Before discussing the treatment options available, let’s first review some of the factors that lead to jowl formation.
As we age, two main things happen. Firstly, our skin becomes less elastic and weaker as we lose collagen and elastin. Secondly, we lose the support structure of our face. We lose fat in the upper part of the cheeks, and we actually lose bone, too. So, there is less to support the cheeks where they should be, and they drop.
Now that we know that jowls appear because of loose skin and loss of volume, we know that we have to both tighten the skin and add volume to treat them. Although this sounds easy, it is actually very difficult to completely eliminate jowls.
To tighten the skin, there are several treatments available. One option is a facelift which basically just pulls the skin tighter. Many people, however, are not ready or willing to go through a facelift. Fortunately, there are many non-invasive options available, too. All of these options work by heating the skin to a specific temperature. It turns out that if you heat collagen to a certain temperature, the existing collagen contracts, and the collagen producing cells are stimulated to make new, healthy collagen.
The non-invasive devices available to tighten skin include Thermage which uses radiofrequency, Ulthera which uses ultrasound, and ThermiTite which also uses radiofrequency energy to heat the collagen.
We have learned over the years that tightening the skin without adding volume can look very unnatural. Think old style face lift that gives a skeleton-like wind-swept look. Scary!
There are three main places we can add volume to reduce the appearance of the jowls. The first is to place volume in the cheeks to treat the underlying loss that primarily leads to the formation of the jowls. I often place volume in the arcs of the cheeks and in the area in front of the ears to lift the jowls up and back. There three main products I use in these areas. They are Voluma, Sculptra, and Radiesse, and they each have their own, unique benefits.
The other areas that we can add volume are in the marionette lines that develop in front of the jowls and in the jawline behind the jowls. Filling the marionette lines does not really target the underlying issue of volume loss, but it does soften the transition from the jowls to the chin which makes them look less obvious. Filling the jawline both pulls the jowls back and makes them look less obvious. For these areas, I usually use either Restylane, Juvederm, or Radiesse.
Other things you can do to treat the jowls include adhering to an excellent skin care program to help build as much collagen as possible and wearing a nightguard to limit teeth grinding which leads to bone volume loss. Facial exercises for jowls have little value.