Jowls form when skin and fat along the jawline lose their support and sag below the jaw’s edge, creating a soft pouch on either side of the chin. Getting rid of them depends on how pronounced they are. Mild jowls can improve with skin-tightening treatments and injectables, while moderate to severe sagging typically requires a surgical lift for lasting results. Here’s what actually works, what doesn’t, and what to expect from each approach.
Why Jowls Form in the First Place
The skin along your jawline is unusually mobile. It glides over the muscles underneath thanks to long, elastic connective tissue fibers that keep everything taut when you’re young. As you age, those fibers stretch out and the skin develops slack. The result is a pocket of redundant skin and fat that sits entirely above the platysma (the broad, thin muscle of the lower face), concentrated right behind the corner of your jaw where the most movement occurs.
Contrary to what many people assume, deeper structures like the submandibular gland or buccal fat pad don’t contribute to the jowl itself. Those create fullness above or below it. The jowl is a surface-level problem: stretched skin and subcutaneous fat that no longer has enough elastic recoil to stay put. Sun exposure accelerates the process by breaking down collagen and elastin in the skin, and genetics determine how quickly your connective tissue loses tension.
Facial Exercises Probably Won’t Help
Jaw exercisers and facial yoga are heavily marketed for jawline contouring, but clinical evidence doesn’t support them. In a case study examining two individuals who used a commercial jaw exerciser for three months, neither reported noticeable changes in jaw appearance. A controlled study evaluating facial workouts for sagging and wrinkles found no significant differences between the exercise group and the control group. The chewing muscles these exercises target don’t affect skin elasticity or subcutaneous fat, which are the actual components of a jowl.
What Topical Products Can (and Can’t) Do
No cream will eliminate jowls, but prescription retinoids can modestly improve skin quality over time. Retinoid creams have demonstrated a 28% improvement in skin elasticity and a 32% reduction in wrinkle depth by stimulating collagen production in the deeper layers of skin. Over-the-counter retinol works on the same principle but at lower concentrations, so results are slower and subtler.
This won’t reverse established sagging, but firmer, thicker skin can slow its progression and slightly improve the appearance of early jowling. Harvard Health identifies daily broad-spectrum sunscreen (SPF 30 or higher) as the single best way to keep your face looking younger, since UV damage is the primary external driver of collagen loss.
Energy-Based Skin Tightening
Two main technologies tighten skin without surgery: focused ultrasound (often branded as Ultherapy) and radiofrequency devices.
Focused ultrasound delivers energy deep beneath the skin, reaching the SMAS layer, the same structural tissue surgeons tighten during a facelift. The ultrasound beams converge at precise points, heating tissue to about 70°C, which causes existing collagen to contract and triggers new collagen production over the following months. This depth of penetration is what distinguishes it from most other nonsurgical options.
Radiofrequency works at lower temperatures (42 to 45°C) and generally treats shallower layers, though the depth varies by device type. Monopolar devices can reach up to 20mm deep, while bipolar devices stay within 2 to 4mm. Radiofrequency microneedling splits the difference by using tiny needles to deliver energy at adjustable depths from 0.5 to 7mm. Because RF operates at lower heat, it typically requires longer treatment times or multiple sessions to stimulate comparable collagen remodeling.
Both approaches produce gradual improvement over weeks to months as new collagen forms. They work best for mild to moderate laxity. If your jowls are heavy enough to cast a shadow along your jawline, energy devices alone are unlikely to produce a dramatic change.
Injectable Fillers to Restore the Jawline
Dermal fillers don’t remove jowls, but they can camouflage them effectively. The strategy is to build up the areas around the jowl rather than filling the jowl itself. Injecting directly into the sagging tissue would only add weight and make things worse.
Three zones along the jaw are typically treated. The pre-jowl sulcus, the depressed area just in front of the jowl near the chin, gets filled to restore a smooth jawline contour. The mandibular line behind the jowl is treated along the jaw’s edge to create definition. And the mandibular angle near the ear can be augmented to add structural support and a more sculpted profile. Product is placed at different depths depending on the zone, using a blunt cannula to minimize bruising.
