The term “jowls” tends to be a general term to describe the appearance of a jawline,
which is not well defined.
Although “jowls” is commonly associated with facial aging associated with sagging
skin, many younger people come in to our office complaining of having “jowls”.
There is considerable confusion about how to improve the jawline since the marketplace
is saturated with “miracle” solutions.
I’ll discuss how I help my patients improve the appearance of their jawlines everyday
in my practice.
I’m Dr Amiya Prasad.
I’m a Board Certified Cosmetic Surgeon and Fellowship Trained Oculofacial Plastic and
I’ve been in practice in Manhattan and Long Island for over 20 years.
My approach to jowls was first established through performing surgical procedures such
as liposuction for better jawline definition and the full range of face and neck lift surgeries.
In addition, I routinely placed chin and pre-jowl implants for this purpose.
This knowledge of deeper facial anatomy has been the basis for the evolution of my approach
using non-surgical solutions for treating jowls, which I will describe in detail.
In my daily practice, patients come asking for procedures, which they learned about online
and from their friends who may or may not have had the procedure they’re interested
I explain to them how it’s first necessary to understand the anatomical basis for their
appearance before discussing treatment options.
Large cap companies with big marketing budgets very effectively influence the consumer into
believing that their product is new and of course better than everything else.
Rarely is this actually true, scientifically speaking.
So let’s start with understanding the anatomy of “jowls”
As I mentioned earlier, the term “jowls” is often applied to the lack of a clear and
This can be attributed commonly to a relative bone deficiency, excess fat below the jawline
and loose, sagging skin.
There are situations where one or combinations of these anatomical issues are present at
the same time.
When it comes to a situation of relative bone deficiency, there are several aspects of the
bone called the mandible where this deficiency can be present.
These include the chin or mentum, the jaw angle and an area of indentation called the
The cause of this deficiency can be familial, essentially characteristics which are inherited
as well as from aging.
Contrary to common perception, which focuses on the skin changes related to aging, diminishing
bone volume has a more significant impact on your appearance.
Typically in your 40’s to 60’s depending on your genetics, bone volume loss has more
effect on the jawline than skin sagging.
I approach this issue by applying the surgical principles used for the placement of facial
implants to the nonsurgical placement of long lasting hyaluronic acid fillers such as Juvederm
Ultra Plus and Juvederm Voluma.
This is called Structural Volumizing.
This means that I’m precisely placing hyaluronic acid filler at the bone level to restore and
enhance the contour where the deficiencies are present.
I routinely perform this procedure in my exam room with minimal discomfort, minimal risk
of bruising and in minimal time.
Bone volume loss also affects the cheekbones, which also support the skin that drapes along
With this concept in mind, I routinely enhance the cheekbones at the same time.
I would also add that the balance of the cheekbone projection with the jawline is important in
how the jawline is perceived.
By applying the golden ratio of or the proportion of 1.6 to 1, the face looks more balanced
and the jawline appears more youthful.
If the anatomic basis for the jowls is fat under the skin and the skin tone is good,
then my approach is to perform suction assisted lipectomy or liposuction.
This procedure takes very little time and is performed with local anesthesia and sedation.
I often find that fat below the jawline is often accompanied by fat under the chin, so
I will routinely treat this area as well.
This approach is safe and efficient.
Ironically, a product made of a bile acid called deoxycholic acid has been aggressively
marketed as a nonsurgical option for fat reduction under the chin.
My concern is that the procedure requires multiple sessions over several months with
significant swelling and inflammation after every session.
In my opinion, this describes a product, which is new, although deoxycholic acid itself is
not new and it has been around for years and is in no way better than what I do with a
cannula and a syringe in a just a few minutes of time.
The idea that the injection is a nonsurgical option misses the fact that injections into
the skin and creating inflammation is more invasive and requires much more recovery than
Another issue related to fat that can also contribute to the appearance of jowls is the
Buccal fat is a specific structure composed of fat that is located in the cheeks.
In some people, as they get older, some part of this fat decreases in volume and the supporting
structures get loose resulting in the fat creating a bulge adjacent to the jaw creating
a jowl appearance.
This is not fat that can be reduced with liposuction nor would I use deoxycholic acid.
For this prolapsed buccal fat, I work from the inside of the mouth and access the buccal
fat through a small opening inside the cheek.
I routinely perform this procedure with local anesthesia with minimal sedation.
The benefits of buccal fat reduction can be quite significant.
If there is a jowl with skin laxity, I assess the degree of skin laxity to determine if
you’re a candidate for a procedure called a “jowl lift” where I use a long pulse
1064 YAG laser or whether to perform a surgical facelift procedure.
The jowl lift procedure involves the use of a 1064 YAG laser to heat the skin and the
fat from the outside to a target temperature, which induces both fat destruction and skin
This procedure is performed in an exam room and takes about 15 minutes per session for
about 3 to 4 sessions spaced about 1 month apart.
This procedure is best suited for people who have good skin tone or the skin is not very
When the skin is loose and the jawline is not well defined, a facelift or face and necklift
procedure is generally the appropriate option.
This procedure is not just lifting sagging skin but it’s also addressing the underlying
tissue connected to the facial muscles called the SMAS or superficial musculoaponeurotic
This deep tissue is the foundational support of the skin and is often referred to when
a patient asks about “tightening the muscle” during a facelift.
I perform face and neck lifting procedures using local anesthesia with LITE IV sedation.
In addition to avoiding general anesthesia I use advanced wound healing technology such
as acellular matrix for better healing of the incisions.
My patients are comfortable during and after surgery, and are able to go home with a minimal
My patients go back to work in 1 to 2 weeks with better looking jawlines.
I do emphasize to my facelift patients that your appearance after facelift surgery also
is also affected by the underlying bone structure and your skin elasticity.
You can think of facelift surgery as a way to restore the anatomy of the sagging tissue.
Your appearance can be further enhanced by addressing the age related bone volume loss
with Structural Volumizing.
Not having a well-defined jawline due to the appearance of having jowls can be very distressing.
It’s generally appreciated that people who are considered attractive, regardless of age
tend to have nice facial definition and harmony characterized by well- defined jawlines.
In the current environment, there are all kinds of skin level devices and dissolvable
threads creating a lot of buzz through aggressive marketing and absurd claims.
It’s important to understand the anatomical principles for your situation so you can avoid
being mislead by flashy marketing.
I always tell my patients that you define the problem before you work on a solution.
For example, if the appearance of jowls is due to a relative bone deficiency, even a
subtle improvement of the jawline through Structural Volumizing can make a significant
impact on how you feel about your appearance; and the results are appreciated immediately.
In conclusion, your facial bone structure, the presence of fat under your skin or in
the buccal space and your skin tone can all be addressed safely and effectively to help
you keep your jawline looking its best, at any age.
I hope you found this information helpful…thank you for your question