- Botox treats jowls by relaxing tension in certain muscles of the lower face and neck
- It can treat minor issues of sagging skin, but is most effective for other signs of aging
- Surgery or minimally invasive skin tightening procedures would be a better solution for medium to severe jowls
Jowls, or loose skin sagging over the jawline, are a natural part of aging – however, many people dislike the way they look. One solution is Botox injections which can temporarily reduce the look of jowls by providing a more defined jawline. Although getting Botox for jowls does not actually remove the loose skin, it can effectively rejuvenate the overall look of the lower face and neck.
What Causes Sagging Jowls?
Jowls result from low levels of collagen and elastin in the skin. Factors that contribute to their development are genetics, smoking, sun damage, weight loss and the natural aging process.
Is Botox Effective for Addressing Sagging Jowls?
Botox is a brand name for botulinum toxin, a neurotoxin that temporarily blocks nerve signals. The most popular cosmetic procedure in the world, it prevents the contraction or tightening of facial muscles that cause dynamic wrinkles – lines created by repeated expressions.
While Botox can contour the lower face in several ways, it can’t eliminate loose skin, making it more appropriate to treat minor skin laxity. By reducing other signs of aging, it can improve the overall look of the lower face.
It’s also important to note that Botox is not FDA-approved for cosmetic use in the lower face. However, it’s widely used off-label for this purpose.
Jawline and neck
Botox is strategically administered at various points in the jaw and neck to reduce multiple signs of aging, including:
- Chin dimpling and wrinkles
- Downturned expression
- Marionette lines (running vertically from the corners of the mouth to the chin)
- Minor sagging of skin and jowls
- Neck lines and wrinkles
- Platysmal banding (vertical neck bands or “turkey neck”)
- Weak jawline definition
One of the most common injection locations is in the platysmal band of muscles, a group of superficial muscles that run vertically from the jaw to the collarbone. Tight platysmas pull downward on the lower third of the face, contributing to the appearance of loose skin and an ill-defined chin and jaw. Injections in this treatment area create the opposite effect by releasing that downward tension.
Neurotoxins have been found to improve lower face contour from both the front and side. One study found that Botox placed behind the jaw in the upper platysmas increased jawline definition and smoothed sagging skin in patients with mild to moderate laxity.
Injections in the depressor anguli oris (DAO), small muscles below each corner of the mouth, can soften a downturned mouth to produce a more positive expression. This slightly reduces sagging skin and contributes to an overall younger, lifted look.
Botox is also commonly injected into the masseter muscles, the large muscles used for chewing. By reducing overactivity in these muscles, they gradually shrink and slim the face.
However, masseter injections can have the opposite effect of increasing sagging skin if the skin is no longer stretched over bulky jaw muscles and instead can hang loose. Therefore, they should be used with caution for jowls.
A Nefertiti lift is a specific injection pattern used to recontour the lower face and neck, providing the visual effect of a mini lift.
The technique has been found particularly effective for younger patients with normal skin elasticity and overactive platysma muscles.
This technique involves injecting microdroplets of Botox uniformly throughout the lower face. One clinical study found it was more effective than the Nefertiti lift at improving jowls specifically, whereas the Nefertiti lift had a greater effect on platysmal bands.
The best candidates for Botox in the jowl area are healthy adult men and women with mild skin laxity in the lower face, generally good skin elasticity and reasonable expectations.
Although its ability to tighten loose skin is limited, Botox is an effective anti-aging treatment for people who want to soften wrinkles and lines on the neck, slim the jawline and reduce platysmal banding.
Botox is not an effective option for people with moderate or excessive amounts of loose skin or fat below the jawline. However, it can often be used in conjunction with another procedure to rejuvenate the lower face.
This procedure should be avoided for anyone who is pregnant or nursing, has an infection or has a history of neuromuscular disease.
