Sagging jowls are a common sign of aging, affecting both men and women. The jawline becomes less defined as skin loses elasticity and fat shifts from the mid-face downward. This change often impacts self-confidence. This article explores the causes of sagging jowls, various treatments, and the potential impact of weight loss.
What Causes Sagging Jowls?
Jowls typically develop due to a combination of aging, gravity, volume loss, and muscle activity. As we age, our skin's collagen and elastin production decreases. These proteins help keep skin firm and resilient. With their decline, the skin becomes thinner and more prone to sagging. Simultaneously, the fat pads in the mid-face migrate downwards, which reduces cheek volume and places additional weight on the lower face. Gravity pulls this soft tissue further, leading to visible jowls.
Other contributing factors include excessive sun exposure, smoking, weight loss, genetics, and repeated facial expressions that activate the platysma and depressor anguli oris muscles. As the skin ages, it starts to lose some of the compounds that help keep its shape, specifically fat and the connective tissue proteins elastin and collagen. The skin also tends to become drier and thinner, making it more difficult to maintain its form. As the skin becomes less resilient and full, it becomes more vulnerable to gravity and slowly begins to sag. Sagging skin around the cheeks and mouth falls to the area around the chin and jawline, creating jowls.
The Role of Weight Loss
It's important to understand the complex relationship between weight loss and jowls.
Weight Loss as a Contributing Factor
Weight loss is paradoxically listed as one of the causes of sagging jowls. While it might seem counterintuitive, losing weight, especially rapidly, can exacerbate the appearance of jowls. As you lose weight, you also lose fat from your face. The layer of fat that once gave your face structure is now reduced, but the skin that stretched to accommodate it often remains. The faster you lose weight, the more likely that your face will show signs of the weight loss.
Read also: The Link Between Weight and Eyesight
Weight Loss as a Potential Solution
Excess weight is another risk factor for jowl development. Though thin people can also get excess skin along their jawlines, the problem tends to be more prominent in people who are heavier. If you have a lot of extra weight to lose, getting rid of it might be one of the most effective jowl treatments. Since jowls are a common side effect of excess weight, simply losing the extra pounds may help to minimize their appearance.
Ozempic Face
The term ‘Ozempic face’ refers to the changes in the face that can happen with rapid weight loss. It’s characterized by gauntness, sunken cheeks, new wrinkles and loose skin on the face and neck. This term first became popular on social media after a celebrity dermatologist used the term to refer to the way that Ozempic (generic name: semaglutide) affected some of his patients. But it’s not a medical term, and it’s probably not one you’ll hear your healthcare provider use. It’s also not limited to taking Ozempic. Facial changes can also occur after having bariatric surgery or adopting lifestyle changes that cause very rapid weight loss. But they’re often associated with weight loss medications like semaglutide and tirzepatide, which can lead people to very quickly achieve weight targets that they haven’t been at in many years.
Losing facial fat can change the way your face looks, of course. But instead of just looking thinner, you may be surprised to find that you look older, too. Rapid weight loss causes you to lose subcutaneous fat from your face and neck, which causes facial hollowing and sagging skin.
Rapid weight loss lowers your levels of two proteins in the skin: elastin, which helps keep skin stretchy, and collagen, which provides support and structure. The faster you lose weight, the more likely you are to experience Ozempic face. Older adults are also more likely to experience Ozempic face because they have lower subcutaneous fat reserves even before starting weight loss treatment.
To try to prevent facial changes associated with rapid weight loss, consider a more gradual approach instead. Focus on slower weight loss - about one to two pounds per week. You can also minimize these side effects by using your medication in combination with a healthy diet and exercise regimen.
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Non-Surgical Injectable Treatments
Injectables have changed how we approach sagging jowls. From fillers and collagen stimulators to fat-dissolving agents and neuromodulators, today’s treatments are safer and more effective than ever.
Dermal Fillers
Dermal fillers are injectable, gel-like substances with various useful purposes. They are FDA-approved to smooth fine lines on the face and hands. They can also improve volume in desired areas. A lesser-known benefit of dermal fillers is that they can stimulate collagen production to improve skin firmness. Hyaluronic acid (HA)-based fillers like Juvederm Voluma, Restylane Lyft, and Restylane Contour are commonly used. These products have high G prime, meaning they offer structure and lift. When injected correctly, they support the skin and mimic the effects of a subtle facelift without surgery.
Practitioners often begin by addressing the mid-face. Adding volume to the malar (cheekbone) region provides an upward pull, relieving the pressure that causes jowling. Next, the pre-jowl sulcus is treated to fill the hollow area next to the chin. Fillers in the jawline and chin add structural support and sharpen the contour.
For safety and precision, many injectors use cannulas when treating the jawline and either needles or cannulas for the cheeks. The procedure is relatively quick and well-tolerated. Results are often immediate, with full settling visible after 1 to 2 weeks. Depending on the product and the patient’s metabolism, results can last from 6 to 18 months.
