Do you feel like you look sad or down faced when you look in the mirror because of a sagging jawline? If you do, you are not alone. A sagging jawline, or “jowls” as it is often referred to, is the skin that forms under the chin and jawline as we age. One of the major concerns of the ageing face, a sagging jawline is caused by a loss of elasticity and thinning of the skin, combined with gravity taking its toll one the underlying structures which support the skin and prop everything up. People who have more fat in their face tend to have less pronounced jowls as the fat provides volume.

As we age, we start to lose fat in our faces and the plumpness and elasticity of our skin begins to fade. This causes our skin to become wrinkled and saggy, resulting in things like jowls. Dramatic weight loss can also contribute to a sagging jawline as it is also associated with loss of volume and fat in the face. Sagging skin is a natural part of the ageing process however lifestyle factors, such as smoking and sun damage, can also accelerate it.

Jowls are more prominent as we reach our 40s but they can start to develop at a younger age if the ageing process is accelerated by sun damage or smoking for example. Our skin starts to age from about the age of 25 onwards but earlier signs of ageing tend to be around the nasolabial folds, cheeks and eyes. Jowls get progressively more noticeable the older we get and are something women in particular in their 40s and 50s start to become more concerned about.

The formation of jowls is down to a number of factors so tightening the skin will help but skin tightening may be better utilised alongside other treatments which replace lost volume or stimulate the production of new collagen. Skin tightening treatments include energy based treatments such as radiofrequency, high-intensity focused ultrasound (HIFU) and laser (including fractional laser or laser resurfacing), however for an area such as the jowls ultrasound is considered to be the most effective. Such treatments work by creating heat in the skin causing it to build new collagen and elastin. Threads can also be used to address a sagging jawline and there are advanced “off label” uses for botulinum toxin for contouring the jawline. Off label means that the drug is not actually approved for this indication although doctors are able to use drugs off label at their discretion. Dermal fillers can also be used to contour the jawline, however if there is significant lose skin and sagging a combination approach may be best. 

Laser rejuvenation can be very effective for a number of ageing related concerns, but it is not necessarily the most effective treatment for jowls. Ultrasound is considered to be more effective in this area. There are many different types of laser but the most powerful one used for facial rejuvenation is an ablative CO2 laser resurfacing. This is very effective at treating scars, wrinkles and pigmentation but does also have a tightening effect. Because ablative laser has more downtime many practitioners now prefer to use what is known as fractional CO2 laser which is non-ablative and therefore not as aggressive as its ablative counterpart. This is because it only targets a fraction of the skin, leaving little spaces in between the areas that are treated.

Yes surgery can be used to address sagging in the area of the neck and jawline. A neck lift or platysmaplastyis probably most effective for jowls although a face-lift may also be performed.

Actually the opposite may be true. Losing weight can make jowls more pronounced. If you have ever heard the term “runners face” this is used to described the hollow, saggy look some runners get as they age because of a lack of fat in the face. Fat is actually your friend in terms of facial ageing as fat equals volume. Losing too much weight or losing weight quickly may contribute to premature ageing.