What causes jowls?

Nearly everyone develops some degree of jowls as they age, losing the collagen that helps maintain the skin’s strength and elasticity. Eventually, this area begins to sag, due to the pull of gravity.

The face also naturally loses fat, and the remaining fat can “slide down,” pulling the skin down with it. Fat tends to atrophy [melt away] where you’d like it to stay—like high in the cheeks—and to increase in the volume where you don’t want it, like in the jowl area, in the neck, and above the nasolabial folds.

Over time, muscles can also become too lax to fully support the fat and skin. Bone loss, which often kicks in after age 35, is another factor.

Genetics and lifestyle (for instance, sun exposure, smoking, or yo-yo dieting) also influence how pronounced your jowls may become.

Some Zeiva Professional Center clients say they developed jowls in their late 20s or early 30s likely have what Zeiva terms “pseudo jowls.” “I see many clients who think that they have jowls, but actually have fat atrophy at the anterior jawline and posterior jawline—in other words, loss of soft tissue volume in front of and behind the jowls, which makes the mid jawline area appear fuller. Not only fat but also the mandibular bone [the jawbone] atrophies in the areas where fat atrophies, which contributes to the hollowness that bookends what appears to be jowls.”

What are the best procedures for sagging jowls?

Like any form of facial rejuvenation, jowl treatment requires careful evaluation to determine the underlying cause, says Zeiva. It’s best to book a consultation to assess your facial structure and explain your best options and potential nonsurgical treatment regime.

“Combination approaches will give you a more significant improvement than a single procedure,” says Zeiva. For instance, even if a surgical facelift is the right choice for you, combining that procedure with fillers to restore lost volume and laser to reactivate collagen can create better results.