Does Tretinoin Help Sagging Jowls?

Tretinoin helps the skin part of sagging jowls. In a 24-week trial on sun-damaged faces, 0.05% tretinoin cream reduced fine wrinkling, roughness and skin laxity compared with a plain cream. Tretinoin will not remove a jowl made of fat or shifted volume, and the FDA label for the 0.02% cream (sold as Renova) says it has not shown an effect on laxity. Think of tretinoin as the nightly treatment for the skin over your jawline, not a lift.

What causes jowls in your 30s and 40s?

Jowls can show up earlier than you expect. "I'm turning 31 soon, and recently noticed that my lower face is slightly sagging," one poster wrote in r/30PlusSkinCare. A 33-year-old in the same subreddit put it this way: "I'm frustrated over my marionette and nasolabial lines and feel like this shouldn't be happening at this age."

A jowl is not one thing. An expert review on lower face and neck treatment says an assessment of the lower face should work out how much of the concern comes from bone, fat, muscle, glands and skin, because each needs a different treatment. The review links the complaint "I am starting to see jowls" to excess fat.

Skin is the layer where sun damage shows. Sun-damaged skin made 56% less collagen I than sun-protected skin. Collagen is the protein that keeps skin firm. How damaged the skin was predicted how much collagen it made better than age did. Tretinoin works on this layer.

What does tretinoin do to the skin along your jawline?

Tretinoin is prescription vitamin A, also called retinoic acid. In a randomized trial of 251 adults with sun-damaged faces, 79% of those using 0.05% tretinoin for 24 weeks improved overall, compared with 48% using a plain cream. Fine wrinkling, blotchy pigment, roughness and laxity all dropped significantly.

It also rebuilds collagen. After 10 to 12 months of 0.1% tretinoin on sun-damaged forearm skin, collagen I formation rose 80%, while it fell 14% in skin treated with a plain cream.

A review of eight randomized trials covering 1,361 people found that tretinoin improved both fine and coarse facial wrinkles compared with a plain cream. The people using it also rated their skin as more improved.

Can tretinoin lift a jowl that is already hanging?

Not on its own. The FDA label for Renova (tretinoin 0.02% cream) says it has not shown an effect on coarse or deep wrinkling or skin laxity. The label also says it does not eliminate wrinkles or restore younger skin.

Strength matters here. The laxity improvement in the 251-person trial came from the 0.05% cream, while the label finding covers the 0.02% cream. The label also says no studies have compared the two Renova strengths head to head. Your clinical team picks the strength that fits your skin.

If you have darker skin, this next finding applies to you. One single-center study looked at 107 people with darker skin types (Fitzpatrick IV to VI). In that study, 29% of people on 0.02% tretinoin showed minimal or mild improvement in fine wrinkling, compared with 43% on the plain cream. The label says this may reflect the small size of the study. Tell your clinical team your skin type when you choose a strength.

Use tretinoin to make the skin over your jawline smoother and more even, with more collagen behind it. Expect it to soften how the jowl area looks, not to move fat or lift tissue back into place.

How does tretinoin compare with in-office treatments for jowls?

Tretinoin is the one you use at home every night, and it works on the skin. In-office treatments go after laxity and fat that a cream cannot reach. Details below come from the expert review on lower face treatment, except the tretinoin row.

You do not have to pick one. The review of eight trials says microneedling and laser treatments are effective options alone or combined with tretinoin. Tretinoin can keep working on your skin between in-office visits.

How long does tretinoin take, and what will my skin go through?

Early changes can show in about a month. Expect some redness and peeling at first, and give it at least 24 weeks before you judge it.

• Timing. A review of seven randomized trials found tretinoin improved wrinkling and pigmentation as early as one month, and the effects were still there after 24 months of use. The 251-person trial judged results at 24 weeks, so give it at least that long before you decide.
• Early irritation. Expect some redness, peeling and stinging. In the 251-person trial, these were usually mild and well tolerated.
• Sensitive skin. If your skin is sensitive, start at a low strength (0.02% or lower), build up gradually and drop to every other night if you need to. This helps you stay on it. Your clinical team will tell you how to build up.
• Stronger reactions. About 7% of people on the 0.02% cream needed a short course of mild steroid cream for irritation, compared with under 1% on the plain cream. About 4% stopped because of side effects.
• Sun and pregnancy. Wear sunscreen of at least SPF 15 every day, because tretinoin raises your chance of sunburn. Do not use it if you are pregnant or planning to be.
• Staying on it. You may lose some of the benefit after 12 weeks off tretinoin, so treat it as a long-term habit.
• Getting it. Our clinical team can prescribe tretinoin if it fits your goal and your skin.

Take the quiz so your clinical team can see whether tretinoin fits the skin along your jawline. They can also choose which strength you start with and how to fit it around any other treatment you are planning.