1 August 2020 onur
Below is how I am asked about the matter.
-Do you do jowl contouring?
-Yes, of course.
– It is non-surgical jowl contouring, right?
-Unfortunately not. To the contrary, it may sometimes require an extensive surgical procedure.
-No, doc, I have a little excess on my jowl. Not something that would require surgery.
Do you think so? Let’s take a look at the cosmetic procedures for the jowl together.
First of all, let’s confirm what we mean by “jowl”.
A jowl is the fullness under the chin, in the upper part of the neck, on the midline.
We call this the “submental” area in medicine.
A beautiful submental contour starts at the tip of the chin, runs straight, taut and parallel to the ground, and moves backwards, where it turns down at an angle of nearly 100 degrees with the neck (chin-neck angle, cervicomental angle).
Deterioration of the submental contours or, as the patients say, “jowl formation” depends on many factors.
Most of the time, patients compress the soft tissue there between their thumb and forefinger, hoping that there is fat in it and that the submental contouring will be improved after removing that fat.
However, the situation is much more complex.
The jowl issue:
It may be due to excess subcutaneous adipose tissue, laxity of the muscle called platysma, excess of deep fat tissue under the platysma, enlargement of digastric muscles, enlargement of submandibular salivary glands, decrease in the tension of submandibular muscles, receding position of the chin, loosening and sagging of facial skin under the chin.
In the aesthetic surgery of the jowl, it will be necessary to develop a personalized treatment plan according to the nature of the problem in the jowl area.
If the jowl formation is only due to excess fat under the skin, this fat layer can be thinned via submental micro liposuction, and the harvested adipose tissue can be transferred to the chin in the same session as a reinforcement. It is a simple process. In clinical conditions, it can be performed under local anesthesia in 20 minutes. Candidates eligible for this procedure are individuals in their 20s, with excellent skin elasticity and with less than 10 milliliters of excess subcutaneous fat. Most patients dream of a simple treatment at this level, but only 20-30% of patients suffering from jowl problems are eligible for submental micro liposuction and fat tissue transfer to the tip of the chin.
Now this is a vital point.
Focus your attention.
As a basic principle, reducing the fat under the skin makes the skin looser and saggier.
If submental liposuction is performed in an individual who is over 30 years old, has more than 10 milliliters of excess fat and is troubled by aging and loosening skin, a sagging of the skin in this area is inevitable. The contour may look better in still photographs, but in real life, the patient is often disturbed by the loosening of the neck skin and the abnormal skin folds that occur while in motion. The same principles apply to all procedures aiming to reduce jowl fat. Non-surgical options such as mesotherapy, needle radiofrequency, focused ultrasound and kybella may also result in skin laxity when applied a little aggressively.
I give you a heads up so that you are not disappointed with having to set off for a simple treatment but then undergoing a premature facelift surgery. I tell this because there is no way to correct this skin laxity other than with face/neck lift surgery.
When you carefully examine the patients who are unhappy with their jowls, you see that the majority of them have a deficiency in the bone skeleton of the jaw. A retracted chin causes the muscles under the chin to relax like a hammock. This looseness may externally seem like fat deposition, but it is a completely different occurrence. The ideal treatment is the surgery for the advancement of the chin tip, namely “genioplasty”.
The “excess fat” that disrupts the chin contour may sometimes be deep within the platysma muscle. This deep fat pad cannot be shaped with liposuction. Attempting to shape it is dangerous. Deep neck structures may be damaged. Serious bleeding and life-threatening airway problems may occur. Therefore, it is necessary to determine during the examination and, if necessary, with ultrasound whether the fat in the jowl area is under the skin or under the muscle and to plan accordingly. Submuscular deep fat deposition should be treated surgically through a 2-3 cm incision under the chin. We call this procedure submental lipectomy.
Another reason for jowl formation is the loosening and sagging of the platysma muscle and facial skin. If the jowl disappears and your neck contour is completely smooth when you put both hands on your cheeks and pull your cheeks up, the problem may be due to sagging skin/sagging platysma. In that case, deep plane facelift surgery is the ideal treatment option.
Most of the time, after analyzing the patient’s problems, we recommend a personalized combination of the treatment options I listed above.
Submental Liposuction + Lower Face/Neck lift,
Submental Lipectomy + Chin Implant
Submental Liposuction + Submental Lipectomy + Platysmaplasty
Genioplasty + Mini-Facelift
Deep Plane Face and Neck Lift + Submandibular Salivary Gland Excision
These are just some examples to possible combinations.
To sum up, this should ultimately not be considered as “Jowl Contouring”, but as “Face and Neck Contouring” within a holistic approach.
Please feel free to contact us for detailed information on your jowl formation and treatment alternatives.
Take good care…
… of yourself and your beauty.