Jowls

Jowls are the point at which facial aging stops being about lines and starts being about shape. Patients describe it as looking heavier than they are, or as their face having lost its outline, and it is usually the change that prompts someone who has been managing with skincare to book a consultation.

Sam Assassa, MD presented on Volumetric Facial Rejuvenation at the International Academy of Cosmetic Surgery congress and founded the American Association of Aesthetic Medicine and Surgery, where he has served as President since 2006. He founded Beverly Hills Aesthetics in 1995 and is board certified in Internal Medicine.

What Causes Jowls

A jowl is descended cheek tissue, and it forms through a sequence that happens in a specific order.

Skin loses elasticity. Collagen and elastin decline and the skin no longer recoils to where it was.

Cheek fat descends. The fat pads of the midface deflate and slide downward, collecting roughly a third of the way forward from the angle of the jaw.

Fat is lost on either side. Volume disappears immediately in front of and behind where the jowl settles, which makes the jowl more prominent by contrast rather than because it grew.

The jawbone thins. The mandible resorbs with age, removing the structural support the soft tissue was resting on.

The platysma pulls down. Neck muscle bands tighten and exert downward tension on the jawline from below.

That last point matters, because it means a jowl is not always a face problem. Some of the pull comes from the neck.

Descent Versus Deflation

These look similar and respond to opposite treatments, which is why they are worth separating.

Deflation means volume has been lost. The face looks flatter and more skeletal, the cheekbones read as sharper, and the jaw softens because nothing is supporting it. This responds well to restoring volume.

Descent means tissue has moved. There is still volume present, it is simply lower than it used to be. Adding more volume to a face that has descended enlarges it rather than lifting it, and that is the mechanism behind results people recognise as overdone.

Most patients past their forties have both, in varying proportion. Which predominates determines whether the plan is built around restoring or around repositioning.

How Jowls Are Treated Without Surgery

• Rebuilding the jaw structure. Jawline contouring with filler restores the bone support that has thinned and fills in front of and behind the jowl, removing the contrast that makes it visible.
• Restoring the midface. Cheek treatment addresses the deflation the jowl descended from, which frequently improves the jaw more than treating the jaw directly.
• Vector lifting. The 3D Vector facelift places structural filler at anchoring points to counteract descent along the lines the tissue fell.
• Releasing the downward pull. Relaxing the platysma reduces the tension drawing the jawline down from the neck, covered on the neck lift page.
• Skin tightening. Relift firms mild to moderate laxity in the lower face across a series of sessions.

The Honest Limit

Non-surgical treatment handles early to moderate jowling well. Beyond that it improves the appearance without resolving the problem, because tissue that has genuinely descended needs repositioning and excess skin needs removing, and no injectable does either.

A patient with significant laxity treated with filler gets a fuller face rather than a lifted one. If that describes your anatomy, you should hear it before you spend anything.

Have Your Jawline Assessed in Beverly Hills

Dr. Assassa will assess how much of your change is deflation, how much is descent, and how much is coming from the neck, then tell you honestly what non-surgical treatment can deliver. Request a consultation or schedule your appointment online.

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