Sagging jawline (jowls) and how it can be improved

Why does the jawline lose definition?

The lower third of the face has a large influence on a person's overall appearance, and a well-defined jawline is perceived as beautiful and youthful ^[4]. The jawline is also one of the features that distinguishes male and female faces ^[4].

With age, the skin around the jaw loosens and the soft tissues sag, which can lead to jowls that hang below the jawline, a sagging chin, and a chin that looks less prominent ^[1]. Volume loss is also understood to be an important cause; in the lower face, it shows up as drooping at the corners of the mouth and sagging below the jawline, so the slim jawline of youth disappears ^[2].

The literature notes that because sagging tissue and volume loss occur together in facial aging, both need to be addressed to achieve a good result ^[5]. The right method depends on which of the two is more significant, so it is important to first identify the cause through an examination.

Refining the jawline with filler

Fillers such as hyaluronic acid, calcium hydroxylapatite, poly-L-lactic acid, and polymethyl methacrylate are used for the chin and jawline, and each material has different properties and injection techniques ^[1]. Filler is used to redefine the shape of the jawline, lift the soft tissues, and improve facial proportions ^[4]. The treatment areas covered included the chin, the hollow in front of the jowls (prejowl), and the lower jawline and the angle of the jaw ^[4].

The temples, midface, and sides of the lower jaw are regarded as pillars that support the face, and in filler treatment, there is growing interest in correcting the side of the jawline as well ^[6].

A 2014 expert consensus organized methods for restoring the jawline with calcium hydroxylapatite filler according to the stage of jawline loss, and concluded that it can be used in patients at any stage ^[2]. These recommendations are a collection of expert opinions, so the level of evidence differs from that of randomized studies, and it should also be kept in mind that the consensus focused on a specific product.

Fat grafting and facelift surgery

Fat grafting, which uses your own fat, can be used to improve the contours of areas treated with filler, including the jawline and chin ^[5]. The authors explained that fat grafting has the advantage of creating contours that blend naturally with the surrounding tissue ^[5]. An approach that surgically moves sagging tissue back into place and removes excess tissue while restoring volume with fat grafting (lift-and-fill) was also described ^[5].

A facelift also has limits. A 2018 review discussed anatomical conditions such as bands in the neck muscle (platysma banding), a full, heavy face, and an underdeveloped midface as difficult challenges for facelift surgery ^[7]. The same review pointed out the limits of what a facelift alone can achieve, and also described consultation that helps patients form realistic expectations ^[7].

When the jaw muscle is the cause

In some cases, the lower face looks wide not because the jawline has sagged but because the chewing muscle (masseter) is large ^[3]. In this situation, besides surgery, a noninvasive method of injecting botulinum toxin into the muscle is used ^[3]. A 2022 review that summarized 14 of 40 studies concluded that this is a safe and effective noninvasive treatment for an enlarged masseter, but stated that there are no standard guidelines ^[3].

According to the same review, after a single injection the effect usually peaks at about 3 months and can last 6 to 12 months, and repeated injections may be needed to maintain the effect ^[3]. Because the studies differed greatly and the patients varied in ethnicity and degree of muscle enlargement, an appropriate dose could not be determined, and the review summarized that the injection technique and dose need to be tailored to each person ^[3]. This treatment reduces muscle volume, so its purpose differs from that of treatments that lift sagging skin.

Risks and limits of the evidence

The advantages of filler include little discomfort and a short recovery ^[1]. However, its effects are temporary, and steps to prevent both short-term and long-term complications are needed to achieve a good result ^[1]. It was also stressed that a thorough knowledge of the anatomy and aging process of the lower face is needed to produce effective and safe results ^[4].

Most of the sources reviewed here are literature reviews and expert opinions, and no results from randomized studies directly comparing treatments for a sagging jawline could be found in the research summaries. Most of the research summaries also do not state the ethnicity of the study participants, so it is difficult to say for certain whether the same results can be expected in Korean patients. For this reason, rather than saying that one method is better, it is more realistic to choose based on the cause and severity.

What to check during your consultation

The right approach to jawline concerns depends on whether sagging, volume loss, or muscle size is the main cause. It is a good idea to check the following during your examination.

• Whether the main cause is sagging, volume loss, or an enlarged muscle
• If filler is used, the type of material and how long it is expected to last
• Whether your condition is better suited to a surgical method
• When botulinum toxin takes effect and whether repeat treatments are needed
• How complications are prevented and what to do if unusual symptoms appear