Jowls & Lower Face Sagging

To understand jowls, you need to understand what holds your face up—and what happens when those structures fail:

The SMAS Layer

The superficial musculoaponeurotic system (SMAS) is a fibrous layer that connects your facial muscles to your skin. Think of it as a 'hammock' holding everything in place. As the SMAS weakens with age, it can no longer resist gravity—and tissue descends.

Fat Compartments

Your face has distinct fat compartments, not a uniform layer. The buccal fat pad and other deep compartments descend with age, pooling along the jawline. This is different from simply 'losing' facial fat—it's redistribution downward.

The Platysma Muscle

The platysma is a thin sheet of muscle running from your chest up to your lower face. As it loosens, it contributes to jowling and creates 'platysmal bands' in the neck.

Bone Resorption

Your jawbone and chin actually shrink with age—a process called resorption. This removes the 'scaffolding' that soft tissue drapes over, accelerating the appearance of jowls.

Understanding which of these factors is dominant in YOUR case determines the right treatment approach.

Grade 1 — Mild (Early Changes)

Early softening of the jawline. You might notice your jawline isn't as 'crisp' as it used to be, especially in photos or certain lighting. The tissue hasn't descended below the jawbone yet.

Treatment approach: Skin tightening (Sylfirm X), biostimulators (Polynucleotides), early filler for definition.

Grade 2 — Moderate

Visible jowling with tissue beginning to hang below the jawbone. The pre-jowl sulcus (the indent before the jowl) is noticeable. Jawline definition is clearly reduced.

Treatment approach: Strategic filler (chin, jawline, pre-jowl), RF treatments, combination protocols.

Grade 3 — Significant

Pronounced jowls with clear tissue descent. The jawline contour is significantly blurred. Often accompanied by marionette lines and neck laxity.

Treatment approach: Aggressive filler strategy, deep RF (Morpheus8), realistic expectations about non-surgical limits.

Grade 4 — Severe

Severe jowling with significant skin laxity and tissue descent. The jawline is largely obscured. Often combined with substantial neck sagging.

Treatment approach: Surgical consultation recommended. Non-surgical treatments may provide modest improvement but cannot replicate facelift results.

During consultation, we'll assess your grade and be honest about what non-surgical treatment can realistically achieve.

If you've searched 'at home treatment for sagging jowls,' you've probably seen advice about facial exercises, jade rollers, and firming creams. Here's the truth:

Facial Exercises

Jowls are caused by tissue descent and skin laxity—not muscle weakness. Your facial muscles aren't 'weak'; the structures holding them up have failed. Exercising the muscles won't lift descended fat pads or tighten stretched skin. In fact, some argue that repeated muscle movement could accelerate wrinkling.

Firming Creams & Serums

No topical product can lift descended tissue. Creams can hydrate and marginally improve surface skin quality, but they cannot:

• Lift descended fat pads
• Tighten the SMAS layer
• Restore lost bone volume
• Reverse significant skin laxity

Jade Rollers & Gua Sha

These may feel pleasant and temporarily reduce puffiness through lymphatic drainage, but they have no effect on the structural causes of jowls.

What DOES Work

Meaningful jowl improvement requires treatments that address the structural causes:

• Fillers — Replace lost volume, provide structural support, camouflage descent
• RF treatments — Tighten skin, stimulate collagen remodelling
• Biostimulators — Improve skin quality and elasticity over time
• Surgery — The only option that can physically lift and remove excess tissue

Save your money on gadgets and miracle creams. Invest in treatments that can actually make a difference.

