How do I get rid of jowls? According to a plastic surgeon

How do I get rid of jowls? This is a question I'm often asked in consultations, but also on social networks, so I've decided to share my expertise on the subject. First of all, I'd like to give you a quick explanation of how and why jowls appear over time, what makes them worse and, above all, how to treat them.

The appearance of jowls

You might think that the appearance of jowls would occur gradually over the years, but in practice, the appearance of jowls is not always the case. aging happens in fits and starts. Patients often say to me: "Doctor, I haven't recognized myself for a few months now, as if my face had changed overnight! But how can we explain this phenomenon?

The jowl is an accumulation of skin or fat at a fixed point on the face, known as the bitterness or marionette line. On this diagram, you can see that some areas of the face can move and others are fixed.

This creates furrows, such as the dark circle, the nasolabial fold or the bitterness line. As the skin slackens over time, excess skin becomes trapped in these grooves, and in our case, it's the bitterness line that creates the jowl.

To be more precise, it's gravity that causes the jowl to appear, and the proof is that if you lie on your back, your jowl will disappear.

So the appearance of jowls is the consequence of skin laxity, but this statement is incomplete: the problem is not just skin sagging caused by loss of collagen. Sagging skin can also be the result of a loss of facial volume. It's obvious that if there's a loss of bone or fat volume on the face, we'll end up with excess skin because the skin will be less taut.

In fact, the older we get, the more our bone mass diminishes, leading to significant changes in the shape of the face over time. The skull loses volume, the orbital cavity enlarges, resulting in a change in the shape of the eyebrow, and the dark circles become more pronounced. But that's not all: the malar bone resorbs and the mandibular bone changes shape, making the face less prominent, less defined, and above all, this loss of volume creates skin laxity and aggravates the jowl! But bone loss doesn't explain everything: facial fat also changes as we age. Over time, the subcutaneous fat of the face diminishes, accelerating the appearance of furrows. This fat loss is exacerbated by multiple factors, such as sun exposure, massive weight loss and, of course, inflammation. In fact, facial fat cells are different from those of the rest of the body, and are highly sensitive to inflammatory phenomena, as well as to UV rays!

What can aggravate the appearance of jowls?

Therefore, a precise analysis of the face enables us to choose the best solution for treating jowls. If skin sagging is mainly the result of a loss of volume, restoring volume to hollow areas with hyaluronic acid may be a good option. But of course, the aim is simply to restore the volume that has been lost over time, and not to over-inject. On the other hand, if you realize that the volumes are correct but that it's the quality of the skin that is the main cause of the appearance of the jowls, you'll have to turn to treatments that will boost collagen production or treatments that will tighten the skin.

So why can the appearance of jowls be so sudden? There are certain periods in life that can favour their appearance. In our thirties, we often notice the appearance of the first fat melting, the face becoming less round, more protruding, and sometimes this leads to the appearance of mini jowls. In your forties, facial skin can become drier, and you'll need to adapt your skincare routine. And in your fifties, hormonal and bone changes can lead to the rapid appearance of jowls. But these are generalities, and each person will age differently, depending on genetics and, above all, lifestyle habits.

Bichat ball surgery!

So what can speed up the appearance of jowls? Cosmetic surgeons can sometimes accelerate the appearance of jowls! And yes, one surgery that's been getting a lot of buzz can make jowls worse, and that's Bichat ball surgery. If you have Bichat's balls, which are cheek fat, removed, volume will be lost and there is a significant risk of accelerating the appearance of bitterness lines and jowls. That's why I don't perform this type of surgery.

The YOYO effect

Another phenomenon that can aggravate the appearance of jowls is the famous Yo-Yo effect: if we gain weight, our facial skin envelope will tighten, which will lift the face, but when we lose this weight again, the skin will relax and excess skin will appear, which can lead to the appearance of jowls. There is also the phenomenon of early bone loss, and to combat this, you need to exercise and avoid dietary deficiencies. Facial fat loss is a natural phenomenon, but is aggravated by exposure to the sun. Last but not least, don't neglect your skin with the right products for your skin type.

