ProductsYou've started pulling the skin at the sides of your jaw upward in the mirror, and you've read that Botox for jowls can help. No, Botox doesn't help jowls. That's because jowls come from lost fat, collagen and elastic tissue and loosened skin, not from the muscle.
Jowls are a localized area of loose skin and fat along the lower jaw that forms as the tissue there stretches with age. That sagging blurs the line where your jaw meets your neck. Botox can sharpen that line slightly by easing a neck muscle that pulls on it. The jowl itself needs a different treatment.
Why jowls aren't a muscle problem
Jowls develop as we age, from three changes that happen, all in the skin's support rather than in the muscle. The fat pads of the lower face shrink and shift, and the jawbone loses volume along its lower edge. The skin over them loosens as collagen and elastin decrease. These are the proteins that keep the skin firm.
As the jawbone loses volume, the skin and fat above it lose their underlying support. This allows the tissue to sag into a jowl.
Botox belongs to a family of drugs called neuromodulators. They work by blocking the nerve signal to a muscle. Relaxing a muscle won't restore lost jawbone volume, replace a fat pad, or restore the skin's collagen and elasticity. I first determine what's causing your jowls and then create a treatment plan to address the underlying cause.
A jaw that looks wide or square is a different problem: an enlarged chewing muscle, covered in my article on jawline Botox for facial contouring.
The one thing Botox does help
Botox can improve the downward pull of the platysma, a muscle in your neck, on your jawline. This treatment is called the Nefertiti lift.
The platysma is a broad, thin sheet of muscle covering the front of your neck and reaching up over the jawline into the lower face. Its fibers pull downward. In some people that pull is strong enough to drag on the jawline. You can see it as vertical cords when the neck tenses. Those cords are called neck bands, or platysma bands.
A Nefertiti lift places small amounts of neuromodulator along and just under the jawbone and into the upper part of the neck bands. The FDA-approved neck band pattern places four small injections on each side into the upper platysma, about 1 to 2 cm below and parallel to the lower edge of the jawbone, from in line with the corner of the mouth back to just in front of the angle of the jaw. The rest of the dose goes into the bands, in small injections spaced along each band. Relaxing that downward pull eases tension along the jaw and can lift the lower face slightly.
I determine the dose and injection pattern after evaluating your anatomy and how your neck muscles move. The total dose depends on the number of visible bands you have and how strongly they pull. It is usually within the 25 to 50 unit range published on our Botox page. Units are the standard measure of a Botox dose.
The improvement is subtle, a slightly sharper jawline, softer neck bands, and a smoother transition from jaw to neck. Botox can reduce the downward pull of the neck muscles, but it doesn't correct sagging skin or eliminate jowls.
How to tell muscle pull from sagging
A simple mirror test can give you an idea of how much your neck muscles contribute to the appearance of your jowls. Sit upright, relax your neck and look at your jawline. Then tense your neck, and see what changes.
If vertical neck bands become more prominent and the jawline looks less defined, the platysma may be contributing to the downward pull. In that case, a Nefertiti lift using Botox may help improve the appearance of the jawline.
If the jawline looks the same relaxed and tensed, and the jowl is there either way, the muscle isn't doing much of the work. Botox is less likely to improve this.
A mirror check is only a guide. I evaluate the jaw and neck at rest and in motion before recommending anything.
Who gets the best result from Botox for jowls
Botox for jowls usually sharpens the jawline in people with early jowling, good skin elasticity, and prominent neck bands. It can create a sharper jawline, but it won't eliminate the jowl.
Likely to see a sharper jawline
- Late thirties to early fifties
- Good skin quality with good elasticity
- Mild blurring of the jawline, without a significant jowl
- Visible vertical neck bands
- A downward pull you can see when you tense your neck
Often suited to another approach
- Skin that has loosened more
- A fuller jowl
- Loose skin under the chin
- Changes in the bone structure along the jaw
If this sounds like you, skin tightening, filler or a combination usually suits you better than Botox alone. I'll go over the options at your consultation, before anything is injected.
