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The term jowl refers to the lower part of a person’s cheek when it descends below the jawline. Jowls can consist of just some loose skin or they can include some descended cheek fat. Jowling is a very common condition we treat that occurs with aging, and results from a combination of skin laxity, descent of cheek fat and volume loss in the structural support of the face.

Underlying changes in the skin, such as less collagen and elastin production as well as a weakening of the collagen fibers contribute to skin laxity over time. We start seeing evidence of volume loss in the skin, fat, muscle and bone of the average person’s face begining as early as a person’s late twenties.

The cheeks and cheekbones are the support structure of the face and as we lose volume, our cheeks flatten and the tissues of the face descend. Like skin laxity, this process of volume loss continues as a person ages.

Combined with the lack of collagen, the facial skin has less foundation on which to rest and less elasticity to tighten itself. As time goes on, visible changes start to occur in the form of lines, wrinkles, cheek droop, eye hooding, sagging neck and jowl formation.


When it comes to aging, prevention is always the best method of treatment. At RIVKIN Aesthetics, we believe in a comprehensive and preventative approach. A healthy lifestyle and daily sunscreen use are imperative to maintain youthful skin. Habits such as smoking, tanning, excessive alcohol consumption and not staying hydrated will cause premature aging and jowl formation. It’s never too late to make better lifestyle choices.

For those with early stages of jowl formation, skin tightening treatments such as Fraxel, Ultherapy or PRP can provide great results. Fraxel, or fractional laser skin resurfacing, is a safe and gentle alternative to traditional laser resurfacing. Not only does it help tighten the skin by stimulating collagen, but it also helps with acne scars, fine lines, wrinkles, pigmentation issues and large pores.

Ultherapy uses the latest FDA approved technology for skin tightening. Also known as Ulthera, Ultherapy uses ultrasound waves to heat skin tissue at multiple depths, which triggers a natural regenerative response that stimulates collagen production and tightens the skin.

PRP treatment (which stands for Platelet Rich Plasma) is a new technique that can help with many issues including jowl formation. PRP combined with microneedling has been shown to cause the release of additional growth factors which stimulate the treated area to produce collagen and other components of skin. This results in a tightening and overall youthful glow to the skin. For those with moderate jowls, getting rid of those jowls and getting great results can often be achieved by a multi-step approach.

Injecting dermal filler such as Voluma or Radiesse in the cheeks and cheekbones re-establishes some of the lost support structure of the face and lifts the sagging tissue. Injection of fillers to the area just in front of the droopy jowl can also contour and redefine the jaw line. When combined with any of the treatments listed above, this can take years off the face.

For jowls that are more moderate than mild, the treatment has been facelift surgery. Thanks to new treatments, however, less invasive options can provide significant results. Procedures such as the Profound radio frequency micro needling offer solutions without the risk and downtime of a surgical jowl lift. Profound works by utilizing finely calibrated radio frequency energy to precisely target the collagen generating tissues just under the skin of the face, tightening the skin and improving the texture at the same time. Profound can also be used at the deeper skin layers to reduce fat deposits and decrease the fatty aspect of jowling.

For jowls that contain fat, we have found that strategically placed Kybella injections also work to reduce the fat and tighten the skin. Like the Profound procedure, Kybella does entail about a week of swelling, but the results are well worth it!

If during the consultation we determine that a patient is suffering from severe jowling, surgery may be the only option. For these candidates, a lower facelift will provide significant improvement, with results lasting 10 years or more. We always encourage our patients to utilize preventative and non-surgical measures for as long as possible, but when its time for surgery, our facial plastic surgery experts will make sure that your procedure is safe and your results are spectacular!

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