We can blame a lot on selfies, but they aren’t solely responsible for the recent boom in jawline scrutiny. Pittsburgh plastic surgeon Leo R. McCafferty, MD notes that our collective jaw fixation stems simply from the vast number of treatments that can target this particular region. He notes that social media, “coupled with the many surgical options that allow for little or no downtime,” add to the growing interest in treating this part of the face.
According to the American Academy of Facial Plastic and Reconstructive Surgery (AAFPRS), 55 percent of plastic surgery patients in 2017 listed seeing themselves on social media as a reason for surgery, up from just 13 percent the previous year. The popularity of jaw “tweakments” transcends age, and no matter the end goal, many of the techniques are the same: shrink excess fat from under the chin; reshape facial contours with filler, implants or neurotoxins; tighten loose skin with energy treatments, thread lifts or strategic placement of injectables; or, for the ultimate transformation, a facelift or necklift.
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“We are now understanding that throughout life, our facial bone structure remodels and changes,” says New York facial plastic surgeon Matthew White, MD. “There have been some great research studies published that really illuminate how important a patient’s bone structure relates to their overall facial appearance, particularly the jawline.” One such study published in the Aesthetic Surgery Journal details this reabsorption of bone, where bone density of the mandible (jaw bone) decreased by about 11 percent for male patients between the “young” age group—average age 30—and the older group with men age 70.
“Natural, chronologic aging of the lower face is attributed to changes in both bone and soft tissue atrophy,” notes Scottsdale, AZ dermatologist Dr. Mariel Bird. “Decreases in bone density caused by bone reabsorption and retraction of the chin lead to the development of hanging jowls and a weakened jaw angle.” Tissue in the upper parts of the face can weigh down the jawline, and as Dr. Bird explains, result in a collection of excess skin underneath the jaw. Thanks to the popularity of neurotoxins and fillers, many of us no longer worry about the top two-thirds of our face, and we now can’t help but notice signs of aging at the jawline.
JAWLINE RESHAPING 101
Average Treatment Cost: Treatment costs vary. The cost of injectable treatments can range from $750–$1,500; $1,500–$3,000 for energy-based treatments; $4,000–$10,000 for an open necklift; and $7,800– $18,000 for a facelift.
Treatment Options: Surgical procedures include a facelift, necklift, liposuction, or a chin implant. Noninvasive procedures include nonsurgical fat reduction, energy-based skin tighteners and injectable treatments.
Best For: Nonsurgical procedures can treat patients with mild-to-moderate fat or minimal-to-moderate loose skin in the lower cheeks and jaw. For patients with a moderate to a larger amount of fat and loose skin around the neck and jawline, surgery may be needed.
Longevity: Neurotoxins last for up to six months, and fillers can last anywhere from six months to two years, depending on the product used. Fat-reduction procedures deliver long-term results. Surgical results from a facelift or necklift may last for up to eight years or longer.
HOW TO: SHRINK
Fat-blasting tools and treatments can slenderize the jaw and minimize excess skin.
If trimming is your aim, a handful of fat-reduction treatments can slim the jaw region. “I often use Kybella under the chin to reduce fullness,” says Eagan, MN dermatologist Charles E. Crutchfield III, MD. Kybella contains a synthetic deoxycholic acid, the bile acid that works in our stomachs to degrade fat for absorption. After multiple injections under the chin—the entire process of which usually takes about 20 minutes—cells are broken down and are eventually expelled through the lymphatic system. “Kybella results can be unpredictable, as it only works on the superficial fat layer under the skin and cannot reduce deep-layer fat under the platysma, which is commonly treated with an open necklift,” says Eugene, OR plastic surgeon Mark Jewell, MD. “Usually, multiple treatments are required, and patients typically experience a noticeable skin reaction to the injections that includes swelling and bruising in the area.”