Sculptra: Collagen Stimulation
While HA fillers provide instant results, biostimulatory injectables like Sculptra work more gradually. Sculptra is made from poly-L-lactic acid (PLLA), a compound that stimulates the body to produce new collagen. Instead of acting as a filler, Sculptra encourages tissue regeneration from within.
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When treating sagging jowls, Sculptra is injected into the lower cheeks and jawline to improve skin quality, volume, and elasticity. Over a period of weeks to months, the treated areas become firmer and more lifted. This makes Sculptra ideal for patients with early signs of laxity or for those who prefer gradual, natural changes. It is also suitable for patients who are not good candidates for HA fillers due to frequent movement in the lower face. The results appear progressively and may last 18 to 24 months or more, depending on the patient’s collagen response.
Botox: Reducing Downward Pull
Botox, a neuromodulator, plays a supportive role in lifting sagging jowls. It works by relaxing muscles that pull the face downward. When used alongside fillers or Sculptra, Botox enhances its lifting effect by neutralising opposing muscle forces.
Botox for sagging jowls is typically injected into two key muscles:
- Platysma: A broad, thin muscle that extends from the chest to the jaw. It pulls the lower face downward when active.
- Depressor anguli oris (DAO): Located near the corners of the mouth. It drags the corners down, contributing to a sad or tired look.
By weakening these muscles, Botox allows the upper facial muscles to create a lifting effect. This technique is subtle but impactful, especially in combination treatments. Results begin to show within 5 to 7 days and last around 3 to 4 months. Repeat sessions are needed to maintain the effect.
Profhilo Structura: Tissue Regeneration
Profhilo Structura is a newer injectable that combines high and low-molecular-weight hyaluronic acid. Unlike traditional fillers, it does not add volume. Instead, it improves skin firmness, hydration, and elasticity by encouraging collagen and elastin production.
Profhilo Structura is particularly effective for patients with thin, sagging skin who do not want volume in the lower face. It is injected into the superficial fat compartments near the preauricular area and zygomatic arch. These areas affect the tissue tension around the jowls.
The protocol involves two sessions spaced 30 days apart, followed by maintenance every 4 to 5 months. Patients report smoother skin, improved firmness, and a noticeable lift within 4 to 6 weeks.
ATX-101: Targeting Fat Pads
Some patients develop sagging jowls due to excess fat rather than just volume loss or skin laxity. In such cases, ATX-101 (known commercially as Kybella in the US or Belkyra elsewhere) can be used to reduce unwanted fat under the jawline.
ATX-101 contains deoxycholic acid, a compound that breaks down fat cells. When injected into the jowl area, it dissolves small pockets of fat that add to facial heaviness. This improves jawline definition and reduces the prominence of sagging skin.
Care must be taken to avoid major nerves in the lower face. Treatment usually requires 1 to 2 sessions, spaced weeks apart. Swelling, tenderness, and numbness are common side effects but usually resolve on their own.
Surgical Options
For individuals seeking more dramatic and longer-lasting results, surgical procedures are available.
Facelift and Neck Lift
One of the best long-term solutions for jowls, turkey necks, double chins, and other signs of aging is a facelift. The surgical procedure seeks to remove excess fat and skin in the lower face, particularly the jawline. Facelifts happen under general anesthesia. First, the surgeon lifts the skin to readjust the underlying muscle and tissue. Next, the surgeon tightens the skin and removes any excess causing the sagging. Facelifts have been proven to address jowls, and results can last 10 or more years. Some surgeons will also recommend a neck lift simultaneously for maximum results.
During most neck lifts, a surgeon will make a cut along the side of the face and under the chin, then reposition and sculpt fat and tissues in the jaw and cheek. They will also cut away some excess skin and tighten some of the surrounding muscles. Neck lifts are widely considered the most effective treatment for jowls, but the surgery has a long recovery time and carries the most significant risk of complications. The most common complications are scarring and infection. Neck lifts are also very expensive compared to other treatment options for jowls.
Mini Facelift
A great option for those with early signs of facial sagging after weight loss.
Other Treatments
Ultherapy
Ultherapy involves the use of ultrasound therapy to stimulate the long-term production of collagen in the deep layers of the skin. Research has shown that this form of therapy provides effective facial rejuvenation through the tightening and lifting of loose skin.
Ultherapy only requires one session, and people can usually return to their everyday activities immediately after the procedure. Most people notice a continual improvement in skin tightness and firmness several months after treatment.
Radiotherapy
Radiotherapy uses intense, radiating heat to stimulate the bundles of collagen and elastin fibers about 2 millimeters (mm) below the skin’s surface. This causes the bundles to recoil and the skin to tighten.
Radiotherapy also stimulates the production of collagen by tricking the body into thinking connective tissues have been damaged. Many people need to repeat sessions a few times a year for maximum results. A well-known brand name of radiotherapy for jowls is Pelleve.
