form jowls earlier and more severely than someone with a stronger bone structure. If you look at actresses like Angeline Jolie, who has an especially strong chin and jaw, which can almost look masculine in youth, these women rarely have problems with jowl formation until much later in life.
Genetics also play a role in the development of jowls, although it is most likely down to the inherited facial shape and bone structure that runs in your family. It is possible that other genetic factors – like skin elasticity – may play a part, although they are not as significant as the inherited bone structure.
Lifestyle factors can significantly impact the severity of jowls. Rapid weight loss – especially through intense aerobic exercise like endurance running – typically burns fat from the fact, resulting in additional loss of support to the overlying skin and worsening of the jowls. Yes, I just said it – too much exercise can be a bad thing (well, as far as your face is concerned, anyway).
Habits such as smoking and excessive sun exposure can accelerate skin ageing, although this typically affects the surface of the skin more than the deeper jowl formation.
The good news is that we now have a range of both surgical and non-surgical options to treat jowls. I’m going to tell you which treatments I think are effective, which are a waste of money and most importantly, why.
Ok, you might not like to hear this, but the gold standard way of treating jowls remains the good old facelift. This doesn’t mean it’s the only way to treat jowls, there are other non-surgical options, but facelift surgery is still the best option if you want the maximum improvement possible.
The facelift operation involves opening the skin at the ears, separating the skin from the underlying tissues and then truly repositioning the tissues of the face. The good news is that facelift techniques have improved considerably over the decades, and most expert facelift surgeons agree that the deep plane technique is the best way to do this. In performing a deep plane facelift, instead of simply tightening things around the edges, the surgeon lifts the deeper tissues of the face as a separate layer, releasing the ‘retaining ligaments’ that hold the face in place and truly reposition the tissues. By properly repositioning the tissues, you avoid placing unnecessary tension on the skin and avoid the pulled or stretched look.
Ok, so facelift surgery isn’t for you. That’s okay. The good news is that there are effective alternatives. The most effective non-surgical alternative for treating jowls is filler injections. Yes, I know that conjures up images of stuffy, over-filled pillow faces – but please bear with me for a minute.
If you remember what we said about the loss of bone and fat being instrumental in the underlying cause of jowl formation, you can begin to understand why volume-restoring injections (using dermal fillers) could be an effective strategy.
The key to treating jowls with dermal fillers, however, is to focus on replacing what has been lost and restoring what was there previously. Occasionally, for example, if you have a receding chin, it can be helpful to use the filler injections to increase the chin projection – but this needs to be done cautiously with expert precision.
The best way to illustrate this is with some before and after examples of patients who treated their jowls using dermal filler injections. All of these patients treated their jowls with fillers, and I hope you agree that none of them looked like they had fillers. It’s all down to the correct diagnosis of the underlying problem and accurate employment of treatment strategy.
You will read a lot about skin tightening procedures using either radiofrequency or ultrasound therapy. Whilst these types of treatments do have a role in improving skin quality, which can create a more youthful look, if you go back to thinking about what we said about the underlying causes of jowls, you can understand why they are not particularly effective at treating jowls.
Thread lifts sound like a great option for lifting jowls. You just pop in a little stitch, and it tacks everything back? Unfortunately, this simply puts a bit of tension on the skin for a short period of time. Because there has been no real tissue repositioning, the lifting effect is very short-lived. I’ve used threads in my own practice because, like everyone else, I wanted to believe in their effectiveness, but I stopped using them over a decade ago. They simply do not work.
The best way of assessing the outcome of any procedure is to look at before and after photos. Honest before and after photos normally show a good degree of improvement, but you will rarely see perfection! There are so many variables involved in both anatomy and healing that even with the best technique in the world, the perfect result is rarely achieved – but a good improvement is the norm.
The anti-ageing ‘business’ is both lucrative and ferocious. Everyone wants a slice of the pie, and there will be no shortage of people who will sell you treatments and procedures with promises of miraculous results. The best advice is to find a doctor you think you can trust and listen to what they say. Do not shop around until you find someone who tells you what you want to hear.
During the consultation, your doctor should discuss your goals, concerns, and suitability for different treatment options. This should feel like an information-gathering and exchange process rather than a sales pitch. Your doctor should want to really understand your medical background and what your concerns are before coming up with a bespoke plan for you.
