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Contouring the Lower Third
Nonsurgical options to lift and redefine the chin and jawline
Daniel Casciato
A chiseled or well-defined jawline is often equated with youth, which is why jowling and sagging of skin in the chin area are common aesthetic concerns for both men and women. Loss of definition in the lower face and neck as we age can be the result of fat pad degradation, skin laxity and/or bone resorption. In the past, surgical lifts and implants were the only viable options for visible improvement. But today, there are a variety of nonsurgical tools that can provide noticeable improvement.
Choosing the most effective treatment or combination of treatments begins by first understanding the patient's individual concerns—which do not always mirror what you as an aesthetic professional consider a key problem, says Alexis Parcells, MD, a plastic and reconstructive surgeon in Shrewsbury, New Jersey. "Understanding the patient's concerns and obtaining a full medical history to investigate the reasons behind the jowling or sagging are integral to designing a successful treatment plan,"she says.
"A few elements play into the aging face and aging jawline," says Sachin Shridharani, MD, plastic surgeon and founder of Luxurgery in Manhattan. "There could be an accumulation of extra fat or evidence of skin laxity and loss of elastic recoil in the skin, or the underlying skeletal structure—their mandible—may be a little atrophied," he says. "This could be because of the natural aging process, poor dentition or medical conditions that create some bony resorption. So when I'm looking at that neck and jawline, the first question is, what is creating this loss of definition?"
To help identify the changes that have occurred with age and achieve the most natural-looking outcomes, Dr. Parcells asks patients to bring in old photos of themselves so she can view the progression of jowling. "Additionally, I will ask the patient if they have attempted any prior treatments, and what their experience was to better understand their satisfaction with specific procedures," she says.
Jowling and Submental Fat
Unwanted submental fat affects both younger and older patients. If a patient is young and has excellent skin quality with a small amount of sag and fat under their chin, they can benefit from a variety of in-office treatments, such as cryolipolysis, Kybella (deoxycholic acid) or small volume liposuction, says Dr. Parcells.
"If they just have some jowl fat, my team and I have pioneered treating the jowls with Kybella to help break down the fat and improve the quality of that jawline," says Dr. Shridharani.
In older patients, these concerns are typically the result of the aging process, which causes loss of volume in the mid-face and poor elasticity in the skin. For these patients, physicians need to look at the whole face when determining a treatment plan. "If someone wants a better defined jawline; it's often not just the jawline we're working on," says Mark Youssef, MD, cosmetic surgeon and founder of Los Angeles-based Younique Cosmetic Surgery & Medical Spa. "Many times, we volumize areas in the upper cheeks with filler, because it elevates the jawline and jowls indirectly from above."
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