Jowls are tissue that sags onto the jawline, just past the corner of the mouth. When the skin and the fat directly under it have loosened, heat-based tightening such as Ulthera HIFU lifting, Thermage FLX, and Tune Face addresses that sag. Microfocused ultrasound treatments such as Ulthera have been reported to tighten mild-to-moderate laxity. When the main cause is the amount of fat, or hollowing in the upper cheek, rather than sagging, heat treatment covers a narrower range.
At a glance
Jowl fat sits in a different layer from the deep fat of the cheek. Two compartments under the skin, above the jaw, make up that tissue.
In both the Ulthera study and the early Thermage-device study, an improvement in laxity was seen after 1 session.
In the early Thermage-device study, tightening was still present at 6 months.
Where skin and fat gather on the jaw border, beside the mouth
In an anatomy study, subcutaneous fat above the jaw was split into an upper compartment and a lower compartment, 2 compartments in all. Jowl fat is these 2 compartments. It is separate from buccal fat, the fat deep in the cheek. When people search for jowls, this is the area they mean: sagging on the jawline, just past the corner of the mouth.
A membrane attached to the jaw marks the border with neck fat below. Because this membrane holds the skin to the jaw border, tissue on the jawline does not slide straight down the neck and stays on the jawline.
Where jawline sagging separates into skin and fat
What heat-based tightening can address depends on whether the main problem is skin laxity, excess fat, or upper-cheek hollowing.
| What shows | What happens at that spot | Relation to heat tightening | When another method is discussed |
|---|---|---|---|
| Laxity of loosened skin and subcutaneous fat | With age, the skin and the subcutaneous tissue loosen. | This is the state Ulthera, Thermage, and Tune Face address. | If the sagging is severe, surgical lifting is discussed. |
| Thick fat over the jaw | The 2 subcutaneous compartments over the jaw are thick. | Radiofrequency studies report a drop in facial fat volume. | Surgery that reduces volume, such as liposuction, is a separate discussion. |
| Hollowing in the upper cheek that makes only the jawline stand out | When the upper cheek loses volume, tissue along the jawline looks heavier by comparison. | It tightens loose tissue; it does not fill lost volume. | Volume loss is handled apart from sagging in lifting when the cheeks are hollow. |
Treatments that gather heat under the cheek and the jaw
Ulthera uses microfocused ultrasound (HIFU) to place small heat points in the dermis, so that new collagen forms and elastin remodels.
Thermage FLX warms the dermis with radiofrequency and tightens the tissue. Tune Face uses Accent Prime, combining ultrasound and radiofrequency. How microfocused ultrasound and radiofrequency produce heat is explained in how Ulthera and Thermage differ in energy, and how Tune Face combines both energies in one device is covered in the Tune Face treatment guide. The Ulthera study, the early Thermage-device study, and the review of radiofrequency treatment overall differ in who was treated and in method, so the figures are not used to compare the devices with each other.
| Treatment | Energy and where the heat lands | What was seen on the jawline and under the cheek | Pain and common reactions | Sessions the study used |
|---|---|---|---|---|
| Ulthera | Microfocused ultrasound. Small heat points in the dermis | Day 90 after 1 session. Reviewers saw an improvement in laxity in about 58% of patients | Moderate pain | 1 session |
| Thermage FLX | Radiofrequency warms the dermis. A study of an earlier device from the same company | Cheek 30, neck 20. Laxity was mild to moderate. Most improved after 1 session, and tightening was still present at 6 months | Temporary redness and swelling, uncommon altered sensation | 1 session |
| Tune Face | Ultrasound and radiofrequency. Accent Prime | Across radiofrequency studies overall: reduced skin laxity, improved elasticity, reported reductions in facial fat volume, and higher satisfaction among people who wanted a modest change | — | Differs by study |
※ Right after treatment, redness and swelling are common and usually settle. Uncommon altered sensation (early Thermage-device study) and wheals, where the skin swells up (Ulthera study), were reported. In the collected radiofrequency studies, an abnormal channel (fistula) formed in the neck skin of 1 person. A review of microfocused-ultrasound studies also reported uncommon jaw-area burns and altered sensation.
From anesthetic cream to redness after treatment
In the early Thermage-device study, anesthetic cream was applied and covered for 60 minutes before treatment. In that same study, heat was placed on the cheek from beside the nasolabial folds to the front of the ear and the jawline, and on the neck from the jaw bone to the middle of the neck.
The common reaction reported across the studies is temporary redness and swelling. When to restart cleansing, exercise, and makeup is set out by device in aftercare after lifting. For the extent and duration of changes after Ulthera, see Ulthera results. For Thermage pain and recovery, see Thermage results.
The quote difference between jawline-only and the whole face
Widening from the jawline alone to the cheek and neck increases the shot count. Once the device and any combined treatment are set, the amount can be checked in pricing.
Notes on when the sagging started and how it changed
Recent weight change, and the type and date of earlier treatment, are weighed together in the treatment plan.
- □ Weight change over the past year
- □ Jawline difference between morning and evening
- □ Type and date of earlier lifting, filler, or thread treatment
- □ Body conditions related to radiofrequency, such as metal implants or a pacemaker
- □ How much change is wanted: a small tidy-up, or a stronger pull
Frequently asked questions
Q1. Do jowls mean the fat has to come out?
Whether fat needs to be reduced depends first on whether the main problem is loose tissue or the amount of fat. The tissue that shows is loosened skin and subcutaneous fat over the jaw. Heat treatment tightens this loosened tissue, so its purpose differs from reducing the amount of fat itself.
Q2. Can Ulthera and Thermage be done on the same day?
Microfocused ultrasound and radiofrequency make heat in different ways. A clinician determines whether both treatments can be performed on the same day based on your skin condition and response to heat. If several treatments are proposed together, see the treatment order guide for how to sequence them.
Q3. Does jawline lifting hurt?
In the Ulthera study, mean pain during treatment, out of 10, was 5.7 on the cheek, 6.1 under the chin, and 6.5 under the jaw bone.
Q4. When can a change be seen?
In the Ulthera study, at day 90, two out of three patients said their sagging had improved. In the early Thermage-device study, tightening was still present at 6 months. How long it lasts after that was not established.
Q5. Do results differ when body weight is high?
In the Ulthera study, more people in the group whose weight is high for their height had no measured change. A review of microfocused-ultrasound studies listed severe laxity, or a high body weight, as conditions requiring careful assessment before treatment.
Sources
- Reece EM et al.(2008), Plast Reconstr Surg: The mandibular septum: anatomical observations of the jowls in aging-implications for facial rejuvenation (PMID 18349664)
- Contini M et al.(2023), Int J Environ Res Public Health: A Systematic Review of the Efficacy of Microfocused Ultrasound for Facial Skin Tightening (PMID 36674277, PMC9861614)
- Oni G et al.(2014), Aesthet Surg J: Evaluation of a microfocused ultrasound system for improving skin laxity and tightening in the lower face (PMID 24990884)
- Alster TS and Tanzi E(2004), Dermatol Surg: Improvement of neck and cheek laxity with a nonablative radiofrequency device: a lifting experience (PMID 15056138)
- Austin GK et al.(2022), Lasers Surg Med: Evaluating the effectiveness and safety of radiofrequency for face and neck rejuvenation: A systematic review (PMID 34923652)
This article is general information and does not replace individual medical care.
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