Little known fact: CoolSculpting was inspired by doctors who noticed that children with penchants for popsicles showed fat reduction in their cheeks. During the cryolipolysis procedure, paddles are applied directly to the skin to suction up fat and crystallize the cells. And, because adipose tissue is more responsive to temperature changes than skin, the frozen fat cells break down and leave the skin unharmed. With several treatments, up to 25 percent of the targeted fat can be reduced. It’s also touted to tighten some of the loose skin that may accompany fat loss, New York dermatologist Peter Chien, MD explains.
“In addition to the FDA indication for CoolSculpting to treat the submental—under the chin—area for fat, it has also received FDA-approval for improving lax tissue under the jawline as well,” he says. “That’s what gives it a distinct advantage over other fat-reduction treatments where lax skin remains after the under-chin fat is removed.” The FDA approved CoolSculpting’s skin-tightening benefits under the chin after an 18-week study found that 77 percent of patients showed tighter skin in the area after treatment. But how does it work? The mechanism is not fully understood, and some believe that rather than tightening, skin thickening may be a side effect from the increased collagen production. “Much of the tightening effects is speculative,” adds Dr. Jewell. “It may actually be caused by skin retraction.
THE SURGICAL OPTION
For jawline contouring, liposuction uses suction technology to target and remove individual fat cells from the area. It’s important to note that while liposuction doesn’t require a large incision, it is still a major surgical procedure, warranting invasive techniques and local anesthesia. “A small, 2-millimeter incision is made under the chin and a small cannula is introduced that removes unwanted fat,” notes Dr. White. Liposuction is considered the gold standard for fat removal and can be an intermediate option for patients in need of surgery, but not quite ready for a full-on facelift or necklift. “For younger patients in their 20s, 30s and early 40s, a less-invasive surgery is liposuction under the jawline and/or chin with the addition of a central neck-tightening approach to really sculpt,” adds Palo Alto, CA facial plastic surgeon Sachin Parikh, MD.
Targeting fat under the chin and around the jawline isn’t the only way to make a big impact. Buccal fat removal, which treats the pocket of fat under the cheekbone and above the jawline, is a facial contouring technique that can also give the illusion of a slimmer jawline. Hollywood starlets in the late ‘90s used to have it done to enhance their cheekbones—now, the same procedure is being used to remove signs of aging, according to Dr. Devgan. “Reducing the buccal fat pad decreases the heaviness of the tissue that contributes to jowling, she says. “It is ideal for those with moderate-to-good elasticity, and debulking heaviness can create a cleaner, leaner jawline contour.”
HOW TO: SHAPE
Reshaping, adding volume and defining is easier than ever with these facial fixes.
Though often injected to treat TMJ, or bruxism, in the jaw—typically causing a slimming side effect—neurotoxins can also be used alone to contour the masseters and create a narrower jaw. Houston dermatologist Paul M. Friedman, MD notes that the long-term effects of bruxism can culminate with tooth damage and may ultimately accelerate lateral bone loss that can become evident between ages 40 and 50. To help prevent this, Dr. Friedman injects neurotoxin into the masseters, reducing muscle bulk to ease clenching and grinding.
As Palo Alto, CA facial plastic surgeon David Lieberman, MD explains, fillers can replenish lost definition and strengthen the line of the jaw. “They can contour the posterior jawline, the anterior jawline or chin area and create an elegant, elongated look.” A few ccs of dermal filler—or the use of microfat grafts, which last even longer than fillers—in the chin can go a long way. “Adding volume to the chin right in front of the jowls—called the prejowl sulcus—or to the angle of the mandible—called the gonial angle—enhances definition,” says Dr. White. “For the jawline, I like using the filler Radiesse, or calcium hydroxylapatite, because of its natural similarity to the mineral component of human bone.” Other doctors may prefer using hyaluronic acid fillers because they are reversible.
Recently, chin implants, although a viable contouring option, have taken a backseat to temporary solutions. “Patients are moving away from permanent implants in favor of fillers,” says Beverly Hills, CA facial plastic surgeon Davis Nguyen, MD. However, for forever results, slicone chin implants have been around since the ‘60s and are still an industry standard for altering angles. “If the central part of the jawline is weak, a chin implant can increase the projection of the chin for balance,” says Laguna Woods, CA facial plastic surgeon Cory Yeh, MD.
