Descent and deflation: These are the enemies of a youthful-looking face. As we age, gravity and a natural loss of fat and elasticity in the skin work together to allow the healthy-looking fullness in our cheeks to migrate to a lessappealing location near the jaw. The result is that hangdog appearance characterized by jowls.

“There’s not any good way to prevent it,” says Dr. Gregory Branham, chief of facial plastic and reconstructive surgery with Washington University Physicians. “There are some things that you can do to exercise your facial musculature on your own or with a machine to stimulate your muscles, but it really doesn’t last very long.”

The only true preventive strategies involve aggressive sun protection and consistent skin care, he adds. But there’s nothing that can be done to change one’s genes, and familial traits have a lot to do with how we age.

To eradicate jowls, the approach is based on the individual’s needs and concerns. Traditionally, facelifts were the go-to solution, but this is not always the best procedure for the problem, Branham says. “The traditional lifting has been to pull it back toward the ear,” he says. “But the jowl usually sags almost vertically, so the thing we recommend now to correct it is to lift the jowl area more vertically.”

There are two ways to lift the jowls upward from where they came. One involves a surgical resuspension of the jowl, and the other focuses on restoring volume in the cheek. By recreating fullness with fat grafting or dermal fillers, the skin is naturally lifted and jowls become less obvious.

Dr. David Caplin, a plastic surgeon with Parkcrest Plastic Surgery, uses fat grafting to help fill out the nasolabial fold, which runs from the side of the nose to the corner of the mouth, and the area along the jawline to help soften contours and camouflage the jowl area. “Fat grafting is the hottest new thing in plastic surgery in the last two or three years,” he adds.

Other noninvasive procedures may help. “Liposuction of the jowl is another possibility, although the procedure must be done conservatively and with a very small suction cannula to prevent postoperative irregularity,” says Dr. Brock Ridenour, a plastic surgeon with Ridenour Plastic Surgery.

“In some cases, radio-frequency devices, such as Thermage, can tighten and result in noticeable improvement of the lower face and jowl,” Ridenour adds. “Cheek implants also can act as a scaffold to support the tissues along the jaw line. In the future, techniques that freeze fat or heat fat may have applications in the treatment of the jowling.”

A board-certified plastic surgeon can help you put your jowls back where they belong—in your cheeks—and help you regain a more youthful appearance.