Understanding Jowls: Causes and Treatments

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: 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.

The Anatomy of Jowls: What Are They?

Jowls refer to the sagging or drooping skin that 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, although some people will develop them younger 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 These are, in my view, outdated views.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 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.

Factors Contributing to the Formation of 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 facial shape

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 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 forming 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.

Genetic Predisposition to Jowls

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 it’s not as significant as the inherited bone structure.

Lifestyle Impacts on Jowl Severity

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 aging, although this typically affects the surface of the skin more than the deeper jowl formation.

Jowls Treatment Options: Surgical and Non-Surgical

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, and which are a waste of money and most importantly WHY.

Facelift Surgery: A Closer Look

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 of doing 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 repositions the tissues. By properly repositioning the tissues, you avoid placing unnecessary tension on the skin and avoid the pulled of stretched look.

Non-Surgical Alternatives to Treat Jowls

Ok, so facelift surgery isn’t for you. That’s ok, 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 about 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, 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 look like they had filler. It’s all down to the correct diagnosis of the underlying problem and accurate employment of treatment strategy.

Skin-Tightening Procedures: Radiofrequency and Ultrasound Therapy

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.

What about thread lifts for 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.

Before and After: The Importance of Realistic Expectations

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.

Choosing the Right Treatment and Practitioner

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 advise 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.

The Consultation Process and Personalized Treatment Plans

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.

Conclusion: Empowering Informed Decisions

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.