Sagging of the jowls is considered to be among the top facial features that contributes to an aging look. This is clearly more true for women than in men in my experience. Woman notice the appearance of jowls much quicker than men and are generally more bothered by them. As the jowls droop, that once more sharply defined and youthful jaw line is lost and the lower face appears wider. A more rectangular or square-shaped face is usually associated with an aged look as opposed to a more tapered and angular facial shape.
The jowls sag, as well as the rest of the sides of the face, from three specific factors. The never-ending downward pull of gravity, loss of skin elasticity and weakening of ligamentous attachments, and a loss of fat under the skin. This is not a muscular problem so no amount of exercise will have a reversal effect. While some non-surgical skin tightening methods have been tried with very slight improvement, real jowl correction is a surgical problem.
Perhaps as a surprise to some, the concept of a facelift is what ideally addresses the sagging jowls. In a traditional facelift, the saggy skin and fat is pulled up along with the rest of the lower face and neck. In essence, the jowl tissues are lifted back up and resuspended. It is no surprise, therefore, why this approach would be so successful.
Rather than resuspension, differing plastic surgery thought is that the droopy fat underneath the jowl skin should be cut out or removed by liposuction. Since hanging fat under the skin is part contributor to the jowl problem, not just saggy skin, removal rather than resuspension seems equally logical. Does it make a difference as to which one is done?
My opinion on the technical management of jowls is…it varies. Both will work for the right patient. It depends as much on what facelift technique is being used as anything. If one is undergoing a full facelift, the wide open exposure permits an easily visualized field in which jowl fat resuspension can be very successfully done. This puts it back from where it came and helps maintain facial volume which is helpful for the older patient who is likely needing a full facelift. In the more limited facelift, also known as a Lifestyle Lift, visualization of the jowls can be more restricted depending upon the extent of the dissection. Simple liposuction or direct excision is easier. Given that the limited facelift is usually done in a younger patient, the preservation of fat volume is not as critical.
One thing about smoothing out the jowls is that it can never really be overdone. Can you really have too smooth or defined of a jowl line? Perhaps in an older patient… yes…if the ears or mouth become distorted from the pull. But in general no. Given that the jowl area is the first area to relax in many facelift patients, concerted effort at its management is justified.
Dr. Barry Eppley
Indianapolis, Indiana