And I'd like to take this opportunity to tell you, if you haven't already done so, to join the waiting list to download thebeautydecoded application which will enable you to choose cosmetics that really suit your skin.

Jowl treatments!

Jowl treatments at home

Unfortunately, there are few ways to improve jowls at home. All kinds of massage techniques can help if lymphatic stasis is a problem, but this is rare. Micro-current therapy can also help, but it's time-consuming and there's a dearth of real scientific studies attesting to its effectiveness. On the other hand, I'm much more convinced by radiofrequency. Radiofrequency delivers electromagnetic waves that diffuse heat into the cutaneous and subcutaneous tissues. There are different types of radiofrequency - monopolar, bipolar and multipolar - and the whole idea is to heat subcutaneous tissue without burning the skin. Concerning radiofrequency, there are quite a few scientific publications on this technique, and I remember a fairly old study published in 2003 on radiofrequency treatment of jowls. And out of 15 patients, 10 were dissatisfied and 5 satisfied. That's only a third, but since then, machines have come a long way, both medical radiofrequencies and those you can use at home.

Medical treatments for jowls

Hyaluronic acid injections

As far as medical techniques for improving jowls are concerned, the one I find most effective apart from surgery is hyaluronic acid injections. If you're in your thirties or forties, we've already seen that your facial fat has diminished slightly and your skin tissue has relaxed slightly. My advice is not to succumb to the temptation of massive injections to tighten the skin, but to improve the jowls with a few targeted injections. The aim is to erase the first signs of ageing before it's too late, since it's much easier to treat early flaws than a face that has been heavily marked by time. So, when you decide to inject hyaluronic acid, don't inject in that part of the face just above the bitterness line or the nasolabial fold, or you'll make the problem worse.

And yes, it would be harmful to add volume to an area that already contains too much. So you need to inject above or below this area. Above this area, a cheekbone injection lifts the middle third of the face, and works very well, but there's a catch. If you already have enough volume in your cheekbones, don't add to it. Naturalness comes first. Another area is the posterior mandibular part, which also lifts the neck and jowls a little. Below this area, we have the nasolabial fold, which can be injected to harmonize contours, but this is the area we're interested in.

For your information, the non-absorbable products used in the early 2000s were unfortunately the source of many complications and are no longer used. What's more, the face evolves over time, and the injection area needs to be adapted to facial changes. Other injectables that can be used include collagen inducers such as Sculptra, which can be useful for improving wrinkled cheeks; they were quite popular before hyaluronic acid supplanted them. With hyaluronic acid, results are almost immediate, whereas with collagen inducers, you start to see results after a few months.

Other treatments

Other medical treatments include ultrasound, which works in much the same way as radiofrequency, lasers and peels, which improve skin quality but have limited effects on the jowls. I'd like to talk about tensor threads. There are many different types of thread, both absorbable and non-absorbable, and I'll be honest, I'm not a fan of this type of procedure. I'm not saying that they don't work, but it's no good putting threads under the skin - too superficial and they can show, too deep and they're useless or damaging.

Surgical treatment of jowls

And finally, the surgical facelift really tightens the tissues and considerably improves the sagging of the neck, jowls and lower nasolabial fold. In my opinion, it's the most effective treatment for erasing jowls, but we have to be honest: the result of a facelift must be natural. We've all seen frozen faces with a "surgical" look, and that's the wrong thing to do. But the consequence of a result that remains natural is often that the jowls will reappear somewhat after a facelift. In some people, the jowls will take years to reappear, and in others, they may reappear after 6 months to a year, so not as before, of course, but a micro-sagging appears. And in fact, a lot depends on the quality of the skin and tissues. And yes, the result of a facelift doesn't just depend on the surgeon; if you have good quality skin, the result will be much better and last longer.