Jowls are the soft sagging that forms along the jawline and either side of the chin as we age. They develop when the skin loses collagen and elastin. At the same time, the fat that once supported the lower face begins to shrink and slip downwards. Almost everyone gets them to some degree. They are a perfectly normal part of ageing. Even so, they have a way of making the face look heavier or more tired than it feels. Thankfully, there is plenty you can do. A good skincare routine improves the quality of the skin but won’t lift a jowl that has already formed. At the other end of the scale, only surgery truly resets significant sagging. In this article, we’ll review what causes jowls, the treatments that genuinely help and how to slow them down.
Please note, we are an online skin clinic so we do not offer injectables, in-clinic procedures or surgery. We have written this because we believe people deserve clear, honest information about all of their options.
What Causes Jowls?
Jowls are the result of the lower face losing both its structural support and its skin quality at once. As we age the skin makes less collagen and elastin. Meanwhile the fat pads in the cheek shrink and slide downwards, and the bone beneath quietly recedes. This descent of the facial fat compartments leaves the lower face unsupported, so skin sags along the jawline and pools into a jowl. The same loss of facial volume tends to deepen marionette lines at the same time. Several things speed the process up:
- Ageing: Collagen production starts to fall from our mid-twenties and drops more steeply from our forties, so the skin gradually thins and loses its spring.
- Sun damage: Ultraviolet light is the single biggest external cause of collagen and elastin breakdown. A lifetime of sun tends to show up as earlier, deeper jowls.
- Smoking: The chemicals in cigarettes break down collagen and reduce the blood supply that keeps skin firm.
- Weight changes: Big swings in weight, and rapid weight loss in particular, can leave the skin without enough underlying volume to support it.
- Genetics: Some people are simply more prone to jowls, especially with naturally thinner skin or a parent who developed them early.
In most cases it’s a combination of these. How much of your jowling is skin quality versus true sagging decides which treatment will actually help. Most people need more than one approach.
Skincare for Jowls
Skincare is the safest place to start, and it is the foundation everything else builds on. Retinoids like tretinoin build collagen and speed up cell turnover, which thickens the skin and improves early crepiness over a few months. Over-the-counter Retinol does the same thing more gently. Daily sunscreen is essential, because ultraviolet light is one of the biggest drivers of sagging in the first place. A consistent routine for ageing skin built around retinoids and sun protection is excellent prevention and genuinely improves skin quality. What it can’t do is lift a jowl that has already formed. For that you need something that addresses the lost volume or the sagging itself, which is where the treatments below come in.
Botox
Botox relaxes the muscles that pull down on the lower face and neck. Placed along the jaw and the platysma band of the neck, it can soften very early jowling and give a slightly cleaner jawline. The effect lasts around 3 to 4 months. It works best as a preventative or for mild cases, because it won’t replace lost volume or lift skin that has already dropped. Beyond early jowling it tends to be used alongside other treatments rather than on its own.
Dermal Fillers
Dermal fillers made of hyaluronic acid restore the volume that has been lost, which is often the more useful approach for jowls. A skilled injector takes a two-pronged approach. They place filler higher in the cheek and along the jaw to re-support the skin and reduce the sag. Sometimes a little goes directly into the crease to soften it. Results are immediate and usually last somewhere between 6 and 18 months. Filler can’t tighten loose skin, and overdoing it weighs the lower face down rather than lifting it. The most serious risk is vascular occlusion, so this should only ever be done by an experienced medical injector.
Skin Boosters
Skin boosters such as Profhilo and Volite are injected to improve the quality of the skin rather than to fill or lift. They deliver hyaluronic acid that hydrates the skin and stimulates collagen and elastin, which helps with early jowling and crepey skin. A typical course is two or three sessions a few weeks apart. They make a good preventative and complement other treatments well, but for established sagging they are a support act rather than the main event.
Microneedling & Radiofrequency
Microneedling creates tiny controlled injuries that prompt the skin to make new collagen, which firms and thickens it over time. Radiofrequency adds heat to the deeper layers to tighten and stimulate collagen further. The two are often combined as radiofrequency microneedling for a stronger effect on mild laxity. Either way you’ll need a course of around three to six sessions, and results build gradually over a few months. They improve skin quality and early sagging, but they won’t match the lift of filler or surgery for a heavy jowl.
Laser and Energy Tightening
Laser treatments resurface the skin and stimulate collagen, which smooths texture and firms the surface. However, standard resurfacing lasers do little for true sagging on their own. The newer devices pair laser or radiofrequency energy with a probe placed under the skin, which can tighten deeper tissue. These are more invasive and need a specialist. As with the other energy treatments, results build over time rather than appearing straight away.
PDO Thread Lifts
Thread lifts use absorbable threads placed under the skin and tightened to lift the jowl, and they trigger some collagen production as they dissolve. The immediate lift can be impressive, which is part of their appeal. They are also the most controversial option here. The concerns are the risk of damaging facial nerves or vessels, the chance of scarring and results that are often short-lived and need repeating. They’re not something we recommend but if you do consider them, then seek an experienced and regulated medical practitioner.
Neck Lift & Facelift Surgery
When jowls are driven by significant sagging, surgery is the only thing that truly lifts the tissue back into place. A facelift or neck lift removes excess skin, repositions the deeper structures and re-drapes what’s left, and the results are long-lasting. A lower facelift targets the jaw and neck specifically. The trade-off is real, because these are operations with anaesthetic, a recovery period, swelling and bruising, plus the usual surgical risks. Consult with an experienced and licensed plastic surgeon to understand the best and safest options for you.
How to Prevent Jowls
Obviously, some causes of jowls are out of your hands, like genetics. Plenty are not. A healthy lifestyle genuinely shows in the skin, so it’s worth eating well, keeping hydrated and going easy on alcohol. The most useful preventative steps are simple:
- Stop smoking, which starves the skin of collagen and blood flow.
- Wear a high SPF all year round and avoid tanning beds.
- Keep a consistent skincare routine with a retinoid and sunscreen.
So Which Jowl Treatment is Best?
There is no single best treatment, because it depends on how advanced your jowls are. For early or mild jowling, skincare, prevention and skin quality treatments like skin boosters or a little Botox go a long way. For moderate jowls, filler to restore volume, often paired with an energy treatment, tends to give the most natural result. For significant sagging, only a surgical lift will truly fix it. Jowls also rarely appear on their own. The same descent shows up as marionette lines, smile lines and a softening neck. It makes sense to look at the whole lower face together. The sensible first step is an honest assessment with a qualified professional who can tell you what’s actually driving yours.
Whilst jowls are a normal part of getting older, there is a lot you can do to soften them and slow their progress. Good skincare, healthy lifestyle and sun protection are key to prevention and improving your baseline. For more dramatic results there’s a range of non-surgical and surgical options depending on your needs, goals, health and budget.
At City Skin Clinic, we don’t provide injectables, in-clinic procedures or surgery. We do however offer personalised skin ageing treatments through our online skin clinic. Our doctors design custom topical formulas using ingredients like tretinoin and azelaic acid where appropriate. Treatments are tailored to suit your individual needs. Start a virtual consultation with one of our doctors. The journey towards great skin starts here.
This article is intended for general informational purposes only and is not a substitute for medical advice, diagnosis or treatment. Always consult a qualified medical provider for any medical concerns or questions you might have.
