How Loose and Sagging Jowls can be Treated with and without Surgery


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 Reconstructive Surgeon. 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 in. 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 well-defined jawline. 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 mandibular notch. 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 the jawline. 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 my approach. Another issue related to fat that can also
contribute to the appearance of jowls is the buccal fat. 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 retraction. 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 loose. 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 system. 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 facial dressing. 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

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