Jowls refer to the sagging skin and tissue that develops along the lower cheek and jawline, disrupting the smooth, defined contour of the lower face. This common anatomical change is associated with the natural aging process. Jowls represent a visible manifestation of underlying structural deterioration, where the skin loses firm support and succumbs to the pull of gravity.
Anatomy and Appearance of Jowls
Jowls are defined as the loose, drooping skin and fat deposits that descend below the lower border of the jawbone, specifically along the chin and mandibular line. In a youthful face, the jawline presents a sharp, straight line from the chin to the angle of the jaw, but jowls interrupt this crisp contour. This sagging tissue creates a poorly defined transition between the face and the neck, sometimes giving the appearance of a double chin.
The physical development of jowls is tied to several deep tissue changes, including the descent of the facial fat pads that once provided support higher up in the cheeks. As these pads shift downward, the overlying skin and subcutaneous connective tissue also stretch. The resulting accumulation of lax tissue collects at the lower boundary of the face, creating the characteristic folds on either side of the chin.
Factors Contributing to Their Development
The primary physiological mechanism behind jowl formation is the age-related breakdown of structural proteins within the skin. Collagen and elastin are the two proteins responsible for the skin’s firmness, structure, and ability to snap back. As a person ages, the production of both these proteins wanes, leading to a loss of skin elasticity and increased laxity.
In combination with this biological change, gravity exerts a constant, relentless downward pull on the facial tissues. The weakened, less resilient skin structure can no longer effectively counteract this force, causing the soft tissues of the mid-face to gradually descend and pool along the jawline. Furthermore, some individuals have a genetic predisposition, inheriting a skin type or bone structure that makes them more likely to develop jowls.
Environmental and lifestyle factors also significantly accelerate the development of jowls. Excessive exposure to ultraviolet (UV) radiation from the sun, known as photoaging, directly damages collagen fibers and impairs the skin’s ability to repair itself. Smoking introduces chemicals that damage collagen and elastin, while also constricting blood vessels, which reduces the flow of nutrients to the skin. Additionally, cycles of significant weight gain and loss can stretch the skin, and subsequent weight reduction may leave the stretched skin unable to fully retract.
Options for Minimizing Their Appearance
The options for addressing jowls vary widely based on the severity of the sagging and the individual’s tolerance for invasiveness. For early or minor laxity, the focus is often on topical and non-invasive methods. Topical treatments containing retinoids, a form of Vitamin A, can stimulate collagen production over many months, offering a modest improvement in skin firmness.
Non-surgical, in-office procedures utilize energy to stimulate the body’s natural healing response and collagen production. Treatments like focused ultrasound (Ultherapy) and radiofrequency (RF) skin tightening deliver controlled thermal energy into the deeper layers of the skin, causing tissue contraction and encouraging the creation of new collagen. These methods are best suited for mild to moderate jowling and require no significant downtime.
For more noticeable jowls, minimally invasive injectable treatments can help to restore a smoother jawline contour. Dermal fillers, often made from hyaluronic acid, can be strategically injected into the mid-face to restore lost volume, providing a subtle upward lift that minimizes the appearance of the jowl below. Fillers can also be placed directly along the jawline to camouflage the sag and redefine the mandibular border.
In cases where the jowls are caused by excess submental fat beneath the chin, specialized injectables containing deoxycholic acid can be used to destroy the fat cells in the area, offering a more defined neck and jawline. Neurotoxin injections, such as botulinum toxin, can also be used in the neck muscles to create a temporary, subtle lifting effect on the lower face.
The most definitive and long-lasting solution for moderate to severe jowling is surgical intervention, typically a facelift, or lower rhytidectomy, combined with a neck lift. These procedures address the excess skin and the underlying muscle and tissue structure (SMAS) that has weakened and descended. A surgical lift allows for the removal of redundant skin and the tightening and repositioning of the deeper facial tissues.