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Take the Depression Out of Your Pre-Jowls

Southlake plastic surgeon, Dr. Vennemeyer, gives tips on restoring a youthful jawline

What is a pre-jowl and how is it making you look older? Everyone knows how jowls can ruin a perfectly young-looking face. Pre-jowls are the depression in front of jowls. The creases that form in this area are often called “marionette folds.” The pre-jowls visually break up the appearance of the jawline. A smooth, continuous jawline from the chin to the angle of the jaw is a youthful characteristic. Unfortunately, many of us start to see the pre-jowl depression starting in our thirties.

Figure 1: The pre-jowls break up the jawline, creating a weakened, aged appearance.

Figure 1: The pre-jowls break up the jawline, creating a weakened, aged appearance.

These distressing little buggers result from three causes. First, drooping cheek tissues form into jowls when they droop over the jawline. The jowls end at a point where the tissues are stuck to the bone—this is where the pre-jowl starts. Thus, the bulging jowl creates a relative depression where the tissues are stuck to the bone. Second, we start losing bone mass in the jawbones. This involutional change makes the chin and the pre-jowl area jawline look weaker. The third cause is a little muscle called the Depressor Anguli Oris or “DAO.” As it’s name would imply to Latin scholars, it is the muscle responsible for pulling down the corners of the mouth. It is mostly used for making unhappy sorts of faces. Excess tension in this muscle contributes to the downturned appearance the corner of your mouth may get. There is a DAO muscle on each side extending from the corner of your mouth to the lower jaw (mandible) right in the middle of the pre-jowl, implicating itself as a major player in the contour problem.

The solution for pre-jowls involves two basic concepts: weakening the DAOs and restoring volume balance. Botox or Xeomin is a perfect way to relax the DAO. I usually use 5 units per side as a starting point in my patients. Once the Botox is working you will notice less mouth downturn and less depression. Volume can be restored with fat grafting or injectable filler. I recommend fat grafting to my patients who plan to have a facelift or other procedure in the near future. For everyone else, I recommend injectable fillers like Juvederm or Radiesse. Restoring volume balance may require removing some jowl volume for the best possible result. Specifically, people with heavy jowls will get the best result from reducing their jowls through a facelift or liposuction, in addition to adding volume in the pre-jowl area. This restores a youthful, tapered shape to your face and improves the square shape that heavy jowls lend.

Figure 2: Note the improvement after a facelift with fat grafting to the pre-jowl areas and chin.

Figure 2: Note the improvement after a facelift with fat grafting to the pre-jowl areas and chin.

Figure 3: Note how the stronger chin and continuous jawline make this woman look younger. She also had fat grafting to the cheeks and a lower eyelid lift.

Figure 3: Note how the stronger chin and continuous jawline make this woman look younger. She also had fat grafting to the cheeks and a lower eyelid lift.

The pre-jowl area in the above patient could be significantly improved with Botox and filler; however, she was interested in a full-face rejuvenation. This made fat grafting a good option for her since she was already having a facelift and lower eyelid lift.

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