Jowls are a common facial feature associated with aging, defined by the sagging skin and tissue that descends along the lower jawline. They represent a change in the youthful contour of the face, often resulting in a less defined and more tired appearance. Their development is a natural, progressive process influenced by complex biological and environmental factors. Understanding the location and causes of jowls is the first step in exploring options for management and rejuvenation.
The Anatomy of Jowls
Jowls are located on the lower third of the face, appearing as loose tissue that drapes over the mandibular border, specifically lateral to the chin and extending towards the corners of the mouth. This area of descent is distinct from the submental region, which is the tissue directly under the chin commonly referred to as a “double chin.”
The formation of the jowl is closely linked to the complex attachments in the lower face. The tissue hangs over the mandibular ligament, a deep structure where the platysma and other lower lip depressor muscles anchor to the jawbone. The jowl area is comprised of superior and inferior fat pads, separated from the neck fat by the mandibular septum. This location has the most mobility, allowing the tissue to slide downward over the bone as elasticity declines.
Why Jowls Appear
The appearance of jowls results from a cumulative breakdown of facial architecture across multiple layers, including the skin, fat, muscle, and bone. A primary cause is the degradation of the skin’s structural proteins, collagen and elastin, which provide firmness and elasticity. Collagen production decreases starting in the mid-twenties, leading to a gradual loss of the skin’s ability to resist gravity and maintain its shape.
Changes in facial fat distribution further contribute to the sagging contour. The fat pads in the upper cheek, known as the malar fat pads, descend over time due to gravity and the loosening of retaining ligaments. This downward migration causes mid-face deflation and contributes to the accumulation of tissue along the lower jawline. Fat deposits within the jowl area can also enlarge, exacerbating the visible bulge along the mandible.
Age-related bone reabsorption in the jawline and chin is another mechanism. The mandible loses volume and structural projection over the decades, which reduces the bony support for the overlying soft tissues. When the facial framework shrinks, the soft tissue is no longer held taut and glides forward and downward, collecting at the mandibular border. Lifestyle factors like sun exposure, smoking, and genetics can accelerate this entire process.
Non-Surgical Treatment Options
Minimally invasive options can effectively manage mild to moderate jowl formation without surgery. Protecting existing skin structure is foundational, involving daily use of broad-spectrum sun protection and topical retinoids to stimulate collagen production. For more noticeable laxity, energy-based devices can be used to tighten the skin.
Radiofrequency (RF) treatments use heat energy to warm the deeper layers of the skin, causing existing collagen fibers to contract while stimulating new collagen production. High-Intensity Focused Ultrasound (HIFU) delivers targeted sound waves to deeper tissue levels than RF, promoting collagen renewal and providing a subtle lifting effect. Combining microneedling with radiofrequency energy allows the heat to be delivered more precisely into the dermis, addressing both skin laxity and textural issues.
Injectable treatments offer another pathway to restore definition. Dermal fillers, typically hyaluronic acid, can be placed strategically along the jawline to fill the crease immediately in front of the jowl, known as the prejowl sulcus, creating a smoother, more continuous line. If the jowl is composed of excess fat, fat-dissolving injections containing deoxycholic acid can be used to permanently destroy a portion of those fat cells, reducing the overall volume.
Surgical and Advanced Interventions
For individuals with pronounced jowl development and significant skin redundancy, surgical interventions offer the most dramatic and long-lasting correction. The gold standard procedure is a surgical facelift, or rhytidectomy, which addresses the deeper structural layer of the face. This surgery involves repositioning the Superficial Musculoaponeurotic System (SMAS), a layer of muscle and connective tissue beneath the skin, to lift and restore the soft tissues to a more youthful position.
A neck lift, or cervicoplasty, is often performed with a facelift if tissue laxity extends significantly below the jawline into the neck. This procedure tightens the platysma muscle and removes excess skin from the neck, completing the contouring of the lower face.
For those seeking a less extensive procedure, a thread lift presents a temporary, minimally invasive option. Thread lifts involve inserting specialized sutures, often made of materials like Poly-L-Lactic Acid (PLLA), beneath the skin to mechanically lift the sagging tissue. These threads have small barbs or cones that grip the subcutaneous tissue, providing a subtle upward pull on the jowl and stimulating collagen production for longer-term firmness.