Last Reviewed on February 10, 2021 by Alice Pien, MD & Asher Milgrom, PhD
Once upon a time…. the skin on our face was tight and toned, and our cheeks proudly proclaimed to the world
“I am healthy, and filled with vim vigor and vitality”
Then one day our cheeks start getting loose and sagging… our jaw line loses its sharp contours… hanging jowls begin to appear, folds around our mouth deepen, marionette lines frame our chin that proclaim to the world…
“gravity is in charge of my face”!
OMG… what is going on? Is it possible to eliminate these jowls without a $25,000 lower facelift surgery? Is it possible to correct this naturally, holistically, physiologically?!
What Causes Jowls?
Let’s start at the beginning… There are two layers that contribute to the sagging of our face and the appearance of jowls, deep nasolabial folds and marionette lines. The dermis layer of the skin and subcutaneous fat under the skin.
1. Subcutaneous Fat Under the Skin
The fat layer under our skin is called ‘subcutaneous fat’. Depending on how thick this layer is, it contributes to the fullness of our face and gives the appearance of youthfulness.
At a certain point in the aging process, most people begin to lose some of this fat which changes the contours of our face. This causes jowls to form. Like deflating a basketball, our face deflates and loses its youthful contours as concavities and flat spots develop. It creeps up on us, until one day when we look at a photo from ten years ago and realize that we are progressing towards the typical boney “skeletal” face of an elderly person.
Depending on the shape of our face and the amount of subcutaneous fat we may have lost, restoring the volume of lost fat can play a role in lifting our cheeks, which will pull the skin upward reducing the appearance of our deepening folds and jowls.
However, if the skin itself has lost its strength and elasticity, the sagging, deepening folds and jowls cannot be completely fixed by restoring lost subcutaneous fat. Unfortunately, in attempting to compensate for sagging skin with a “quick fix” solution, some people will overfill the subcutaneous fat layer with various dermal fillers which results in a very unnatural “puffy” appearance typical of the Hollywood “overdone” look.
Bottom line, fillers can help to minimize jowls… BUT weak sagging skin must be addressed where it occurs, in the collagen matrix of the dermis.
2. Dermis Layer of the Skin
The other layer that is responsible for the sagging of our face and development of jowls is the dermis. It contains the collagen matrix of our skin which is responsible for our skin’s strength, elasticity, flexibility, resilience, tone and tightness.
Around the age of 40, the physiological machinery that maintains, repairs and regenerates our collagen matrix grinds to a halt, causing the physical infrastructure of the collagen matrix to weaken and degenerate. Consequently, the skin thins, wrinkles and sags, leading to deep nasolabial folds, marionette lines and the dreaded jowls.
The loss of dermal collagen and its progressive weakening is the key factor in the looseness of our skin, the sagging of our cheeks, and the appearance of jowls, deepening nasolabial folds and marionette lines.
The good news: The collagen matrix can be regenerated, tightened and toned. The appearance of jowls can be reduced.
By using a customized combination of lasers, whose energy stimulates the natural physiological mechanisms that rebuild, repair and regenerate new, healthy and beautiful skin, our skin can function as it did when we were much younger, regenerating itself from the inside out. Bottom line, our skin will tighten and lift itself, and restore our natural, jowl free, younger appearance.
How to Get Rid of Jowls
There are many different treatments that are effective in reducing the appearance of jowls. Below we talk about the treatments that are the most effective.
Using Fillers to Get Rid of Jowls
What kind of filler should I use to replenish lost subcutaneous fat?
There are various types of pharmaceutically manufactured fillers that can substitute for the volume of fat that has been lost. The substances used are all naturally occurring, but artificially manufactured.
Of course, they are all FDA approved for reducing the appearance of jowls, and safe to use.
Depending on the substance used in the filler, the filler will last between 5 to 9 months before our body dissolves it away and our face “deflates” again.
However, better than artificially made fillers, fat transplants are also used to reduce the appearance of jowls.
Simply put, fat is harvested from our own body, from a location where we have extra fat to spare and moved to where it has been lost in our face.