HOW TO: ELEVATE
These tighten-and-lifters help give lax skin a boost.
The deep-plane facelift—a modified version of the conventional surgery— involves lifting the whole face by repositioning deeper muscles in addition to the overlying skin (in a traditional facelift, only the outer layers are lifted). The modified deep-plane is a go-to for facial plastic surgeons like Drs. Lieberman and Parikh, who note that, in their opinion, “it delivers the most consistent and transformative changes to the jawline and is ideal for patients with heavy jowling and excess skin.” Dr. Jewell mentions that while the deep-plane technique is effective, the SMAS facelift is more of the standard. “The deep-plane facelift is one of the accepted procedures for facial rejuvenation, but the more straightforward SMAS facelift works for the majority of patients.”
Thread lifts use dissolvable sutures (commonly referred to as threads) to address sagging in regions of the face, like lower cheeks and jowls, but are not the best option for patients with significant laxity. Silhouette InstaLift, which received FDA clearance in 2015, suspends lax skin by pulling up portions of the face with sutures that run underneath the skin. The procedure is typically done under local anesthesia, and patients usually experience minimal downtime and mild swelling. Though the sutures eventually absorb and results aren’t permanent (they last up to three years, but in some cases, as little as six months), Covington, LA dermatologist Christel Malinski, MD says “they trigger the body’s healing response to generate new collagen,” resulting in a firmer, more youthful look.
Nonsurgical skin tighteners utilize various forms of energy to target deeper layers of skin, causing them to contract and produce new collagen, thereby creating a tightening effect. They’re more effective for those with mild-to-moderate laxity (severe laxity responds best to a facelift), so patient selection is important. Thermage, a radio-frequency (RF) device, uses heat to induce the contraction and collagen boost; Profound RF combines microneedling and radio frequency to stimulate collagen production; and both can be used along the jawline. Ultherapy, an ultrasound procedure, can also tighten. “Focused ultrasound energy penetrates deeper than a laser and can induce collagen remodeling,” says Dr. White. “After a treatment—only one is normally needed— jawline and neck tissues gradually tighten.”
Many new innovations on the horizon are aimed at tossing the turkey neck aside, but are yet unproven in terms of safety and efficacy. Allergan is rumored to be launching a new injectable in 2020 aimed at the jaw and chin, though information has not become public yet. At-home DIY skin tools, like facial rollers and gua sha stones, are available to temporarily reduce puffiness around the jaw. Perhaps one of the most exciting new treatments is InMode’s new minimally invasive AccuTite device for both the face and body.
“It utilizes radio frequency administered through a cannula to break down fat and remodel tissue in a 30-minute, in-office procedure with local anesthesia,” says Los Angeles facial plastic surgeon Kian Karimi, MD. Better yet, it claims to be a one-and-done job with lasting results. “AccuTite is a one-time procedure that delivers impressive results with minimal downtime,” adds Dr. Karimi. “Although it is new to the market, variations of the technology—radio-frequency assisted lipolysis (RFAL)—show results can last up to five years or more.” Dr. Karimi says he pairs AccuTite with the Morpheus8 radio-frequency microneedling treatment for optimal results.
“Combining treatments can target multiple layers of the skin and soft tissues for a more significant improvement,” he explains. No matter the treatment, Dr. Jewell advises to find a board-certified plastic surgeon or dermatologist who knows facial anatomy and the risks associated with heating tissue: “This new AccuTite technology relies on deep-layer heating, which can be poorly controlled,” he cautions. “Some doctors try to heat under the surface of the dermis after they have heated the deep layers to perform additional tightening, but doing so risks full-thickness thermal burns. Choosing the right doctor is as important as choosing the right treatment.”
—Medically reviewed by La Jolla, CA plastic surgeon Robert Singer, MD, Eugene, OR plastic surgeon Mark Jewell, MD, Chicago facial plastic surgeon Steve Dayan, MD and Montclair, NJ dermatologist Jeanine B. Downie, MD
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