Searching 'jowls in 20s'? You're not alone—and you're not imagining it. While jowls typically appear in the 40s and beyond, some people notice early changes much sooner:

Why You Might Get Jowls Early

• Genetics: The biggest factor. If your parents had early jowling, you may too
• Weight loss: Significant weight loss in your 20s-30s can leave skin lax before it's had time to develop the resilience of mature skin
• Naturally weak chin/jawline: Less bone structure means less support for soft tissue
• Thin skin: Some people naturally have less subcutaneous fat, making descent more visible earlier
• Sun damage: Accumulated UV exposure from childhood onwards breaks down collagen

The Good News About Early Jowls

Treating jowls earlier is actually easier than treating them later:

• Skin still has reasonable elasticity
• Less tissue descent to address
• Treatments can slow progression, not just correct existing damage
• Collagen-stimulating treatments work better in younger skin

Early Intervention Options

For Grade 1-2 jowling in younger patients:

• Sylfirm X for skin tightening and collagen stimulation
• Polynucleotides for skin quality improvement
• Strategic chin or jawline filler for structural support

Early treatment is 'prejuvenation'—staying ahead of ageing rather than playing catch-up.

This is one of the most common questions we hear—and it's a valid concern. Let's address it directly:

The Theory

Masseter Botox (used for jaw slimming or teeth grinding) relaxes the masseter muscle, causing it to shrink. The concern is that this loss of muscle bulk removes support for the lower face, accelerating jowl formation.

The Evidence

There is some anecdotal and emerging evidence that aggressive, repeated masseter Botox over many years may contribute to lower face sagging in some patients—particularly those already prone to jowling. However:

• This typically requires high doses over extended periods
• Not everyone experiences this—genetics and baseline anatomy matter
• The jaw-slimming benefit may outweigh the risk for many patients
• Conservative dosing and treatment intervals can minimise risk

Our Approach

We take a considered approach to masseter Botox:

• Assess your baseline lower face laxity before treatment
• Use conservative doses rather than aggressive muscle reduction
• Monitor for any changes over time
• Discuss the trade-off honestly with patients concerned about jowling
• Consider alternatives for patients with existing lower face laxity

If you're concerned about this, discuss it at your consultation. We can assess your individual risk factors.

Important: This guide is for educational purposes. Treatment recommendations are made only after face-to-face assessment by a GMC-registered doctor, taking into account your anatomy, medical history, and goals.

We believe in honesty. Non-surgical treatments are excellent for mild-moderate jowling, but they have limits. Here's when we recommend surgical consultation instead:

Signs You May Need Surgery

• Significant skin excess: If you can pinch a large amount of loose skin, it needs to be removed—not filled
• Grade 4 jowling: Severe descent that non-surgical treatments cannot adequately address
• Neck involvement: Significant neck banding and laxity usually requires surgical correction
• Previous non-surgical treatments haven't worked: If you've tried fillers and RF without satisfactory results
• Looking for dramatic change: Non-surgical provides improvement; surgery provides transformation

What a Facelift Can Do

A SMAS facelift physically lifts the descended tissue, tightens the underlying structures, and removes excess skin. It addresses the problem in a way that fillers and RF treatments cannot replicate for severe cases.

Our Approach

When we assess that surgery would serve you better than non-surgical treatment, we'll tell you honestly—and provide referrals to trusted facelift surgeons we've worked with. Some patients also benefit from non-surgical treatments:

• Before surgery: 'Prejuvenation' to optimise skin quality
• After surgery: Maintenance to preserve results over time

Our goal is the best outcome for you—even if that means referring you elsewhere.

The lower face is one of the most challenging areas to treat non-surgically. Here's why patients trust us:

Diagnostic-First Approach

We don't just see 'jowls'—we assess WHY they've formed. Is it fat descent? Skin laxity? Bone loss? Poor mid-face support? The answer determines the treatment.

Combination Expertise

Effective jowl treatment usually requires multiple modalities—filler for structure, RF for tightening, biostimulators for skin quality. We design protocols that layer these treatments strategically.

Honest About Limitations

We won't promise non-surgical results that require surgery. If you're a Grade 4, we'll tell you—and provide a surgical referral if appropriate.

GMC-Registered Medical Team

The lower face is anatomically complex. All treatments are performed by GMC-registered doctors with specialist training in facial anatomy and aesthetics.

Natural Results Focus

Our goal is a refreshed, defined jawline—not an overfilled, unnatural look. We use filler strategically to support and define, not to mask with volume.

Premium Products Only

We use FDA-approved fillers (Juvederm, Restylane) and advanced devices (Sylfirm X, Morpheus8) for optimal safety and results.