Managing the Jowls of Facial Aging

Published: 09th May 2008
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One of the earliest signs of facial aging is the development of jowls or jowling. The jowls are areas of skin and fat that have fallen from the side of the face to hang along or below the jawline. As we age, these areas tend to become more noticeable as the sag worsens. The once straight jawline of youth is gradually replaced by the saggy full jowls of the aging face. Why this occurs is the age-old phenomenon of time and gravity, weakening the attachments of the skin to the underlying muscle so that a tight bond between the two no longer exists.

Patients are really bothered by the development of jowling, particularly younger ages who see it as the reality that aging is occurring. There are numerous options to treat the jowls, both surgical and non-surgical, with varying degrees of effectiveness. The most effective methods, to no surprise, are surgical and include facelifts and liposuction. A full facelift is best viewed as a jowl-neck lift. In its more limited form, it is primarily a jowl lift. It works by pulling skin and deeper tissues up and back, eliminating the jowls by pulling loose tissue above the jawline again. The loose jowl tissue is simply repositioned and not removed. More minor procedures that have recently gained popularity, which aims to do the same thing, are the Threadlifts or Featherlifts. In this simple procedure, barned sutures are passed deep into the cheek and facial tissue above the jowl area and cinched up from above. For very minor degress of jowling, this has some benefit but is not effective enough with large amounts of jowling and the long-term results with these procedures is suspect. Actually removing jowl fat can be done with liposuction, reducing their size. This can be done alone or in conjunction with some form of a facelift. When performed alone, liposuction of the jowls must be done very carefully and conservatively, lest you get irregularities that are apparent in the overlying skin. When done with a facelift, the lifting and tightening of the skin usually eliminates this concern.

Minimally-invasive treatment options are tightening of the skin by external heat-generating devices and LipoDissolve. neither approach treats both of the jowl issues, skin and fat, and therefore they are usually less effective than surgery. Some tightening of the skin can be caused by heating the underside of the chin through a series of treatments. Devices such as Thermage or SkinTyte do it differently but the objective is the same, heat up and the skin on its underside and cause it to tighten. The long-term results of this procedure appear to be short-lived and that is why I perform them in conjunction with other procedures rather than as a stand alone technique. LipoDissolve treats the jowls by fat-dissolving injections done as a series. The jowl is reduced in size by the fat-melting injections. In my experience, it is just as effective as liposuction, albeit a lot slower. When performing non-surgical jowl reduction, I like the combination of LipoDissolve and Skin Tyte. That combination seems be particularly effective as both components of the problem, skin and fat, are addressed. They are also great touch-up procedures to do after a facelift when a little rebound relaxation in the jowl area occurs.

Different surgical and non-surgical treatments exists for the jowls. The range of different facelift options create the best results that will last the longest and should always be chosen in the more severe cases of facial jowling. In more minor jowling, LipoDissolve and Skin Tyte work well if the patient can tolerate a slower speed of noticeable improvement.


Dr Barry Eppley, board-certified plastic surgeon of Indianapolis, runs a private plastic surgery practice at his hospital-based medspa locations at Clarian Health in Indianapolis. To learn more about the latest trends in plastic surgery, go to his daily blog, .

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