What the FDA approval covers, and what it doesn't
Botox Cosmetic, the version of Botox approved for cosmetic use, is FDA-approved for moderate to severe platysma bands, the vertical cords in the neck. The approved pattern includes those injections just below the jawline, but the approval is for the bands. Treating with the goal of sharpening the jawline is an off-label use. Off-label means prescribing an approved medication for a purpose or placement the FDA has not specifically approved. I'll tell you which part of your treatment is which before I inject.
The two clinical trials behind that approval also set expectations. Doctors and patients each rated the neck bands on a severity scale. Success meant both agreed the bands had improved by at least two steps on that scale, down to minimal or mild. At day 14, about 31 to 32 percent of treated patients reached that goal, compared with 0 to 2 percent of patients given a placebo, an injection with no active drug in it. Those figures measure neck bands, not jowls.
What addresses jowls
Jowls respond to treatments that tighten the skin over the jaw or restore support above it, and to surgery when the skin is very loose. Radio frequency skin tightening uses controlled heat to stimulate new collagen and elastic tissue, improving mild to moderate laxity. You can learn more on our skin tightening page. Dermal fillers are injectable gels that restore lost volume in areas such as the cheeks and jawline. You can learn more on our dermal fillers page. I take a conservative approach to filler, focusing on natural-looking results so your face doesn't look overfilled.
For very loose skin, a facelift or neck lift performed by a board-certified plastic or facial plastic surgeon may be a better option.
Where Botox fits in a jowl treatment plan
When muscle pull contributes to jowling, I may start with Botox and reassess before recommending any additional treatments. Jowls are often caused by muscle activity and loss of underlying support. Addressing the muscle pull first can help clarify how much it contributes to the loss of jawline definition.
I tailor the treatments to the cause of your jowls, spacing treatments over several months. If volume loss or skin laxity is causing most of the sagging, I may not use Botox at all. I perform every Botox and filler injection myself, so the physician who assessed your jaw is the same physician who treats it.
Every Botox treatment includes a complimentary two-week follow-up. If any additional Botox is needed at that visit, it is provided at no extra charge. This allows me to begin conservatively and make adjustments based on your response.
What this costs
Botox is priced by treatment area. During the consultation, I will assess your jawline and neck, and recommend the best treatment plan. I will review the costs before proceeding.
FAQ
Does Botox get rid of jowls?
No, Botox doesn't get rid of jowls. At most, it sharpens the jaw edge a little by easing the neck muscle's pull.
Is the Nefertiti lift FDA-approved?
Not as a jawline treatment. Botox Cosmetic is FDA-approved for moderate to severe neck bands, and the approved pattern includes small injections just below the jawline. Using it with the aim of defining the jawline is off-label.
Can Botox in the neck affect swallowing?
It can, which is why placement matters. The label, the drug's official FDA prescribing information, carries a boxed warning, the FDA's most serious type of warning, printed in a box at the top. It says that if the effect spreads beyond the injection area, swallowing and breathing difficulties can be life threatening. The label directs that neck band injections stay out of the structures beneath the platysma and at least 1 cm below the jawbone. If you already have trouble swallowing or breathing, tell me before any neck treatment.
Why did Botox do nothing for my jawline?
Usually because the problem came from lost support or loose skin. Muscle pull was likely a small part of it. Botox only changes what the muscle is doing.
Next step: find out what's causing your jowls
The next step is finding out how much of your jawline comes from muscle pull, lost support or loose skin. Your first visit is a 15-minute consultation at our Upper East Side office, 931 5th Avenue. I'll examine your face and neck, explain what's causing your jowls and recommend only what fits. Request an appointment for that assessment, or call (212) 517-8855. I've injected Botox in New York City since 1992, and I do every injection myself. How I approach Botox explains how I determine the placement and the dose. You can learn more about treatments that stimulate collagen and elastic tissue on our skin tightening page.