Laser Therapy and Chemical Peels
Additional treatment options for jowls include laser therapy and chemical peels.
Lifestyle Changes and Prevention
No one method can entirely prevent jowls, but some lifestyle choices can help reduce the severity or risk of early development.
- Staying hydrated.
- Wearing sunscreen with UVA and UVB protection.
- Wearing protective clothing during periods of prolonged or intense sun exposure.
- Using moisturizers.
- Using creams and lotions high in antioxidants that promote the production of collagen, such as retinol (a type of vitamin A), vitamin C, and vitamin E.
- Avoiding habits and expressions that cause the jaw and cheek muscles to face downward, especially chewing gum, frowning, and using the computer for a long time.
- Eating a healthful diet.
- Exercising regularly.
- Not smoking.
- Sleeping on the back instead of the side or stomach.
- Doing facial exercises that promote flexible muscles in the entire face.
Facial Exercises
Some research shows that facial exercises, and exercise in general, can help reduce the appearance and severity of jowls by making the facial, jaw, and neck muscles better able to hold their shape. A 2021 review concluded that there is limited evidence that facial exercises can aid with facial rejuvenation. However, many studies had positive outcomes. Exercise also significantly improves several factors that contribute to the overall health of the skin. This may help reduce the age of onset, severity, and appearance of jowls.
Any exercise that engages or stretches the facial muscles evenly without overusing them may help reduce jowls. Most recommended exercises should be done one after another to ensure the facial muscles are worked evenly. People should hold each exercise for 5 to 20 seconds before releasing. Each exercise can be repeated 8 to 12 times, several times daily.
Common facial exercises that may help improve jowls include:
- Yawning and opening the mouth as far as possible, then closing it very slowly without letting the teeth touch.
- Puckering the lips outwards. This exercise works best when done lying down, and by using the fingers to draw the sides of the mouth downward.
- Blowing the cheeks up as far as comfortable.
- Chewing with the head tilted slightly up.
- Grinning as widely as comfortable then slowly tilting the head up and down.
- Putting the lower lip on the top lip and tilting the head up.
- Lying down flat, curling the neck in toward the chest with the tongue pressing on the roof of the mouth.
- Humming with the tongue pressed against the roof of the mouth.
- Saying the sounds “o” followed by “e,” using more force than usual and exaggerating mouth movements.
Combining Treatments
The best outcomes often come from a combination of treatments. For example, a patient might receive cheek fillers to lift the mid-face, chin fillers to balance facial proportions, and Botox to relax pulling muscles. Another patient may benefit from Sculptra for overall firmness, followed by Profhilo Structura to fine-tune skin texture.
A comprehensive treatment plan should address the root cause of sagging, whether it is fat, laxity, or bone resorption. Combination therapies not only enhance results but also extend their longevity.
Final Thoughts
The relationship between weight loss and jowls is complex. While weight loss can sometimes improve the appearance of jowls, it can also, paradoxically, make them worse, particularly if the weight loss is rapid. Several effective treatments are available to address sagging jowls, ranging from non-invasive injectables to surgical procedures. Lifestyle changes, including a healthy diet, regular exercise, and good skincare, can also play a role in preventing and managing jowls.
FAQs
Can you reverse sagging jowls?
Yes, you can improve and even reverse the appearance of sagging jowls using non-surgical injectable treatments. Dermal fillers, Sculptra, Botox, and fat-dissolving injections like ATX-101 can lift, contour, and restore jawline definition without the need for surgery.
How do you fix saggy jowls without surgery?
Non-surgical options include dermal fillers to restore lost volume, Botox to relax pulling muscles, and collagen-stimulating injectables like Sculptra or Profhilo Structura to firm and lift the skin. These treatments are safe and effective when performed by trained professionals.
What is the best procedure to lift sagging jowls?
The best procedure depends on the cause of sagging. For volume loss, dermal fillers work best. For skin laxity, Sculptra or Profhilo offers long-term results. If fat is the issue, ATX-101 helps reduce fullness in the lower face. Often, a combination of these gives the best outcome.
How can I tighten my saggy jowls naturally?
While natural methods like facial exercises, good skincare, and a healthy lifestyle help slow ageing, they cannot produce results as significant as injectables. In-clinic treatments are more effective for visible tightening.
What do celebrities do for sagging jowls?
Many celebrities use a mix of dermal fillers, Sculptra, Botox, and advanced skin-tightening procedures to maintain a youthful jawline without undergoing surgery. These treatments provide subtle, camera-ready results with minimal downtime.
What vitamin deficiency causes sagging skin?
Vitamin C and Vitamin E deficiencies can reduce collagen production and skin elasticity, making the skin prone to sagging. Maintaining a balanced diet and skincare routine supports better skin health.
How much does it cost to get a jowl lift?
Costs vary depending on the treatment type and region. Injectable treatments for jowls typically range between £300 to £1200 per session in the UK. Combination treatments or full-face rejuvenation may cost more.