Jowls are the sagging skin and tissue that hang below the jawline, developing as facial fat shifts downward and collagen and elastin production naturally decline with age. They are not, as dermatologist Dr Megan Casady Flahive explains, simply excess skin; they represent displaced facial tissue that has lost its structural support. Treatment ranges from facial exercises and retinoid cream with modest, limited evidence, to dermal fillers and surgical options with more established, though invasive, results.
What Are Jowls?
Jowls are the area of loose, sagging skin and tissue that collects between the lower cheeks and chin, along the jawline. As facial plastic surgeon Dr Naderi puts it, the face doesn’t simply “sag” with age; it reorganises. Multiple layers of support, deeper connective tissue, fat pads, and even the underlying bone, all change simultaneously, and the resulting shift of facial volume downward is what becomes visible externally as jowls.
What Actually Causes Jowls
| Cause | Mechanism |
|---|---|
| Collagen and elastin decline | Skin loses tightness and elasticity; collagen production begins declining from around age 18 |
| Facial volume loss | Fat in the face shrinks and shifts downward, removing support beneath the skin |
| Skeletal resorption | Facial bone structure gradually erodes, so less elastic skin hangs on a less prominent frame |
| Gravity | Continuously pulls down on skin and fat in the lower face over time |
| Genetics | Some people are more predisposed to jowls and facial sagging patterns than others |
| Weight fluctuations | Repeated stretching and shrinking from weight changes weakens skin elasticity over time |
| Sun exposure | UV radiation damages collagen and elastin, accelerating the ageing process specifically in this area |
| Repeated facial habits | Sleeping predominantly on one side, or habitually overusing cheek and jaw muscles, may contribute over years |
Weight gain can also worsen jowls specifically, since jowls contain body fat, meaning increased overall body fat can directly increase their size.
At-Home Treatments
Facial Exercises
A 2021 review concluded there is limited evidence that facial exercises aid facial rejuvenation, though many individual studies included in the review reported positive outcomes. The theory is that strengthening facial, jaw and neck muscles helps them better hold their shape, and exercise generally supports several factors relevant to overall skin health, even if the evidence specifically for jowls remains preliminary. Our guide to benefits of face yoga covers the research behind facial exercise routines in more depth, including a landmark study on a related outcome, mid-face fullness.
Retinoid Cream
Retinoids are among the most well-studied topical options for jowls specifically, working by stimulating collagen production over time. Results take months, not days, and require consistent use to maintain. Our guide to the benefits of retinol for anti-ageing covers exactly how this mechanism works and how to introduce it into a routine without irritation.
Facial Massage
Massage is commonly recommended as an at-home option, working through improved circulation and temporary muscle engagement, though like most at-home approaches, it offers modest, temporary improvement rather than a structural change to sagging tissue.
Collagen Supplements
Since collagen decline is a central driver of jowls, supplementation is a reasonable, low-risk addition to a broader routine. Our guide to benefits of collagen supplements covers what recent research actually shows, including realistic timelines and where the evidence remains genuinely limited.
Sunscreen and Prevention
The most consistently recommended prevention step across dermatology sources is straightforward: regular sunscreen use and avoiding smoking. Since UV exposure directly damages the collagen and elastin responsible for skin firmness, consistent daily SPF is one of the few genuinely evidence-backed ways to slow jowl development before it becomes pronounced. Our guide to benefits of daily SPF use covers the clinical trial evidence behind this specifically.
Non-Surgical Medical Treatments
| Treatment | How It Works |
|---|---|
| Dermal fillers | Add volume to the lower face and cheeks, lifting and supporting sagging skin from within |
| Radiofrequency skin tightening | Uses heat energy to stimulate collagen production and tighten existing skin |
| Ultrasound therapy (e.g. HIFU) | Delivers focused energy beneath the skin surface to stimulate deeper collagen renewal |
| Thread lifts | Uses dissolvable threads to mechanically lift and reposition sagging tissue |
By supporting the mid-face specifically, treatments that restore volume higher in the face often make jowls appear less pronounced, even without directly treating the jawline area itself.
Surgical Options
Surgical treatment, most commonly a lower facelift or neck lift, involves excision of excess skin and the lifting and repositioning of remaining facial tissue to create a more defined jawline. This remains the most effective option for significant, established jowls, since it directly addresses the structural, multi-layer descent of facial anatomy rather than working only at the skin’s surface.
Choosing the Right Approach
| Severity | Reasonable Starting Point |
|---|---|
| Mild, early signs | Sunscreen, retinoid cream, facial exercises, collagen support |
| Moderate | Non-surgical options: fillers, radiofrequency, ultrasound therapy |
| Significant, established | Surgical consultation for a lower facelift or neck lift |
Choice of treatment ultimately depends on individual preferences, the extent of sagging, and the specific outcome desired, which is why a consultation with a board-certified dermatologist or facial plastic surgeon is the most reliable way to get a personalised recommendation.
When Jowls Might Signal Something More Serious
Most jowls are purely cosmetic and not a health risk. However, sudden facial sagging, particularly if it’s asymmetrical, accompanied by drooping on one side of the face, slurred speech, or sudden weakness, could signal a stroke or another serious neurological issue and requires emergency care immediately. Gradual, symmetrical jowl development over years is the typical, non-urgent pattern; anything sudden or one-sided is not.
Is It Necessary to Treat Jowls at All?
No. It’s entirely reasonable to embrace the natural ageing process without pursuing any treatment or skincare product for jowls specifically. Since jowls are a normal, expected part of ageing for most people, treatment is a personal choice driven by individual preference and comfort with one’s appearance, not a medical necessity.
Frequently Asked Questions
At what age do jowls typically start to develop?
There’s no fixed age, since it depends heavily on genetics, sun exposure history and lifestyle factors, but collagen production begins declining from around age 18, and visible jowls most commonly become noticeable from the late 30s through the 50s onward.
Can losing weight get rid of jowls?
Not necessarily, and it can sometimes worsen their appearance. Since jowls contain body fat, significant weight loss can reduce their volume, but the accompanying loss of skin elasticity from rapid weight change can also leave skin looser and more prone to sagging in the same area.
Do jowls run in families?
Yes, genetics play a documented role in facial ageing patterns, including a predisposition to developing jowls. Some people are simply more genetically inclined toward this pattern of facial sagging than others, independent of lifestyle factors.
Is there a permanent, non-surgical fix for jowls?
No non-surgical treatment offers a truly permanent result, since ageing, gravity and collagen decline continue regardless of any single treatment. Fillers, radiofrequency and ultrasound treatments typically need to be repeated periodically to maintain their effect, while surgery offers the most lasting structural change.
This article is for general information only and is not a substitute for professional dermatological or medical advice. If facial sagging is sudden, asymmetrical, or accompanied by other neurological symptoms, please seek emergency medical care immediately.
About the Author: Written by the Well Ideas editorial team, dedicated to researching and sharing practical, evidence-informed wellness guidance for a healthier everyday life.