Understanding the causes and treatments of jowls is the first step towards making an informed decision about your aesthetic journey. Knowledge is power, and it can help you navigate the complex world of aesthetic medicine with confidence.
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We are well and truly into filler season now with all of our patients planning ahead for weddings and summer holidays.
This is one of our patients who wanted to treat her jowls and facial sagging, but didn’t want surgery so we opted for our signature non-surgical volumetric facelift using filler injections only. This is her a couple of weeks later looking, and feeling, fabulous.
What do you think?
In case you missed it, here’s Dr Rhona and Dr Iain’s live Q&A discussing everything to do with periods and heavy menstrual bleeding.
Thanks to everyone who joined and asked questions. We’ll be doing more of these so keep an eye out for the next one!
And if you’d like to know more about the treatments we can offer for heavy menstrual bleeding, check out the link in our bio!
Thank you to our incredible patient for allowing us to share these pictures with you.
This patient has been with me for years but the thing we have always struggled with has been the texture of the skin around the mouth and lower face which has had a lot of sun over the years.
We’d tried less invasive options but ultimately when the skin changes get to this level the only thing that makes a dramatic improvement is full field resurfacing.
There is literally no other treatment capable of undoing sun damage like this. The patient is only a few weeks post-op and still a bit red so she is wearing make up to hide the redness, but already obsessed by the texture of her new skin.
What do you think?
If you`d like to know if you`d benefit from this treatment send us a DM with some pictures or visit the link in our profile for more information on full laser resurfacing.
We`re going live on Wednesday at 7PM! Join Dr Rhona and Dr Iain (@driainmartin) on Instagram live, where they`ll be discussing everything about periods and heavy menstrual bleeding including:
What is “normal” when it comes to menstruation
Heavy periods - what is a heavy period and what might be causing it
Myths vs facts - getting the right information and the right treatment for period problems
They`ll also be answering your questions live, so if there`s anything you`d like to ask, leave a comment or head to our stories. We hope you can join us!
Since we are now in full swing filler season, I’m very grateful to this patient for allowing us to share her pictures to demonstrate how much lift we can achieve just using filler.
Discover more about our method at the link in our bio.
Summer is almost here! If you’re putting off wearing your favourite summer dresses and shorts because of varicose veins, now is the time to think about treatment.
Varicose veins aren’t just a cosmetic concern - they can ache and throb, as well as make us feel self-conscious, especially as the warmer weather approaches.
With so many treatments available, it can be difficult to know where to start. Here’s our lovely Dr Alex with a quick overview of how we can help reduce discomfort, improve appearance and boost your confidence in time for summer.
If you, or someone you know, have been thinking about treatment, now is a great time to explore your options with plenty of time to feel the benefits before summer - check the link in our bio for more details.
Now that spring has finally sprung we are very much in peak time for filler treatments in the clinic.
So many patients would benefit from filler, but are scared of them because of the horror stories so I wanted to share a few examples this week of what filler looks like - in the correct hands!
Here are some examples of the natural looks we achieve with the McKeown Method.
Discover more about our method at the link in our bio.
What a difference a week is! This is one of our patients just a week out from her deep plane face and neck lift by the ever so talented @bramhallplasticsurgery.
The deep plane technique is the most technically challenging facelift to perform and Russell remains the only surgeon in Scotland performing this procedure, which involves going much deeper into the face to reposition the tissues rather than just pull them tight.
The outcome is a much more effective rejuvenation, even in unflattering poses when your head is bent forward, and a result that lasts much longer than a traditional facelift.
What do you think?
Thank you so much to our wonderful patient for allowing us to share her before and after pictures. She’s around 6 weeks after full field resurfacing.
One of the great things about this treatment is that, in addition to wiping wrinkles away, it also gives some pretty impressive skin tightening too. If you look at her forehead, upper and lower eyelids you can really see how much tighter the skin is.
The stubborn forehead lines and lines through the eyebrows have gone and, of course, the lines around the mouth are significantly reduced. These will continue to improve for up to six months as the skin continues to heal. She’s still a little pink, which will fade over the next few months, but with a little tinted moisturiser you’d never know. The patient is over the moon.
What do you think?
We can now offer full laser resurfacing with sedation and you can see more about the procedure in the link in our profile.