Best Non-Surgical Treatments for Jowls

The best non-surgical treatment for jowls depends on what is causing them. Loose skin along the jaw is treated with microfocused ultrasound (Ultherapy) or RF microneedling. Lost volume at the jaw and chin is treated with filler. Fat under the chin is treated with Kybella. In a review of 13 studies on microfocused ultrasound, 77% of people treated were rated improved at 90 days. Deep, heavy sagging is still surgical territory, and no device or injection replaces surgery.

Are my jowls loose skin, lost volume or fat?

Jowls usually come from one or more of three things:

• skin that has loosened
• volume lost along the jaw and chin
• fat sitting under the chin

Work out which one is yours first, because each is treated differently. You can have more than one.

With age, the jawbone loses some of its bone, and the parotid gland (a saliva gland in front of the ear) can drop. Both take away the support that keeps your jawline sharp. Dermatologists reviewing jawline treatments note that filler can restore that lost volume.

Jowls often show up in your mid-30s, even when you have done everything right. A 37-year-old in r/30PlusSkinCare posted about sudden lower-face sagging after years of tretinoin, SPF and a healthy lifestyle: "Because I've done 'everything right,' I'm struggling to understand why this happened so suddenly." The top reply: "It is a bit of an awkward age because we're too young for facelifts but no amount of creams and 'drink more water' suggestions will stop volume loss."

Sagging that appears suddenly on one side of the face is a different situation. When a woman in r/30PlusSkinCare posted exactly that, the top reply said: "If it's happened all of a sudden please go to urgent care. This looks like Bells Palsy but could be something much more serious." If your sagging appeared overnight on one side, get it checked before you book anything cosmetic.

Does Ultherapy or RF microneedling work for jowls?

Yes, when your main problem is loose skin. Microfocused ultrasound (Ultherapy is the best-known brand) heats tissue 1.5 to 4.5 mm below the skin, which triggers new collagen. Your skin firms up over 2 to 3 months, not on the day.

A meta-analysis of 13 studies with 477 people looked at microfocused ultrasound for facial tightening:

• 77% were rated improved at 90 days, and 69% at 180 days.
• 78% were satisfied at 90 days, and 71% at 180 days.
• Pain averaged about 3 out of 10, and no one had to stop because of pain.

For the lower face in particular, one study followed people for a year after microfocused ultrasound. Blinded reviewers rated 93% of results as satisfactory, and 85% of patients said they were satisfied, according to a dermatologist's guide to neck and jawline treatments.

RF microneedling (Morpheus8 and similar) works best alongside ultrasound in the data so far. In a 30-person split-face trial, the results for lower-face slimming were:

• At 1 month: ultrasound plus RF microneedling reduced lower-face volume by about 2.3 mL. Ultrasound alone reduced it by about 0.4 mL. RF microneedling alone produced no real change.
• At 3 and 6 months: the combination looked similar to ultrasound alone, and both were ahead of RF microneedling alone.

So the combination got you there faster, while ultrasound alone caught up by month 3.

In that same trial, treatments that included ultrasound caused more temporary tingling or numbness (paresthesia). They also caused rare cases of temporary muscle weakness. Ask the person treating you what to watch for afterward.

Most studies of these treatments only follow people for about a year, so nobody can promise how long your result will hold.

Can filler lift jowls?

Filler helps when the problem is lost volume. It rebuilds the jaw and chin, so the jowl stands out less. It does not tighten loose skin.

Two types of filler come up for the jawline:

• Hyaluronic acid filler: in an 18-month open-label study (one where everyone knew what they were getting), 43.1% of people improved at least one grade on a jawline volume scale. On a chin volume scale, 77.8% improved. That makes the chin the easier win. 95% were happy with how they looked.
• Calcium hydroxylapatite filler (Radiesse): this gives firmer support than hyaluronic acid and prompts your skin to build collagen. In one study, the improvement in jawline sagging lasted up to a year.

A blocked blood vessel (vascular occlusion) from hyaluronic acid filler is rare, especially when the injector uses a blunt microcannula, according to the dermatologists' review. Ask your injector which they use.

What helps when the fullness is under the chin?

Kybella (deoxycholic acid) is FDA-approved to improve moderate to severe fullness from fat under the chin in adults. The Kybella label says it is not approved for fat outside that area, and that such use is not recommended.

That limit matters. The label reports serious reactions when Kybella was injected outside the chin area, including:

• nerve and muscle injury
• facial weakness
• lumps that may not go away

If anyone offers to inject it into the jowl itself, say no.

Under the chin, Kybella works for most people. In the two main trials, about two in three people improved at least one grade (70.0% and 66.5%). On placebo, 18.6% and 22.2% improved. Treatment was up to 6 sessions, given at least a month apart.

Side effects in the trials:

• Swelling: 87% of people had it.
• Numbness: 66% had it.
• Nerve injury causing an uneven smile: 4% had it, compared with under 1% on placebo.

The label also says to weigh the risks if your skin is very loose, because removing the fat can leave a result you will not like.

Which jowl treatment fits me, and what does it cost?

Devices and filler work on your jawline in a clinic chair. If you also want prescription skin care to go with them, take the quiz. Tell our clinical team about your jawline goal and see which skin plan fits, with options such as tretinoin, GHK-Cu copper peptide and NAD+ face cream.