What to Expect From the Procedure
A Botox treatment is a relatively simple outpatient procedure which doesn’t require much in the way of preparation. One week before your treatment it is recommended to avoid alcohol or blood thinning medication, including nonsteroidal anti-inflammatory drugs.
Your provider will map out where to place the injections, then administer them. The actual injections will take 10–20 minutes. Afterward, it’s important to keep the treated area dry for 36 hours and to follow all provided instructions; otherwise, no downtime is required.
Results will usually appear after about 2 weeks. The shape of the jawline will be better defined, and the overall look of the lower face will appear more lifted. These results become more pronounced after multiple treatments.
How long does Botox for jowls last?
Botox injections typically last for 3–6 months. This procedure becomes more effective with time as the more relaxed the targeted muscles become, the less frequently they’ll need to be treated.
Before and Afters
Safety and Side Effects
Although Botox is considered safe, it does carry some risk of side effects including:
- Crooked smile
- Headache or flu-like symptoms
In rare cases, more serious complications can occur if the neurotoxin migrates outside the treatment area.
How Much Does Botox for Jowls Cost?
The cost of Botox for jowls depends on the provider’s experience and location, as well as how many units are required. As of 2020, the national average cost of Botox and other neurotoxins was $466.
The amount of Botox required to treat the neck can vary greatly. For instance, while as few as two units might treat minor sagging, up to 50 units may be necessary to address prominent platysmal bands.
Is Botox the Best Treatment for Sagging Jowls?
Because Botox can’t remove sagging skin, other procedures may be more effective at treating jowls. These options range from minimally invasive spa treatments to surgical procedures requiring anesthesia.
- Microneedling: Also called collagen induction therapy, this procedure involves stamping the face or neck with a needle-tipped device. The resulting microwounds induce collagen production and tighten skin for a more youthful look
- Kybella: An injectable consisting of synthesized deoxycholic acid, a compound that breaks down fat. While Kybella doesn’t treat sagging skin specifically, it’s been shown to be safe and effective for treating a double chin and may improve the overall appearance of the jawline
- Chemical peels: These procedures remove the topmost layers of skin and reduce signs of sun damage (one cause of premature jowls) and stimulate production of collagen and elastin for skin that is more taut and firm
- Dermal fillers: Fillers can define and sculpt the face, including the jawline. Typically made of hyaluronic acid, they plump sagging skin to minimize the appearance of jowls
- Laser therapies: These treatments heat the deepest layers of the dermis to tighten and lift sagging jowls
- Thread lift: Sometimes called a nonsurgical facelift, this procedure involves placing biodegradable threads beneath the skin. They’ve been shown to effectively anchor and tighten mild to moderate sagging skin on the lower face for up to 8 months.
Plastic surgery is a highly effective solution for jowls. While it requires a significant recovery period, the results can be dramatic and are considered permanent.
- Face lift: Cosmetic surgery that removes excess skin and fat on the lower two-thirds of the face to eliminate sagging jowls
- Neck lift: Similar to a face lift, this procedure removes loose skin and fat on the lower face and neck to rejuvenate and define the jawline.
Botox treats jowls by relaxing tense muscles to increase jawline definition and create an overall more lifted appearance in the lower face and neck. To do so, it’s injected into the platysmal and masseter muscles, along the jawline and below the mouth. Botox typically lasts 3–6 months in the lower face and becomes more effective with each treatment.
However, Botox is only effective for mild cases of jowls, as it can’t get rid of excess skin. People with medium to severe loose skin or fat below the jawline would find that other options, including surgery, are better treatment options.
