First, I want to clarify some terminology. The “prejowl” area is exactly as it sounds. It is the area lateral to the chin but medial to the “jowls”, so basically it is an area between the chin and jowls. The most common aesthetic defect affecting this area is a lack of fullness making the chin look too pointy. The treatment includes “filling” the area with fillers such as Restylane or Radiesse, using pre-jowl implants such as the “Mittleman prejowl implant” or using fat grafting in the area. All are valid options. With Artefill, the new permanent filler recently approved by the FDA, the options are even more abundant.
Now the other issue is “jowling” or “jowls.” This refers to fullness or sagging in the area of the jowls. The gold-standard treatment is a “traditional” lower facelift and the reason I place the word “traditional” in quotes is that if you have done your homework you will appreciate and possibly be overwhelmed by the fact that there are numerous approaches, incisions, dissection techniques and extents and methods for carrying out a “traditional” facelift. No two surgeons do a facelift the same way – almost.
Some patients, especially younger patients with very minimal jowls and good skin tone, can benefit from a “mini” type lift and delay undergoing a more extensive facelift for many years. Again, there are many variations of “mini lifts” as well.
Liposuction of the jowls can be carried out very conservatively and it is somewhat effective. However, there are risks associated with it and, given the very slight benefits, it may not be the best option by itself.
As the appearance of the “aging face” is a result of tissue and volume loss, replenishment of this “volume” using fat grafting or fat transfer is a valid option. The same can be achieved with fillers or implants. As the area under the skin is “filled”, it “pulls” on the more dependent lower areas and in effect “lifts” the skin and jowls.
If you decide to go with a min-lift, you can expect a 5 to 7 day recovery for the edema, bruising and “rippling” to substantially subside despite what the advertisers of “weekend facelifts” and other marketing hype today would make you believe. Unfortunately, men cannot use makeup for cover-up and camouflage but they generally heal faster due to the nature of male skin with an abundant presence of hair follicles and sebaceous units. Women can easily use makeup to cover the slight bruises that may persist beyond the first few days and go about their daily routines after a mini-lift. There usually is not much pain or swelling associated with mini-lifts although each patient may have a different experience. A very important consideration is incision placement, especially in men since again men cannot cover scars with makeup. The proper placement and location of incisions are much more important than the length of the incision in assuring that the scars are hidden and camouflaged well.