Understanding Jowls: Causes and Treatments

One of the most commonly complained about features in the clinic is jowls. People, especially women, hate them, reminding them of their mother or other elderly relatives. People often think jowls are simply the result of gravity, but they are not! The process that results in the formation of jowls or sagging in the lower face is much more complex than simply gravity. In this article, I want to help you understand what causes sagging jowls and what the best options are to treat jowls.

The Anatomy of Jowls: What Are They?

Jowls refer to the sagging or drooping skin in the lower cheek, typically along the jawline. This change in facial contour is often associated with ageing, and most people will develop jowls as they get older. However, some people develop them at a younger age and more severely than others.

You will hear that jowls are caused by ‘gravity’ or ‘loss of collagen and elastin from the skin’. These are, in my view, outdated views. The evolution of jowls starts with changes much bigger in the face, at the level of the bone. As we get older, the bones of the face are gradually reabsorbed, resulting in a loss of structural support for the overlying soft tissues. This allows the soft tissues, i.e., the skin and fat, to glide forward, collecting at the retaining ligament beside the chin and resulting in the fleshy pockets of tissue we associate with jowls.

Factors Contributing to the Formation of Jowls

There are a number of factors that contribute to how quickly people develop jowls in life, and to what extent they develop.

Understanding these factors can help in formulating the best approach to treating jowls in your particular case.

The basic facial shape

The basic underlying shape of your face is a strong predictor of how quickly or severely you may develop jowls as you get older. Since the loss of bone is the key factor undermining the process of jowl formation, it stands to reason that people who have a more delicate bone structure will develop jowls faster and more severely than those who have a stronger natural bone structure.

If, for example, you have quite a petite chin, naturally, this can look quite delicate and feminine when you are young. However, as you age and bone is lost, it predisposes you to form jowls earlier and more severely than someone with a stronger bone structure. If you look at actresses like Angeline Jolie, who has an especially strong chin and jaw, which can almost look masculine in youth, these women rarely have problems with jowl formation until much later in life.

Genetic Predisposition to Jowls

Genetics also plays a role in the development of jowls, although it is most likely due to the inherited facial shape and bone structure that runs in your family. It is possible that other genetic factors, like skin elasticity, may play a part, although they are not as significant as the inherited bone structure.

Lifestyle Impacts on Jowl Severity

Lifestyle factors can significantly impact the severity of jowls. Rapid weight loss, especially through intense aerobic exercise like endurance running, typically burns fat from the face, resulting in additional loss of support to the overlying skin and worsening of the jowls. Yes, I just said it, too much exercise can be a bad thing (well, as far as your face is concerned, anyway).

Habits such as smoking and excessive sun exposure can accelerate skin ageing, although this typically affects the surface of the skin more than the deeper jowl formation.

Jowls Treatment Options: Surgical and Non-Surgical

The good news is that we now have a range of both surgical and non-surgical jowl removal options to treat jowls. I’m going to tell you which treatments I think are effective, which are a waste of money, and most importantly, why.

Facelift Surgery: A Closer Look

Ok, you might not like to hear this, but the gold standard way of treating jowls remains the good old facelift. This doesn’t mean it’s the only way to treat jowls; there are other non-surgical options, but facelift surgery is still the best option if you want the maximum improvement possible.

The facelift operation involves opening the skin at the ears, separating the skin from the underlying tissues, and then truly repositioning the tissues of the face. The good news is that facelift techniques have improved considerably over the decades, and most expert facelift surgeons agree that the deep plane technique is the best way to do this. In performing a deep plane facelift, instead of simply tightening things around the edges, the surgeon lifts the deeper tissues of the face as a separate layer, releasing the ‘retaining ligaments’ that hold the face in place and truly reposition the tissues. By properly repositioning the tissues, you avoid placing unnecessary tension on the skin and avoiding the pulled or stretched look.

Non-Surgical Alternatives to Treat Jowls

Ok, so facelift surgery isn’t for you. That’s okay. The good news is that there are effective alternatives. The most effective non-surgical alternative for treating jowls is filler injections. Yes, I know that conjures up images of stuffy, over-filled pillow faces – but please bear with me for a minute.

If you remember what we said about the loss of bone and fat being instrumental in the underlying cause of jowl formation, you can begin to understand why volume-restoring injections (using dermal fillers) could be an effective strategy.

