Dr. Barbour's Answer: There are several causes of this problem and any one or all may be contributing factors with any individual person. Likewise, one procedure may not always be the answer. While we can improve the situation -- sometimes significantly -- with a well-chosen procedure, sometimes it takes attention to each of the causes to effect an optimal result.
The possible contributors to this common source of our angst are:
1. Our skulls shrink as we age and this can manifest rather early in people who have a small jawbone (mandible) genetically. I’m not talking about osteoporosis; I’m talking about just having birthdays. If you could see a 20 year old skull compared to a 50- then 80 year old skull, you would be amazed at how much the bones shrink. Because of the way the bone shrinks and a little ligament on either side of your chin, what appears to be a jowl often can be only what we call a “pseudojowl”. With a pseudojowl, it looks as though the area is going south, but it’s really more a matter of things around it shrinking and effectively going north! In this case, we can re-contour the jaw by injecting a “bio-stimulating” filler on either side of the pseudojowl that also will form collagen at the area and help bring back the contour you had there when you were younger. If we perform a facelift when the problem is bone loss, we end up with a weird Cruella de Ville look (you can’t treat volume loss with traction and have it look good). This condition in its isolated form is more common in younger patients, but as we get older it becomes more a “part” of the jowl problem.
2. We actually do accumulate some fat there as we age. Again, genetics play a role and it is a cruel act of Mother Nature that we lose and gain fat differently in different parts of our face (and bodies). This is where, if fat accumulation is part of the problem, we can selectively sculpt it down with a tiny instrument and a bit of liposuction. Gravity starts as soon as we’re vertical and sooner or later it shows. This is where we need to tighten things up. In mild-to-moderate cases, and depending on how much of a change the person wants, we can either perform Pellevé to gently firm, lift and tighten the area, or we can perform a facelift. A facelift will give a more definitive result and is indicated when there is moderate to significant sagging. And in these instances, there is often sagging elsewhere on the face and neck that will also benefit from a lift.
3. Although “jowls” are more a condition happening to the tissue under the skin, loose skin can definitely exacerbate the appearance of jowling. In those people who have significant loss of elasticity in the skin, laser skin resurfacing (and Pellevé to a lesser extent) can tighten the “envelope” covering the jowl and make it look much softer. In addition, the whole face looks much smoother because the laser both resurfaces and significantly shrinks the skin. All lasers are not alike, and most of them tend to overpromise and underdeliver. The right laser and the right person performing the procedure are crucial to a beautiful result.
As far as “miracle creams” go, the two you should not be without are a good sunscreen with proper application – and repeated application if you’re spending time out in the sun; and some form of a retinoid cream or gel because they will stimulate collagen formation in the skin and make it more elastic. So as far as the skin itself contributes to a jowly appearance, both will ultimately help.