The Jowl Question That Every Expert Faces
Here's a question I hear every single day: "What's the best treatment for jowls, or a face that seems to be falling around the mouth—without a facelift?" It's the struggle that sits in the chair in front of me daily. And let me tell you, the lower face is the tough one. We can do a great job with the upper face, but when the conversation turns to the lower face, it becomes a real discussion. The reason isn't just sag—though that's what you see. It's oh, so much more complex. It involves bone loss in the face, which is why I often talk about collagen supplements, vitamin K2, and D3. Whatever you can do to maintain the bone in the face, especially for women, plays a big role in the lower face and jaw. Look at how much bone we lose in the jaw over time. The more you maintain through a healthy diet and lifestyle, the better. But no matter what, that sagging eventually gets you.
Why Surgery Isn't the Only Answer
Now, surgery is a good option if there's a lot of sag and jowling—some people will need it to get the result they want. However, 99% of people will say, "I don't have 50 grand to spend on it. I don't have the downtime, nor do I want to be cut." So watch those facelift videos if you want, but for non-surgical approaches, the easiest way to answer this is with my top three. And understand, every clinic struggles with this, even surgeons. Because there's only so much you can do—there's a facial nerve there that affects expression. You can't just go suck this stuff out and be left with loose skin.
Number One: Address the Upper Face First
The number one treatment for the lower face is still addressing the upper face—the temples, the high cheeks, the pre-auricular area. So many people don't use collagen stimulators and biostimulators here, but this pulls the face back. Then, you replace what is lost with bone to the extent you can using fillers. Calcium fillers, Sculptra, or specific hyaluronic acid fillers can not only hide the jowling but also, if done in the right layers, mimic bone. This straightens the jawline out. Then you can use some fillers through here. But be careful—fillers can widen the lower mouth, so you see people look funky because too much filler was used. That's why I use Easy Gel or platelet-rich fibrin gel all around the jawline and for vertical lip lines. This is the most common and most accessible approach for most people.
Number Two: Radio Frequency and Microneedling
Number two involves radio frequency microneedling and external radio frequency heating. One uses suction and contours—for me, it's a Viora facial contouring FC applicator. A series of treatments helps shrink the fat cells. Alternatively, or alongside that, I use RF microneedling, where needles go in and only the tip is hot. Think of it as burning fat away. Three sessions of this, and I also do the submentum area. That's how I dress that lower face.
Number Three: Fat Dissolving—With Caution
I'll give you a third option, but you have to be mindful. You can also dissolve fat in this area using something like PC DC (phosphorylcholine deoxycholate) in many countries. In the United States and Canada, we have Kybella (US) or Belkyra (Canada) that dissolve fat. Understand, you can also dissolve the myelin around the facial nerve, which is temporary. Usually, it comes back within six weeks, but you might get a crooked smile for a period of time. I've seen it happen in about 4 to 5% of people because you're putting it right where that nerve is. Kybella is really meant to be used submentally where the nerve isn't present. In studies, it always comes back, but this is the area where it can happen. When you smile, you get a crooked smile. Everything has a side effect.
The Best Treatment Is All Three Together
You see, the best treatment is going all three of these together. If you have significant jowling and you don't want surgery, you optimize the upper face, use fillers along the lower face, dissolve some fat, and use RF technology. Most of my patients do a little bit of all of these—not any one thing. That gives you the natural result. But that's why everyone's looking at $5,000 to $10,000. When you add those things up in the United States and Canada, sterile, safe, with state-of-the-art devices that cost the clinic $100,000 to $300,000, those things need to be paid for. But if you want it done properly, with a series of treatments, and you want to look natural without surgery, that's about the normal cost.
Budgeting and Building Your Treatment Plan
When you start to go down in cost, people say, "I'll just do the filler part." That's okay, but it might not be optimal. "I'll just do the dissolving part." Great, but you haven't replaced the bone or the fat. "Okay, I'll do that but not the RF microneedling." Wouldn't you rather get rid of some fat so you need less filler, less Easy Gel, and less of everything else? When you do little things together, that's how you get the natural result. Yes, it costs more, and money is a problem. Aesthetics is expensive. But safety is utmost importance too. It's a balance.
The nice thing about non-surgical is you can start with one treatment. A lot of people say, "Give me the number one thing to start with." And I know you've recommended two others—I'll then add it. So money is a thing, and you have to budget for this. But for those who are older, I can tell you this: A plastic surgeon who lives across the street from me has done thousands of facelifts. He retired. I once mentioned my back was out, and he said, "Dr. Rajani, you're old. When you get old, it's like a contact sport." And it is. The amount of maintenance you had to do at 20 was almost nothing. At 40, a little bit. By 60, it seems like your whole life is maintenance—maintaining your body, your healthy lifestyle, your living. For those who still have to work, like myself, it's hard to eat right and be healthy. Yes, there is a lot of maintenance to getting old, but we're blessed to be here, to get old, and to say, "Hey, I'm complaining about my back. I'm complaining about my face." Those are small complaints in life.
So pick your top treatments. Pick away at what's comfortable for you. Add them and work up to it. It's not surgery—you don't have to decide everything in one day. Minimally invasive gives you that opportunity. Have you treated your jowls? What's your number one treatment? That's how I do it. Every practice is a little different.