Jowls are the initial signs of facial aging, and many people want to know how to treat jowls. People try everything under the sun to try to address the annoying jowls, both from forming and to get rid of them. Unfortunately, there are many attempts that lead you nowhere. You end up wasting lots of time, money, and energy, and end up with lots of disappointment.
This blog will hopefully put into perspective and make it clear what you need to do if you start to see jowls forming. If you are younger and you don't have them yet, when do they form? which they inevitably will in all of us, this will give you perspective on exactly what to do when it happens and what not to do along the way or when it happens.
The Principle of Looking Older: Skin vs Shape
The principle of looking older is a change in the facial shape. So, when you think of somebody who's young, there are two persistent qualities. Number one is that they have young-looking skin. What is young-looking skin? It's supple, it's clear, doesn't have a lot of fine lines and wrinkles, and young skin doesn't have a lot of pigmentation.
Second is that the shape of the face is firm along the jawline, firm along the neck, elevated all the way through, shaped almost like an upside-down triangle or like a heart. You see somebody across the street, you know it’s a young person. And the reason you know that is because they have these two aspects.
What You Can and Cannot Control
Now, just to clarify a couple of points, I'm going to separate skin from shape, and I'm going to simply say this: the skin is 100% in your control. You totally have command over defining skin aging. It really comes down to sun protection and the use of the right active skin care ingredients consistently over time.
Now, when it comes to shape, you have no control over it. Sad to say, you can eat the best foods in the world, you can diet the best, you have the least stress, and all the best genetics. Eventually, it's going to happen. The best genetics in the world delays aging by five to 10 years. People with a stressful life, aging comes a little bit sooner.
What Are Jowls?
What are jowls, and what do you do about them? A jowl is defined by soft tissue that's sagging below the jawline. In a young-looking face, the jawbone and the soft tissue over it are normally straight. In older faces with jowls, the sagging soft tissue falls below the jawline.
On the front view, a young face is shaped like a V, or a heart shape. As the face ages, it becomes much more like a square. Squaring effect can be seen as a loss of definition along the jawline, a loss of that V-shape, which is jowling.
When Do Jowls Form?
For women, it tends to happen right around the late 40s and 50s when estrogen levels drop during perimenopause and menopause.
What Causes Jowling?
So, what is causing jowling? There is a tissue called SMAS made of fascia and muscles, which is a scaffold holding your entire face and neck together. With aging and loss of collagen and elastin, the SMAS becomes longer. So this elongation of the SMAS causes the face and neck to come down. When that happens, the lack of firmness of soft tissue over these bony structures, like your cheeks and your jawline, makes you look older. It also impacts the neck since it is connected to the facial fascia.
When the face descends, nothing is holding the neck up anymore, and so your neck starts to sag too. So jowling leads to neck laxity as well.
A Simple Way to Identify Jowling
Now, another really simple way to know if you have jowls or what you're bothered by is if you watch yourself in front of a mirror by putting one finger over the cheekbone and one over the jawline, then pulling it toward your top and bottom of your earlobe, respectively. Now you look a lot like what you used to look like. I love the way it looks. Then you have a jowling and aging face.
Common Triggers and Early Approaches
SMAS elongation can be triggered by hormonal changes, stress, poor lifestyle, and genetics. Most people initially do other treatments to avoid surgery in order to correct this. What are the treatments that people normally start with to combat the aging face?
Most people start with minimally invasive treatments like fillers or thread lifts in order to lift the jowls and nasolabial folds. Then, resort to heat-based minimally invasive treatments like Radiofrequency-based devices, Thermage, and Ultherapy, whose primary function is to create controlled thermal injury in the subdermal tissues. Like putting your face in a microwave or heating it up, which causes the subdermal fat to melt. More harm than good. These treatments not only don’t work but also can cause harm.
The Reality of Treatment: Surgery
So, buckle up, the simple answer is surgery. I know, you're going to say, of course, you're a facelift surgeon. You like to operate. You want to get us!! Look, if the non-invasive treatment that I just mentioned worked, I could have multiple MedSpa offices all throughout California, packed with nurses and nurse practitioners in them.
But I firmly believe these devices may provide younger patients some signs of improvement; they DO NOT work for people in their 50s and 60’s. So, please try to take it from the perspective and lessons that I’ve learned since I was a young facial plastic surgeon: what's real and what's not.
Evolution of Surgical Techniques
Over time, I came to understand that minimally invasive techniques can work well for younger patients but often fall short for patients over 50. My evolution began with mini facelifts, followed by my Triple SMAS Plication technique published in PRS, then the High Lateral SMAS lift, and then extended deep plane approaches. Later, I combined the high lateral SMAS and extended deep plane techniques. This led to the development of a new technique representing a paradigm shift in facial rejuvenation.
It was published in the prestigious Plastic & Reconstructive Surgery and presented at national and international conferences. This method, called the Preservation Deep Plane Facelift with a Rotating Pedicle Flap, is an advanced technique that allows me to sculpt and refine the face by restoring youthful structure while preserving the individual's natural expression and facial harmony.
Results and Patient Outcomes
Today, my patients with advanced facial aging who undergo the Preservation Lift return with laughter, confidence, and a renewed sense of youthful vitality, especially those who have previously experienced disappointing results from many noninvasive treatments.