A well-defined jaw line is one of the universal traits of beauty – and is a desirable feature amongst individuals of all ages (think Angelina Jolie…) It is therefore not surprising that one of the most common complaint to aesthetic doctors are sagging jowls .Dr Sly Nedic imparts valuable advice on how best to treat (and prevent) jelly jowls…
A jowl is a bulge that appears along the jaw line during the ageing process, and is a typical characteristic of women in their 50′s. This bulge contains underlining structures such as lax skin, descending soft tissues as well as fat and muscle that are inevitably pulled down by gravity. The descent of this area is part of the normal ageing process, in which the loss of collagen, elastin and muscle laxity plays a significant role. This becomes more complicated when the pre-jowls sulcus (deep line in front of jowls) appear more visible. The reason for this development is a result of the partial bone reabsorption that occurs with ageing. It is also partly due to the enhanced tightening of the underlying ligament called the mandibular ligament. We describe them as marionette lines, which together with jowls make for one very bitter looking face. Jowls and the sagging skin of the lower face are topics often discussed in many forums and anti-aging publications, with the main concern being focused on how to correct them once they have become apparent. Unfortunately, I have more women in their forties (and even younger), coming to my practice with lower face sagging and jowls, asking how to prevent further premature ageing.
What is the Cause?
A variety of prevention methods can be utilized, depending on the underlying cause. Apart from natural ageing, there are some hidden causes of jowl formation of which we are not aware of – but are found to be easily prevented.
Sugar is not just bad for our waistline; it can be detrimental to our skin as well. Once sugar is digested, it binds with proteins and lipids in the skin, which results in glycation. This is a process that triggers the inflammation that causes tissue damage and premature ageing. As glycation continues, the collagen and elastin fibers become more brittle – thereby losing their ability to support and provide elasticity to the skin. During glycation, free radicals are formed called AGEs (Advanced Glycation End Products) which are involved in accelerating the ageing process – thus causing more tissue damage and inflammation. In very simple terms: the more sugar you eat, the more AGEs you produce – all resulting in less collagen and elastin available for support of the facial skin. This is a major cause of lower facial sagging and premature jowl formation in younger individuals. It can also worsen the problem in ageing women. The method for the most effective prevention of glycation is very simple: avoid sugar!
The Role in Collagen Damage
Stress is linked to biological ageing, which eventually affects our cells and their function. This includes the effectiveness of DNA repair, production of free radicals and tissue-damaging oxidants. Furthermore, prolonged cortisol secretion due to chronic stress can stimulate the cortisol-induced collagen loss in our skin, which in turn reduces the skin’s ability to retain its firmness and elasticity. For that reason, even younger skin can lose its tone and begins to sag, which, in turn causes patients to develop jowls for the first time. Other triggers that may alter cortisol levels are: prolonged sleep deprivation, excessive caffeine intake, intense physical exercise (such as marathon running), lengthened periods of commuting and emotional trauma.
Sculpturing the Face
Exciting novel research showed that use of Neuromodulators (Botox®) could actually be used to combat depression. Our facial muscles express our emotions, and so those facial muscles send feedback signals to the brain in order to reinforce those emotions. Hyperkinetic wrinkles often show our underlying emotions, therefore a face without them communicates with our brain to stop having such ‘heavy’ emotions. In other words: a happy looking face creates happy emotions, however, the opposite is also true. The emotion of a persistently bitter and angry person will eventually sculpt the face in this negative manner, thereby creating a permanent pre-jowl sulcus and inverted corners of the mouth. The hyperactivity of a particular muscle in the pre-jowl area called DAO (depressor anguli oris) is responsible for marionette lines. So even if there is no direct involvement in the creation of jowls, it is enhanced. Injecting botulinum toxin into the DAO muscle can easily prevent this condition. European doctors often use German Chancellor, Angela Merkel’s face to describe marionette lines with a great sense of humor: ‘The terrible state of the European economy has molded her face into becoming permanently bitter.’ With this in mind then, wouldn’t it be great to see if there are any signs of emotional damage on our politicians faces from our electricity crisis in South Africa? Finally, if the jowls are apparent there are a variety of treatments available (from infrared light, to radiofrequencies like Thermage® or Tripollar). In addition, a combination of botulinum toxin and fillers are also highly effective in treating jowls. In closing, it’s important to note that success is hugely dependent on the severity of the problem. That is why prevention is always better than cure… whenever applicable.