Jaw Line and Chin Issues
Sagging along the jaw line
One of the most common questions that I get from patients is how to fix the sagging skin along the jaw line that results in the appearance of a loose double chin or "turkey neck". The effects of sun damage, age, and gravity all work to put some excess skin along the chin and jaw line.
It is much easier to prevent and to correct mild sagging than it is to deal with a lot of sagging, getting rid of a double chin or getting rid of a turkey neck in your late 50s or 60s. To predict whether you will have this problem, look at the women in your family, like your mother and grandmother. Genes often times have a big effect in how your face ages, particularly along the jaw line.
There are a few jaw augmentation options available for getting rid of double chin or getting rid of turkey neck. The best non-surgical option for sagging chin or sagging neck skin is Thermage. A full-face Thermage costs $2,000 to $3,000, and the Thermage treatments will produce gradual tightening over about 6 months.
Thermage treatments produce noticeable but not dramatic results. It is not like a surgical facelift, but it does help in reducing double chin. Another difference between Thermage and a surgical facelift is that a second Thermage skin tightening can be done 4-6 months later. Plan on needing 2 if you are over 50 or have moderate sagging. Remember skin tightening Thermage is for mild to moderate sagging. However, if you have a lot of sagging, a facelift is a better solution.
The Thermage treatment that is done now is far different than the one that was done over 4 years ago when Thermage first came on the market.
Sculptra can also give very good non surgical chin augmentation results for sagging along the jaw line by replacing the volume that has been lost above the jawline (think of a deflating balloon). Sculptra is a "volumizer," an injectable poly-lactic acid that stimulates the body's production of natural collagen. When injected in the cheeks, Sculptra causes the body to produce more collagen, which fills the cheeks more and lifts the skin in the lower face and jaw line.
The Sculptra cost is $600 to $2000 per treatment, and you will need 2-4 treatments 6-12 weeks apart, followed by 1 maintenance treatment every 12-18 months. Sculptra is FDA approved for HIV, with broader approval pending.
Additional volume, especially for the upper cheeks, can also be added to lift sagging skin with Juverderm Ultra Plus or Perlane. These are the heavier molecular weight of the hyaluronic acid fillers Juvederm and Restylane. Both Juvederm and Restylane cost about $450 to $600 per syringe, and you may need two syringes to add enough volume to get some jaw line lift. These fillers need to be repeated every 4-9 months, because they do not stimulate the production of natural collagen.
I wish there were a non-surgical solution to full-fledged jowls, but there isn’t. You can try a full-face Thermage treatment to provide some jowl tightening, and you can use Sculptra to add volume to the cheeks which will produce some lifting along the jaw line lift.
But the best correction for full-fledged and prominent jowls is surgery. See your plastic surgeon for more information on that option.
"Notching" along the jaw line
Some people get two little indentations that occur on the jaw line directly below the outside corners of their mouth. These indentations, or notches, interrupt the smoothness of the jaw line and can give it a shape that looks a little bit like an "S." Medically this is called prejowl sulcus. ideally we want our jaw line to be a smooth line from the ear to the chin. Different things can cause these notches, and the treatment will differ depending on your particular situation.
If the cause of this notching is thinning of the fat pad in the chin area or over-activity of the muscle that holds down the corners of the mouth, your best option is filling the area with Juvederm or Restylane. A drop of Botox in this area can also help.
If the notching is caused by sagging along the outer sides of the jaw, then your best non-surgical options are Thermage treatments combined with a longer-lasting volumizer like Sculptra.
Thermage is a radio frequency device that tightens the skin. Sculptra is the synthetic lactic acid that is injected and stimulates the production of natural collagen to add volume, which in turn lifts the skin on the cheeks and the outer sides of the jaw.
Thermage and Sculptra together can produce a very good result for the notching along the jaw line, because they lift from higher up on the cheeks. Thermage and Sculptra together take about 6 months to produce their effect, and the cost of Thermage plus the series of Sculptra treatments will cost, at a minimum, about $3,500 to over $8,000. You will need to repeat the Sculptra approximately once a year and the Thermage every year or two.
Some of us get lumpy or bumpy skin on our chins as we age. I call this cobblestone chin, although it is not always known as that. I know from attending the Paris conference on aging skin that the French call it peau d’orange, or the skin of an orange.
Cobblestone chin can be fairly easy to correct with a few drops of Botox. The Botox relaxes the dimples and can cost as little as $200.
If you feel that you have a receding chin, you should definitely have your bite checked by a doctor or dentist for any bone or joint issues. Make sure that there is nothing wrong with the mechanics of your jaw itself.
The only real non-surgical alternative for receding chin is use of one of the thicker, higher-molecular-weight fillers, like Juvéderm Ultra Plus or Perlane. These hyaluronic acid fillers are used for contouring noses and can augment and contour the chin area as well. It will cost $450 to $600, and the results, quite honestly, are variable. Some injectors can work wonders around the chin, but I’ve also seen people spend a lot of money for fillers around the chin and not gotten a very good result.
See Dr. Irwin's Guide to Fillers: Restylane/Juvéderm
See a plastic surgeon about the option of a chin implant and learn more about chin implant cost. If you check out a chin implant, be sure to consider how your face will age around that implant. Link to learn more about chin augmentation.
Next, learn about Neck and Chest Issues
See Dr. Irwin's expert answers to other reader's questions on Jaw line and Chin Issues:
Is There a Cure for Melasma? Is it self-limiting? What about pregnancy? Botox and Fillers in Active Women 60-90 Years of Age I have a moustache line on my upper lip! Are lasers or other devices safe with a pacemaker? Is there a way to get rid of sun damage spots (lentigoes, etc.) on the body that works? Will taking breaks from Retin A or other retinoids lessen their effects? Can too much non permanent filler make permanent changes in ones face?
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