Bottom line, we are replacing our lost fat with our own fat! … its simply moved to a new neighborhood!! The results are fabulous, and typically last for much longer than fillers, and often last for years!
Using Lasers to Get Rid of Jowls
What kind of laser technology is used to achieve a natural physiological face lift and reduce the appearance of jowls?
Laser energy can be applied to the skin in 4 basic ways.
1. Solid Beam Lasers
By projecting a solid beam/column of energy that contacts the surface of the skin and is absorbed by the skin as it penetrates in depth.
Of course, as the beam penetrates through the skin, energy is absorbed by the tissues, and progressively less energy is available the deeper it goes. Thus, providing high levels of energy at the deepest parts of the dermis is difficult to achieve without increasing the energy at the surface beyond the point where the surface layer will be burned.
2. Fractional Lasers
Fractional lasers employ sophisticated optical engineering that breaks the solid beam of energy mentioned above into tiny micro-columns of energy.
With a fractionated beam, only a limited percentage of the surface area is filled with laser energy, while most of the surface area is comprised of the empty space between the micro beams that is not receiving any laser energy. Thus, the overall surface is not in danger of being burned, and higher amounts of energy can be safely delivered to the deepest layers of the dermis. The geometry of how the energy interacts with the collagen matrix is also important in that it stimulates contraction of the skin, reducing jowls.
3. Radio Frequency Devices (RF Micro-needling)
Radio frequency (RF) devices can also be fractioned into small columns of energy by utilizing a pad of needles through which the RF energy is delivered. Essentially the needles are inserted into the skin and deliver the RF energy to the surrounding tissue at the tip of the needles.
4. Bipolar Radio Frequency
The newest method by which energy is delivered to the skin employs an energy emitter that glides on the surface of the skin, and a receiver that is inserted under the skin to which the energy is delivered. This is our top neck and jowl tightening procedure.
In sum, there are a variety of different frequencies of energy that interact with the collagen matrix of the dermis and can be used to reduce the appearance of jowls. Each of these energies can be delivered by these 4 different methods, and can cause a spectrum of different physiological responses that:
- Contract existing collagen
- Stimulate the repair of existing collagen
- Stimulate the generation of new collagen
Resulting in lifting, toning, strengthening, thickening and tightening of the skin and jowls.
Other Modalities to Get Rid of Jowls
By now you know that for the best clinical and aesthetic outcome, the natural regenerative physiology of the patient must be stimulated and supported to achieve maximal results.
As in all cases of excellent medicine, customization is necessary, and a wide array of tools should be at the disposal of the physician.
These modalities include:
A Physiological Process to Tighten Skin
Bottom line… when searching for a doctor who can tighten, tone and lift your skin naturally, removing jowls, hi-tech medical lasers are amazing tools that can precisely target different kinds of tissues and cells that can give you the results you want.
However, it is a physiological process, that requires three essential ingredients:
- The doctor must understand the interaction between the physics of the technology and the physiology of the skin. There is no single laser that can do the job… and the physician must understand all the parameters of laser energy, its: Frequency, Power, Pulse duration, Target specificity, Geometry of beam, synergistic interaction of lasers in combinations… and of course, how to integrate into the protocols the other naturopathic modalities.
- The protocols must be tailored and customized for each patient.
- The patient must have patience. As the physiology cannot achieve full stimulation in one session, a series of treatments are typically necessary, with sufficient interval of time in-between treatments to allow for the physiology to do its work.
About the Authors
Doctors Alice Pien, MD and Asher Milgrom, Phd are established pioneers in the fields of Regenerative Medicine and Skincare. Their expertise ranges from advanced laser systems to HCT/P – Stem Cell medicine. Their medical education and advanced certifications span from medical schools of NY State University, the University of Chicago, to Johns Hopkins, Harvard and UCLA. They approach medicine with the clinical expertise of over 85,000 successful treatments over the past 20 years and significant scientific research resulting in proprietary protocols that they customize for each individual patient.
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