- Biello A, Oney R, Zhu B. Botulinum Toxin Treatment Of The Upper Face. [Updated 2022 Apr 30]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2022 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK574523/
- Felix Bravo BS, De Bastos JT, Da Rocha CRM, et al. Definition of the Mandibular Angle Using Botulinum Toxin Type A: A New Technique for the Improvement of Mandibular Contour and Definition. J Clin Aesthet Dermatol. 2019;12(11):32-34. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6937167/
- de Almeida ART, Romiti A, Carruthers JDA. The Facial Platysma and Its Underappreciated Role in Lower Face Dynamics and Contour. Dermatol Surg. 2017;43(8):1042-1049. doi:10.1097/DSS.0000000000001135
- Corduff N. Neuromodulating the SMAS for Natural Dynamic Results. Plast Reconstr Surg Glob Open. 2021;9(8):e3755. Published 2021 Aug 25. doi:10.1097/GOX.0000000000003755
- Levy PM. The ‘Nefertiti lift’: a new technique for specific re-contouring of the jawline. J Cosmet Laser Ther. 2007;9(4):249-252. doi:10.1080/14764170701545657
- Jabbour SF, Kechichian EG, Awaida CJ, Tomb RR, Nasr MW. Botulinum Toxin for Neck Rejuvenation: Assessing Efficacy and Redefining Patient Selection. Plast Reconstr Surg. 2017;140(1):9e-17e. doi:10.1097/PRS.0000000000003429
- Awaida CJ, Jabbour SF, Rayess YA, El Khoury JS, Kechichian EG, Nasr MW. Evaluation of the Microbotox Technique: An Algorithmic Approach for Lower Face and Neck Rejuvenation and a Crossover Clinical Trial. Plast Reconstr Surg. 2018;142(3):640-649. doi:10.1097/PRS.0000000000004695
- Wu WT. Botox facial slimming/facial sculpting: the role of botulinum toxin-A in the treatment of hypertrophic masseteric muscle and parotid enlargement to narrow the lower facial width. Facial Plast Surg Clin North Am. 2010;18(1):133-140. doi:10.1016/j.fsc.2009.11.014
- Sugrue CM, Kelly JL, McInerney N. Botulinum Toxin Treatment for Mild to Moderate Platysma Bands: A Systematic Review of Efficacy, Safety, and Injection Technique. Aesthetic Surgery Journal. 2018;39(2):201-206. doi:10.1093/asj/sjy179
- Witmanowski H, Błochowiak K. The whole truth about botulinum toxin – a review. Postepy Dermatol Alergol. 2020;37(6):853-861. doi:10.5114/ada.2019.82795
- American Society of Plastic Surgeons. Plastic Surgery Statistics Report. 2020. https://www.plasticsurgery.org/documents/News/Statistics/2020/plastic-surgery-statistics-full-report-2020.pdf
- Singh A, Yadav S. Microneedling: Advances and widening horizons. Indian Dermatol Online J. 2016;7(4):244-254. doi:10.4103/2229-5178.185468
- Shamban AT. Noninvasive Submental Fat Compartment Treatment. Plast Reconstr Surg Glob Open. 2016;4(12 Suppl Anatomy and Safety in Cosmetic Medicine: Cosmetic Bootcamp):e1155. Published 2016 Dec 14. doi:10.1097/GOX.0000000000001155
- O’Connor AA, Lowe PM, Shumack S, Lim AC. Chemical peels: A review of current practice. Australas J Dermatol. 2017;59(3):171-181. doi:10.1111/ajd.12715
- Soleymani T, Lanoue J, Rahman Z. A Practical Approach to Chemical Peels: A Review of Fundamentals and Step-by-step Algorithmic Protocol for Treatment. J Clin Aesthet Dermatol. 2018;11(8):21-28. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6122508/
- Jacobson LGS, Alexiades-Armenakas M, Bernstein L, Geronemus RG. Treatment of Nasolabial Folds and Jowls With a Noninvasive Radiofrequency Device. Arch Dermatol. 2003;139(10):1371–1372. doi:10.1001/archderm.139.10.1371
- Diaspro A, Luni M, Rossini G. Thread Lifting of the Jawline: A Pilot Study for Quantitative Evaluation. J Cutan Aesthet Surg. 2021;14(1):47-54. doi:10.4103/JCAS.JCAS_41_20