Dr. Sethi:
How to fix jowls without surgery. Jowls can be very complicated, because it’s usually not something that you can sort of singularly target. When someone has jowls, or is just starting to get jowls, it’s a sign of skin laxity, so skin getting looser, and actually also loss of facial fat, and loss of facial fat can happen really at any age, depending on the reason for it. So, as we age, we do naturally lose facial fat that was previously helping give our face or our skin a nice lift and projection, and, in cases where people have lost a lot of weight, they can also start losing so much facial fat that they have sort of an accelerated aging of the face.
So, going back to jowls, jowls are formed by drop of volume in the front of the face, and skin laxity in the lower cheek area, and kind of starting by the ears, and this movement downwards causes the appearance of jowls. A lot of times, people think that if they were to address that, they should just focus in the lower face area, but that is not a strategy that will lead to success, and it may not even look right when done. So, when I’m assessing someone for whether they’re a surgical or a non-surgical patient for addressing their jowls, the first thing I do is look at their temples and start assessing their facial volume overall. Temples, cheeks are usually also losing volume if you’re starting to have jowls, and when we are addressing jowls, we want to address the full face. There is also a window of opportunity in terms of when can you address jowls in a surgical versus non-surgical way? This is just sort of an approximate guideline, not always the case, but, typically, if you’re starting to see jowls in your late thirties to early forties, there are a few non-surgical things that can be very effective and look very natural. However, if you have more, I would say, advanced jowling, which we usually see when people are in their late fifties or mid-fifties to sixties, then surgery is honestly the best option.
Now, going back to how do we address them? So when I’m thinking of addressing jowls full face, Sculptra is my favorite go-to procedure. Sculptra is bio-stimulator. It’s an injection, but it’s not a filler. Sculptra comes in a powdered form, and it’s reconstituted in normal saline, and injected underneath the skin in multiple places: the temples, mid-face, lower face, and sometimes I also sprinkle it in other parts of the face, like the nasolabial area, and it’s a collagen booster. Sculptra is injected, and, over a course of three to six months, it’s going to stimulate enough collagen to replace that facial fat loss. The other nice thing about Sculptra is that, because it’s a collagen stimulator, it also has nice benefits on the appearance of your skin. Sculptra is something that is dosed in vials, and typically, most people require three sessions that are spaced six weeks apart, with two vials injected at each session. After six months, I reassess the patient, and see if they need just a little more of a boost. So, when it comes to jowling, full face is clearly the best, a full face assessment and strategy is the best way to go, and Sculptra does that beautifully.
The other procedure that is very popular in combination with Sculptra is Ultherapy. Now, if you are seeing jowls in the lower face, you likely also have laxity below the chin and in the neck, and I like to use Ultherapy for that. We do not use Sculptra in the neck area, it’s contraindicated, but Ultherapy, which is a procedure that’s ultrasound-based, will help tighten the muscle in the neck and the skin, and the neck is an interesting area, because the muscle of the neck is attached directly to the skin, which is why Ultherapy works very well in tightening in that area. Finally, some people ask if microneedling with radio frequency will address jowls. For that one, it’s sort of a maybe. If you are starting to see jowls very, very early on, microneedling with radio frequency can give you just enough tightening to reduce those jowls, but, again, usually, it is not the go-to way to do it, and I find that it’s usually when we’re seeing people starting to see jowls in their mid-thirties to early forties.
The final thing I’m going to leave you with is whether fillers can help with reduction of jowls. Fillers are not a good solution for jowls, because, as we age, we naturally start losing volume, and our skin shifts downward, and we look like volume is shifting downwards. Now, if you think about what fillers do, fillers fill spaces and add volume. So, if you add volume to the lower face, where you already have jowls that are giving you volume, you are just going to worsen the solution. Adding fillers to the face to address jowls is never done, primarily because of this issue with volume being brought downwards. If you are considering a filler to address facial fat loss, it’s usually going to be in the mid-face, not in the jowl area. Again, there are so many different customized ways to address jowls, but it is something that has a window of opportunity, usually in the forties to early fifties. After that, it tends to be a little more surgical. If you enjoy watching our content, learning about medical aesthetic treatments, skincare, beauty trends, please follow us, and ask us any questions in the comments.
