Before we start thinking about how to treat jowls, we need to understand what they are and why they form. Read on and all will be explained…
Jowls are areas of loose skin that sag below the jawline, giving a sad appearance. What once was a sharp jawline with a straight line from the angle of the jaw to the chin, becomes step-like. The reason for this is as we age through all the layers of the face, gravity is also at play. So as our collagen and elastin diminishes (note - sun exposure massively speeds up this process!!) the skin loses it’s elasticity and bounce and becomes saggy. Therefore with the pull of gravity, the skin hangs. Not only that, but as we age the fat pads in our cheek shrinks but the fat pads around the nasolabial folds (nose to mouth lines) actually get bigger. The ligaments in our face also become more lax. All these factors combined means the extra tissues hang below the bony jawline.
Interestingly the mandibular ligament runs from the corner of the mouth to the jaw line and acts as a barrier to the excess tissues, meaning they gather behind it much like a groyne on a beach (thank you A-level geography). This creates the step in the jaw line as in front of the ligament the skin is tight along the bone but behind the ligament, the excess tissues hang, known as jowls.
So, what to do about them? To be completely honest, jowls are not the easiest thing to treat. There is no quick fix and the best outcomes are when a few modalities are used at the same time. First up, Obagi medical grade skin care is a must. We need to get back on the collagen train and bring the skin back to optimum health. This is generally with products like tretinoin (vitamin A), Vitamin C and of course SPF to stop more collagen being destroyed. Now, I’m not in the business of misleading so this alone will not help jowls, however it is the basis of all anti-aging treatments being effective, so don’t discount it as an option.
I generally treat jowls with dermal filler but will always counsel patients on the option of a surgical facelift if I think non surgical treatments are futile. For some people, this is an option they would consider and for others it is a line they will not cross so then I explain how I can improve their appearance but on the understanding it is not comparable with a surgical facelift. I will have a consultation and assess the face and will come up with a bespoke treatment plan which usually involves in the region of 5-6mls of dermal filler. This is not used in the jowl area. Far from it actually. You have to be careful not to add more volume to the lower face which can look heavy and unnatural. My ethos is looking into why the jowls have formed and treating the cause - therefore I use dermal filler in the upper face (cheeks and temples) before I do anything in the lower face. I also treat the jaw line (and chin) directly and indirectly so some injections are more like scaffolding to hold up tissues, but some injections are to disguise the bumps to make them look less noticeable. If you look at the shadows on your face, that is where you have lost volume and that is generally where filler can be used to disguise the valleys and mountains on the face, but all done in a completely harmonious way so the face doesn’t look different or alien (god forbid). You just look refreshed and like you’ve had a good holiday. My ethos isn’t about trying to reverse all aging - it’s just about making you look and feel better. No chasing perfection or making everyone look like carbon copies of each other. Just you, on a good day.
So, are jowls reversible? Not entirely. But can they be disguised with clever techniques by a skilled injector? Absolutely.
Dr Laura Milligan
Optimise Medical
Clinics in Hampshire (Otterbourne, Alresford, Bishops Waltham and Stockbridge)
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