Results are immediate and typically last 12 to 18 months depending on the filler used and how quickly your body metabolizes it. This approach works especially well for people whose jowls are partly caused by volume loss in the chin and jaw area rather than pure skin laxity.
Fat-Dissolving Injections
Deoxycholic acid injections (sold as Kybella) destroy fat cells by rupturing their membranes. Originally approved for double chins, some practitioners use it off-label to reduce jowl fat. Patients may need up to six sessions spaced at least a month apart, with about 1.6 to 1.8 mL injected per session in the jowl area.
There are important caveats. This treatment only works when excess fat is the problem. If your jowls are primarily caused by displaced tissue sagging downward rather than fat accumulation, deoxycholic acid is actually contraindicated because removing volume would worsen the hollow, aged appearance. Side effects in the jowl area include temporary nerve weakness affecting the mouth (occurring at roughly 4% of treatment sites), swelling, and in about 5% of patients, temporary hair loss near the injection site that resolves within a few months.
Thread Lifts for Moderate Sagging
Thread lifts use barbed sutures inserted under the skin to physically reposition sagging tissue. The threads are anchored in the temple area and pulled through to the jowl, creating a meshwork of support that mimics natural ligaments. Over time, the body forms scar tissue around the threads, adding structural reinforcement.
Longevity varies enormously depending on your starting point. Younger patients with good skin thickness and adequate facial volume see results lasting three to four years on average. Older patients with thin skin, significant volume loss, and severe sagging may only benefit for a year or two. One study of 160 patients using dissolvable threads found that all initial improvements had disappeared at one year, though practitioners using permanent thread materials and more advanced anchoring techniques report longer-lasting outcomes.
Complication rates also vary widely with technique. The same 160-patient study reported complications in 34% of cases, including thread displacement, infection requiring removal, and skin dimpling. Experienced practitioners using refined methods report complication rates below 3%. This is a procedure where your provider’s skill level matters enormously.
Surgical Options for Lasting Results
Surgery remains the most effective and durable solution for jowls, particularly when sagging is moderate to severe.
Standard Facelift
A full lower facelift tightens the skin and deeper tissue of the cheeks, jowls, and neck. It typically rejuvenates the face by 10 to 15 years and maintains results for a similar timeframe. The procedure takes two to six hours depending on scope. Most patients return to work or school within two weeks, with sutures removed at the end of the first week. Swelling and bruising are most noticeable in week one and largely resolve by week two.
Mini Facelift
A mini facelift targets the jowls and lower face through smaller incisions but doesn’t address the neck as comprehensively. It’s a good fit for younger patients with mild jowling or as a touch-up years after a prior facelift. Recovery is similar but often slightly faster. The trade-off is less dramatic improvement and shorter-lasting results compared to a full facelift.
Neck Lift
A neck lift focuses specifically on loose neck skin and takes one to three hours. It doesn’t address the jowls or cheeks directly, so it’s typically combined with a facelift rather than performed alone for jowl correction.
After any of these procedures, your face continues to age normally, which is why results aren’t permanent. But the clock effectively gets reset by a decade or more, and most people find that even years later, they still look younger than they would have without the surgery.
Choosing the Right Approach
The best treatment depends on what’s actually causing your jowls and how far they’ve progressed. Early jowling with mild skin laxity responds well to a combination of energy-based tightening and strategic filler placement. If excess fat is a clear contributor, fat-dissolving injections can reduce bulk, but only when skin quality is still decent enough to retract afterward. Thread lifts occupy a middle ground for people who want more lift than devices can provide but aren’t ready for surgery. For significant sagging with redundant skin, a facelift delivers results that no combination of nonsurgical treatments can match.
Many practitioners combine approaches. Filler along the jawline paired with ultrasound tightening, for instance, or a thread lift supplemented with radiofrequency microneedling. The key is accurately diagnosing whether the problem is primarily loose skin, excess fat, volume loss, or tissue descent, because treating the wrong cause can make jowls look worse rather than better.