In the age of selfies and filters, it’s easy to hone in on the areas that we don’t like. One area in particular which I get questions about is the jawline.

“How can I sharpen my jawline?”
“How can I prevent my jowls getting worst?”
“How do I get rid of my jowls?”
“I don’t want to wear polo necks all my life.

The term “jowls” refer to the sagging skin below the jawline.

In this blog, I go through

  • What causes jowls
  • How to prevent it
  • How to treat it


 I like knowing why things happen so we can reverse engineer it and address the problem from the root cause.

Our jawline is “held up” by our bones, muscles, ligaments, fat pads and skin.

As we age, our face changes because:-

  • Fat pads in the upper face reduce in size and increases in the bottom half. The fat pad especially in our temples and cheeks act as a
    “lifting support” to the jawline.
  • Bone changes shape and density (due to drop in hormones) so we lose the strong structural support for a defined jawline.
  • Muscles and ligaments loses its tension.

This results in hollowness around our temples, flattening of the mid-face, marionette lines, shortening and flattening of the chin. All these results in formation and worsening of jowls.

This can be caused by:-

  • Normal part of ageing
  • Sudden weight loss
  • Inflammatory lifestyle factors e.g. smoking, prolonged UV exposure


That depends on the extent of the jowl.

Going down the treatment list from the least invasive to more intensive treatments, we can improve the jawline by:-

1. Nefertiti Neck Lift

This is a Botox treatment, relaxing the muscles that pull the jawline down (the neck platysma muscle, the chin muscles and the corner of the mouth). Once these muscles are relaxed, the lifting muscles of the face can act less opposed and have a stronger affect. This is more suitable for mild to moderate jowls. Results take up to 2 weeks to show and last up to 3 months.

2. Dermal Filler
As mentioned above on the causes, jowls are often associated with volume loss.

This looks like shadows in the:-

  • temple area
  • under the eyes
  • in front of your cheek
  • cheek bone
  • below your cheek bone in front of your ears
  • nose-mouth line
  • marionette (corner of the mouth to the chin)
  • chin

Dermal fillers are great for restoring volume lost in the areas where it is needed. It stimulates the fat pads, improving the “lifting supporot” from above.

This is suitable for mild to moderate jowls.

If there is loss of structural support, dermal fillers can be used to build up and stimulate the bones, providing more definition for the chin and jawline.

Results are seen immediately and can last up to 12-18 months.

3. PDO Threads
PDO threads improves the jawline by helping to reposition the tissues to as close where it was originally.

There are 2 types of PDO threads:-

  • Stimulating threads which are smooth and aims to stimulate collagen. THIS MAY FIRM THE SKIN BUT THIS WILL NOT LIFT!
  • Lifting threads which are designed with cogs, cones, barbs, or multi-punched so it can anchor the tissues and provide the structural support. Lifting threads also stimulate collagen and as we are repositioning the tissues, patients may not require extra volume restoration with dermal fillers.

This is suitable for moderate to severe jowls. It’s also suitable for patients who do not wish to have or are not suitable for dermal fillers.

There is a downtime of about 2 weeks. You can immediate results due to the mechanical lift and maximum results are seen in 3 months following new collagen lay down. Results last between 12-18 months.

Treatments can be combined and tailored depending on patient’s uniqure presentation, lifestyle and budget.


Radiofrequency (RF) uses heat waves at specific wavelengths to stimulate collagen. It can help firm the skin and MAY improve the jowls.

It’s more suited for mild jowls.

The problem is it may also “destroy” the fat cells which we do not want as our fat pads reduce in size as we age.

Radiofrequency will not be able to provide the “lifting support” above as the treatments mentioned.

There are newer devices using a combination of RF waves delivered through a series of needles that puncture the skin. This allows deeper penetration and may be useful for jowls that have a heavier appearance. This is better for moderate jowls but if someone has marked volume loss above, other treatments may be needed.

Downtime can be up to 2 weeks with maximum results seen in 3 months time.


Surgery can be considered if you have moderate to severe jowls and treatment options above will not / do not give you the results that you are looking for. 

Surgery is typically the more suitable choice if there is a lot of excess skin, a marked drop of the fat pads and patients want a long term solution.

I have had patients who’ve had non-surgical treatments to prolong the need for surgical treatment by up to 5 years and when they are ready, I refer them to my surgical colleague.

If you have not ruled out surgery, I always recommend patients to have a consultation with a plastic surgeon to have an idea what’s possible and you can better plan for the future. Surgical results can last up to 10 years.


Anything that can slow down ageing is a good start.

  1. Improve your skin’s resilience and elasticity. I wrote a blog about it here.


  2. Avoid crash diets, yoyo diets, prolonged fasting and strict elimination diets which can cause fast (but often unhealthy) weight loss.


  3. Balance and optimise your hormones which will protect your bones. Building and maintaining muscle is a key component to this as we lose muscle very quickly as we age.


  4. Facial exercises that strengthen the lifting muscles of the face is helpful if done consistently. I would avoid the exercise to accentuate the neck muscle platysma. Here’s a video I did in the past.

5. Facial massages e.g. using gua sha is helpful for lymphatic drainage to reduce puffiness, encourage blood flow and strengthen the skin.

6. Sleep on your back and avoid sleeping on the side of your face (I know this can be a challenge) as the side you sleep on can look older with repetitive pressure on one side. If you are able to, invest in silk pillow cases which reduces the creases.

7. Nefertiti neck lift can help treat early signs and prevent it getting worst.

I hope you find this blog useful. 

If you like my approach and would like me to help you achieve a more defined jawline, please get in touch with my team on [email protected] 

Until next blog, here’s to looking sharp and posied (and less polo necks),

Dr Terry