beauty
By Valerie Monroe, a Cut contributor. She is author of the “How Not to F*ck Up Your Face” column. Previously, she created a monthly “Ask Val” column at O, The Oprah Magazine, where she was the beauty director for nearly 16 years.
Photo-Illustration: by The Cut; Photo: Getty Images
This column first ran in Valerie Monroe’s newsletter,How Not to F*ck Up Your Face, which you can subscribe to on Substack.
A few weeks ago, I told you a post about jowls was in the works (pronounce it like “bowls” — much more fun). It turns out jowls are a rich subject, and there’s a lot I didn’t know about them, because who cares about jowls until you have them? But here we are.
I first learned that there are two different kinds of jowls. Dermatologist Hadley King, M.D., explained the difference: “For some people, they’re just composed of skin, caused by increasing laxity over time, and for others, they contain fat,” she said. The treatment for each kind is different, and because the wrong treatment can make the jowl look more pronounced, you want to know what you’re dealing with.
King said if you’re unhappily gifted with lax-skin-no-fat jowls, trying to remove fat from the area could make skin laxity more evident.Well-placed filler along the cheekbone, at the angle of the jaw and the pre-jowl sulcus (the area between the tighter skin of the chin and the softer skin of the cheek), can make the jawline look smoother and create vectors that subtly reduce the look of jowls, she said.
King also suggested that tightening devices like Sofwave, Ulthera, and Radio Frequency (RF) microneedling can reduce the appearance of jowling, as can a thread lift. (I’ve written about thread lifts un-encouragingly, though King thinks the newer generation of threads are better than the ones from the late ’90s/early 2000s, and she hasn’t heard about the new threads breaking.)
Plastic surgeon Alan Matarasso, M.D., says that threads can be a temporary solution for some, but urges caution. “It’s fine for people beginning to get early jowling, as it’ll help reduce them,” said Matarasso. It might be right for the 40-year-old who you’d say is crazy to do anything, yet her jowls bother her. A few things to be aware of: A thread lift is expensive ($1,600 to $3,500, according to RealSelf), the results are temporary, and it may result in some scarring. (And it is very, very painful.)
But King wouldn’t recommend the treatments above for those with fatty jowls. Instead, procedures that remove fat like Kybella and deep RF microneedling will likely achieve the desired result. Speaking of desired results, King wrote about the energy-based devices mentioned above when I exhibited some skepticism about their efficacy: “I agree that the results achieved by energy-based devices are variable. I have trusted colleagues who swear by the results they get from devices like Ulthera and Morpheus8. I personally saw improvement in my neck after Sofwave.I’ve treated a lot of people with Ulthera, Sofwave, Endymed Intensif, and most recently Candela Matrix Pro, and I can say that patients are generally pleased.”
The part I especially want you to hear:
“Managing expectations is an important part of patient satisfaction,” said King.“I explain that results are variable, because they depend on how much or how well your skin produces collagen in response to the energy, and that they won’t be as dramatic as those produced by surgery. Patients hoping for subtle results tend to be happy when they see subtle results.”
There’s an anecdote I want to share from another beloved dermatologist: I asked what kind of results she was seeing with a new device she was using on her patients. (I can’t remember the device.) “I’ve had some good, subtle results,” said the doctor. “Subtle?” I asked. “Yes, one patient who was especially pleased said she no longer minded how she looked from below when she wiped off her mirrored co*cktail table.” In other words, “subtle” might mean results are most noticeable when you’re peered at from below.
Now for microcurrent devices, which cause muscles to contract from a low-voltage current. “There’s little scientific data to support the anti-aging claims,” said King.These devices are often recommended more for “pre-juvenation” and maintenance because the results are likely to be modest, she said. Why might you see a change in jowls after a treatment? “Because microcurrent causes muscle contraction, the immediate effect can tone the jawline — but only temporarily.” King hasn’t seen convincingevidence of long-term effects.
From electric shock to bloody shock, there’s Ellacor. “The idea of lifting with ‘scarless micro-coring technology’” — basically, super-intense microneedling — “is appealing, and I was excited about this before it came out,” said King.But she spoke to a surgical colleague who tried it and described it as a very “bloody” procedure. He also said it requires three treatments to get results he thought were comparable to using a CO2 laser. Maybe, like King, we’ll sit this one out for now.
The most low-lift option is just doing some facial exercises at home: “The muscles we use to makefacialexpressions cause many of the wrinkles on our face, particularly crow’s feet, the ‘elevens’ between the brows, and horizontal lines across the forehead,” said King.Repeated muscle contractions of the upper face can deepen forehead lines and crow’s feet.
In fairness to exercise junkies, King points to a 2018 study that showed a 30-minute daily or alternate-day facial-exerciseprogram sustained over 20 weeks may modestly improve the facial appearance of select middle-aged women. However, thestudy’s sample size was small (just 16 women completed the full program); only middle-aged women who self-selected in participated; there were numerous dropouts; and there was no control group. Bottom line: For certain motivated patients,facialexercisescould be beneficial, but results require consistency and time — and they won’t happen for everyone.
One last caveat: Facial exercise isn’t a good idea if you’ve had dermal filler, said King, because some thinking suggests theexercisesmay reduce the fillers’ longevity.
And if you’ve exhausted all other options, plastic surgeon Alan Matarasso, M.D., explains the surgical options for jowls: “A full facelift renovates the whole shebang,” said Matarasso. A necklift (with cuts behind the ears) takes out the bottom of the jowl but doesn’t fully pull it up. “An extended necklift — in which we cut less than an inch in the crease in front of the earlobe — will more fully help pull up the jowl, so that’s an option for those who don’t want a full facelift,” he said. The extended necklift can improve the appearance of jowls for a minimum of five to ten years; though you’ll never get to the point where you would’ve been without surgery, eventually your jowls will reappear.
Dr. Matarasso suggests the best time for a facelift is between 45 and 50 years old. None of this valuable information — thank you, Dr. Matarasso! — makes me regret not having had surgery, but I think if your jowls make you miserable and you’ve considered all options other than surgery, then a consultation with a plastic surgeon might be the right path. When a life without jowls is happier, leave them at the curb. It’s nobody’s business but yours.
Tags:
- style
- how not to f*ck up your face
- beauty
- aging
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