The key to treating jowls with dermal fillers, however, is to focus on replacing what has been lost and restoring what was there previously. Occasionally, for example, if you have a receding chin, it can be helpful to use the filler injections to increase the chin projection – but this needs to be done cautiously with expert precision.

The best way to illustrate this is with some before-and-after examples of patients who treated their jowls using dermal filler injections. All of these patients treated their jowls with fillers, and I hope you agree that none of them looked like they had fillers. It’s all down to the correct diagnosis of the underlying problem and accurate employment of the treatment strategy.

Skin-Tightening Procedures: Radiofrequency and Ultrasound Therapy

You will read a lot about skin tightening procedures using either radiofrequency or ultrasound therapy. Whilst these types of treatments do have a role in improving skin quality, which can create a more youthful look, if you go back to thinking about what we said about the underlying causes of jowls, you can understand why they are not particularly effective at treating jowls.

What about thread lifts for treating jowls?

Thread lifts sound like a great option for lifting jowls. You just pop in a little stitch, and it tacks everything back? Unfortunately, this simply puts a bit of tension on the skin for a short period of time. Because there has been no real tissue repositioning, the lifting effect is very short-lived. I’ve used threads in my own practice because, like everyone else, I wanted to believe in their effectiveness, but I stopped using them over a decade ago. They simply do not work.

Before and After: The Importance of Realistic Expectations

The best way of assessing the outcome of any procedure is to look at before and after photos. Honest before and after photos normally show a good degree of improvement, but you will rarely see perfection! There are so many variables involved in both anatomy and healing that even with the best technique in the world, the perfect result is rarely achieved – but a good improvement is the norm.

Choosing the Right Treatment and Practitioner

The anti-ageing ‘business’ is both lucrative and ferocious. Everyone wants a slice of the pie, and there will be no shortage of people who will sell you treatments and procedures with promises of miraculous results. The best advice is to find a doctor you think you can trust and listen to what they say. Do not shop around until you find someone who tells you what you want to hear.

The Consultation Process and Personalized Treatment Plans

During the consultation, your doctor should discuss your goals, concerns, and suitability for different treatment options. This should feel like an information-gathering and exchange process rather than a sales pitch. Your doctor should want to really understand your medical background and what your concerns are before coming up with a bespoke plan for you.

Empowering Informed Decisions

Understanding the causes and treatments of jowls is the first step towards making an informed decision about your aesthetic journey. Knowledge is power, and it can help you navigate the complex world of aesthetic medicine with confidence.

Frequently Asked Questions

What actually causes jowls?

Jowls form because of changes deep beneath the skin, not gravity alone. As we age, the bones of the face gradually reabsorb, which removes structural support for the overlying soft tissues. The skin and fat then glide forward and collect at the retaining ligament beside the chin, creating the fleshy pockets we recognise as jowls. Loss of collagen and elastin in the skin plays a smaller role on top of this underlying skeletal change.

Are jowls hereditary?

Genetics play a role, but mostly through inherited bone structure and facial shape. People with naturally delicate bones, such as a petite chin or fine jawline, tend to develop jowls earlier and more severely than those with stronger underlying structure. Skin elasticity has a smaller genetic component but is far less influential than the bone framework you inherit.

Can losing weight cause jowls?

Yes. Rapid weight loss, particularly through endurance exercise like long-distance running, often reduces facial fat and removes support from the overlying skin. This can worsen the appearance of jowls. Smoking and prolonged sun exposure also accelerate skin ageing, although these tend to affect skin quality on the surface rather than the deeper structural cause of jowl formation.

What is the most effective treatment for jowls?

Facelift surgery, particularly the deep plane technique, remains the gold standard for treating jowls because it physically repositions the deeper tissues of the face. For patients who prefer a non-surgical option, dermal fillers can be highly effective when used to restore lost volume in the cheeks, mid-face, and chin. The right choice depends on the severity of the jowls, your anatomy, and your preferred recovery time.

Do thread lifts work for jowls?

In our clinical experience, thread lifts produce only a short-lived effect. Because they place tension on the skin without genuinely repositioning the underlying tissue, the lifting result tends to fade quickly. Dr McKeown trialled threads in his own practice but stopped using them over a decade ago. Surgical lifting and well-placed dermal fillers remain the more reliable options for addressing jowls.