Jowls: Causes, symptoms and treatment

Jowls form when the soft tissue of the mid-face loses its support and slides down past the jawline. Two things drive it, and most people have both.

Collagen and elastin decline. These are the proteins that give skin its firmness and skin elasticity. Production slows from the mid-twenties and the existing supply breaks down with age, so the skin no longer snaps back and gravity does the rest.

Facial volume descends. The fat pads that sit high in the cheek thin and drop. Weight that used to sit over the cheekbone ends up along the jaw.

Several things speed both up:

Genetics. Early jowls often run in families. If your parents developed them in their forties, you are more likely to.

Sun damage. UV exposure, from the sun or from tanning beds, breaks down collagen faster than ageing alone. It shows as fine lines and wrinkles long before it shows as jowls, and it is the single most modifiable cause.

Weight loss. As weight is gained the skin stretches. When it is lost quickly, the skin does not shrink back at the same rate, and what is left is loose.

Smoking. Nicotine restricts blood flow to the skin while the chemicals in smoke create collagen-destroying enzymes.

Sagging jowls can be treated without surgery, and for most people that is the right starting point.

Facial exercises are often suggested. They strengthen the muscles of the lower face, but there is no good evidence that they lift descended fat or tighten loose skin.

Our practitioners perform thousands of non-surgical treatments a year to reduce the appearance of jowls, using dermal fillers, Endolift, EMFACE and Ultraformer. Which suits you depends on whether the problem is lost volume or loose skin.

Filler does not fill the jowl. It rebuilds the structure above it, so the tissue that has descended is supported from higher in the face.

In an Aesthetic Surgery Journal study on hyaluronic acid filler for chin and jawline redefinition, 96.7% of patients described their appearance afterwards as "much improved" or "very much improved".

Jawline contouring with filler is precise work. Our specialist doctors and nurses use Juvéderm soft tissue dermal filler, and each injection is placed at a structural point along the jaw and mid-face to restore facial contours and reduce the appearance of jowls and, in some cases, a double chin. Chin filler is frequently part of the same plan, because the chin anchors the front of the jawline.

It is a non-surgical injectable treatment with minimal downtime, so you can return to normal activities the same day. Results last around 12 to 18 months.

Filler suits you if the jawline has lost definition but skin quality is still good. It suits you less well if the dominant problem is loose skin, where adding weight to tissue that cannot hold it makes the sag more obvious rather than less.

Where the problem is the skin rather than the volume beneath it, a device-based skin tightening treatment is the better route.

Endolift is minimally invasive, delivering laser energy beneath the skin through microscopic optical fibres to stimulate collagen production and tighten tissue from below without an incision. It also reduces small fat pockets along the jaw.

Ultraformer uses focused ultrasound to lift at a deeper level, reaching the supporting layer without breaking the surface of the skin.

EMFACE combines high-intensity facial electrical stimulation with radiofrequency, working on muscle tone as well as collagen and elastin.

All three work gradually rather than immediately, because they rely on your own collagen forming over the following weeks and months. That is normal, and it is worth knowing before you start, since people who expect a visible change within a fortnight tend to conclude a treatment has failed when it is in fact working.

There is no single best treatment, because jowls are not a single problem.

If the jawline has softened but the skin is good, filler placed high restores the structure and does the most.

If the skin is the problem, tightening does more than any amount of volume.

If both, a combination, usually tightening first and volume second.

If the jowls are advanced with significant loose skin, non-surgical treatment will soften the appearance but it will not remove tissue. A surgical neck lift or facelift achieves what no injectable or device can. PHI Clinic performs only non-surgical treatments, and where surgery is the honest answer our practitioners will say so rather than treat and hope.

Where heaviness in the lower face is partly driven by an over-active masseter muscle, Botox in London can be combined with skin-tightening approaches.