ProductsMany people notice jowls in a photograph taken from slightly below, or on a video call, when the jawline has a soft break on either side of the chin. My name is Dr. Debra Jaliman, and as a dermatologist in New York City, I look for three causes of jowls, because the right plan depends on which one is behind yours. Skin tightening for jowls helps most when loose skin is the main problem and the fat and bone underneath are still largely in place. When fullness has been lost higher in the face, filler in the cheeks may help. When there's a lot of excess skin, surgery may be the better choice.
What a jowl actually is
A jowl is soft tissue that has sagged below the jawline on either side of the chin, breaking the line between jaw and neck. The medical word for this sagging is ptosis, which means something has dropped lower than it used to sit.
Jowls form in that spot because of how the lower face is attached. Beside the mouth and chin, the skin is fixed to the lip muscles and moves with them as one unit. Behind that zone, the fatty layer over the jaw moves freely so the mouth can open wide, and with age it lengthens and loosens.
As this tissue loosens, it slides down and gathers against the fixed zone. That tissue includes fat pads, the pockets of fat that give the face its shape. So the jowl bulges beside the chin while the chin itself stays where it was.
What causes jowls: three changes, and only one is about skin
Jowls come from three overlapping changes: loose skin, fat that shrinks or moves lower, and bone loss.
- Loose skin. The medical term is laxity, which means the skin has lost firmness. As collagen and elastin decline, the skin holds the tissue beneath it less well, the same process behind crepey skin.
- Fat that shrinks or moves lower. Pockets of fat in the middle of the face appear to move lower with age, and the changes vary by region of the face. In the lower face, fat pads can shrink and shift as well.
- Bone loss. The medical term is resorption, which means the body slowly loses bone and doesn't replace it. With age, bone is lost around the eye sockets and along the jaw. The rear of the jawbone can lose height with age.
Radiofrequency skin tightening works on the skin by stimulating new collagen. So it usually helps the first cause most, does less for fat that has moved lower, and doesn't act on bone at all. That is why a jowl treated with tightening alone sometimes improves less than people expect, and why bone loss limits what non-surgical treatment can do.
Some jawlines also have a downward pull from the neck muscle, which blurs the line further. Botox can soften that pull in some patients. I'll tell you if Botox isn't the best choice for you.
At what age do jowls start: a decade-by-decade pattern
Jowls commonly start to show in the forties or later, though the timeline varies from person to person. Sun and smoking can speed skin aging.
Late thirties
Many people see little change yet. Prevention at this stage means caring for your skin and wearing daily sunscreen. UVA rays can pass through window glass, so sun exposure can add up even on days you barely go outside.
Forties
This is when some people start developing jowls. The change is usually early looseness, and some people are also losing facial fat. Non-surgical skin tightening suits early jowls and mild to moderate looseness best.
Fifties
Loose skin is often joined by fat changes. For women, skin can lose about 30% of its collagen in the first five years of menopause. Non-surgical treatment can still help, but the goal is improvement rather than restoring the jawline you had at 40.
Sixties and beyond
More bone has usually been lost along the jaw. If sagging is advanced, surgery may be the better option, even if you came in hoping to avoid it.
Can jowls be fixed without surgery: skin tightening for jowls by stage
At the earlier stages, often yes. I tailor the plan to the stage and the cause, and then I recommend the treatment that fits.
Early jowls
If loose skin is the main cause, I usually recommend radiofrequency skin tightening. It uses controlled heat in the deeper layers of the skin. In our office, that means a radiofrequency device such as Thermage CPT or TempSure Envi. I determine which treatment is best for you, and my medical assistant, who has 13 years of experience, performs it. Thermage CPT is given as a single treatment, and TempSure Envi is a series of four sessions about a month apart. Results develop gradually over 3 to 6 months and typically last 12 to 18 months, depending on the device, so maintenance sessions may be needed. There is no downtime.
The device I recommend depends on you. Thermage CPT delivers deep heating and is used for lifting and shaping, while TempSure Envi uses gentle, even heating and suits the jawline and neck. If you worry that heat will melt the fat in your face or affect your filler, these devices don't destroy fat at appropriate settings and, when performed correctly, don't melt dermal fillers. TempSure Envi also monitors skin temperature in real time, which helps protect facial fat and fillers. Laser treatments such as Fraxel can improve skin texture alongside tightening.
Moderate jowls
Here, tightening alone can fall short, because part of the problem is lost fullness rather than loose skin. I evaluate where fullness has been lost before I recommend filler. Dermal fillers can create a subtle lift in the cheeks, jawline, and middle of the face. One filler used for the cheeks is Juvederm Voluma XC, which the FDA has approved for cheek augmentation, or adding fullness to the cheeks, in adults over 21.
Some patients need one syringe for subtle enhancement, and others need more. With filler, I take a conservative approach so the face doesn't look overfilled. How long filler lasts depends on the product and the area. When a plan includes both filler and tightening, I usually space treatments over months and reassess before each step.
Advanced sagging
When excess skin is the main issue, tightening and filler may not be enough, and I'll tell you so.
When surgery is the more realistic answer
Excess skin, more than lost fullness, usually points to surgery. Age alone doesn't decide this, so I evaluate it at your consultation. When sagging is advanced, I refer you to a board-certified plastic or facial plastic surgeon for a facelift or neck lift.
For early and moderate jowls, a step-by-step non-surgical plan means little downtime and gradual change.
FAQ
At what age do jowls usually start?
Some people notice jowls in their forties, and others not until their fifties or later.
Can jowls be fixed without surgery?
It depends on the stage. Early and moderate jowls commonly improve with radiofrequency skin tightening, filler in the cheeks, or both, with change usually building over several months. With significant loose skin below the jaw, surgery usually offers more.
Does losing weight make jowls worse?
It can. GLP-1 weight loss medications can bring facial volume loss and sagging, and after significant, quick weight loss, skin doesn't always shrink back. If you're planning major weight loss, tell me at your consultation, because it can change your jawline and your plan.
What the first visit involves
- I examine your face and neck, at rest and as you move.
- I explain which of the three causes is behind your jowls.
- Before any injection, I review your medical history, medications, and allergies, including lidocaine, a numbing medicine many fillers contain.
- I recommend only what fits you, and that can include surgery.
Your consultation covers your whole face, not just your jawline, and we'll talk through your facial structure, skin quality, and goals. Filler is purchased by the syringe or half syringe, and we'll go over exact pricing for skin tightening at your consultation. The consultation fee is credited toward same-day treatment or a future appointment.
Finding out which cause is behind your jowls
.Skin tightening for jowls works best when loose skin is the main cause, and the plan changes as fat and bone loss play a bigger part. You don't have to work out which cause is yours. I evaluate that with you. I've injected Botox in New York City since 1992, and I place every filler and Botox injection myself. To have your jawline checked at 931 5th Ave on the Upper East Side, book a consultation with Dr. Jaliman or call (212) 517-8855.
