On 29



| By

Renata Khelemsky, MD

Beauty magazines, social media channels, and even medical literature have recently seen a spike in the topic of the “jawline.” Eye-catching photographs of celebrity profiles and their chiseled jawlines have made their way into mainstream media, from health and fitness blogs to plastic surgery websites. Even make-up techniques have evolved to include contouring tricks that appear to “enhance the jawline.”  For men, a jawline boost may come from grooming the facial hair in creative ways. Why the sudden focus on this border between our faces and necks?  

For most of us, the jawline has merely been a passing thought. In fact, words like “jowls” and “neckline” may have been more common before the “jawline” made an entrance. However, a discussion on “getting rid of jowls” has an arguably different ring to it than one on “defining the jawline.” First off, the jowls connote an aging and a saggy facial appearance. Second, we may tend to think of our older relatives when using the word “jowls,” even though jowls may appear as early as our forties. On the other hand, the term “jawline” takes on a more neutral, almost attractive, connotation. A jawline can be enhanced, not necessarily fixed. A jawline strives to be maintained, rather than treated. In other words, the jawline speaks in terms of positives, while the jowls do so in the negative. The question now is, are we still talking about the same thing, just in lovelier terms? My answer is, perhaps but usually not. Please, read on. 

The Jawline of Youth

Once upon a time, we were all free of excess skin, lines, and wrinkles. We had our genetics and our youthful complexion to our advantage, and for some individuals, the sum of these two things would equal a truly photogenic jawline. But, did we ever stop to notice our jawline as teenagers? If you go back to your high school senior class photos, you will see that not all jawlines were created equal. During our early teenage years, the jawline reflects the ongoing facial growth process. Between the ages of 16 to 21, the bony structures of the face grow to completion. An interesting fact is that the lower jaw (also known as the mandible in anatomical terms) is the last of the facial bones to develop. In the absence of aging, the jawline of our youth is a direct reflection of how much the lower jaw grows. What determines this amount of growth is largely our genetics and, to a lesser extent, what happens from the outside world, such as injuries and nutrition. 

The shape and length of our individual mandible becomes the imprint of our jawline. Some individuals will have a strong jawline, showcased by a strong and curvy shadow from the ear to the chin. A “strong” jawline is easily noticed by the shadow between the face and neck and is considered an attractive feature. On the other hand, a “weak” jawline usually means a short and retrusive chin, with a less obvious edge between the face and neck. As you can imagine, young adults without neck aging or sagging skin can still dislike their jawline purely due to the unfavorable anatomy of the lower jaw. Of course, there are also extreme cases of jawline deformities, such as those individuals with problems of their teeth and jaws who have either under- or over-bites. These rare cases, along with the full spectrum of jawline aesthetics in the overall population, all point to the important connection between our bony anatomy and jawline appearance. As I always say, “The bone sets the tone!”

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Aging & the Jawline 

What happens when we begin to age? As we age, the facial skin gradually loses its tone and elasticity, causing wrinkling of the skin. At a deeper level, there is a gradual loss of support along the ligaments and collagen fibers of the face, leading to sagging of the once-youthful fat pads in our cheeks and midface. A key feature of this aging process affects the jawline with the downward migration of the fat pad in the area of the jowl. This fat pad normally lies above the jawline. However, with the onset of facial aging, the jowl fat pad descends and rests over the jawline border, obscuring its sleek contour. The result is a less apparent and less attractive jawline, not due to the deficiency of the bony shape and size, but rather due to an excess of fat and skin in this area.  

By sharing with you this technical process of aging and anatomy, I hope to educate patients that understanding the various layers of anatomy along the jaw is key to choosing the right treatment. A proper jawline assessment goes beyond a photograph. It warrants a close-up and tactile evaluation of the two elements that matter: bone and skin. For some patients, my assessment of their jawline does not neatly fall into one category or the other. Instead, I find that many patients show signs of insufficient bony support as well as excessive soft tissues (such as skin and fat). To demonstrate this point, I often use the analogy of a hanger and a coat. With a strong and wide hanger, one can expect a heavy coat to have excellent support in the shoulders and to maintain its shape on the hanger. On the other hand, a small children’s hanger will not stand up to a bulky coat and neither will it reveal its actual shape. In this analogy, the jaw bone is the hanger and the facial skin is the coat.  For a given “size” of facial skin, the stronger the hanger, the better the jawline.  

Finding the Right Treatment

Younger Patients Have Multiple Options

If you are concerned with the appearance of your jawline, I recommend a consultation with a facial plastic surgery specialist. I am a firm believer in the accurate and thorough assessment of jawline anatomy to get you to your desired results. Various treatments can be considered for patients in all parts of the esthetic and aging spectrum. A relatively straightforward case in the young patient with little to no signs of aging, who is simply not pleased with a weak or shortened jawline. Such patients may consider nonsurgical treatment options such as dermal fillers that are used along the chin and sides of the jaw to enhance and elongate the jawline. There are several techniques that are used to achieve attractive jawline results using dermal fillers, and I recommend seeing a provider who has the unique experience in facial aesthetics and injections. Filler treatments are popular because they provide an immediate fix and last for 1 to 2 years, depending on the type of filler used.  

Other nonsurgical treatments for jawline contouring focus on removing the stubborn fat pocket beneath the chin. This can be accomplished with an injectable medication called Kybella or with an applicator that uses freezing technology known as CoolSculpting. For the right candidates, these treatments are popular because they are nonsurgical with little to no downtime and the results are permanent (unlike fillers). However, these treatments do not have an immediate effect and may take several sessions to obtain the final result.  

Alternatively, young patients without significant aging may consider a permanent surgical procedure in the form of chin augmentation using a facial implant. Facial implants have a long track record of safety and predictability, allowing patients to select the amount of enhancement desired in chin projection. Occasionally, alternative surgical procedures on the bony chin itself can be performed for patients with more complex issues, such as chin asymmetry or a shortened height of the chin.    

The Balance of Aging & Surgery

Jawline enhancement in the group of patients with moderate facial aging, however, must consider the amount of excess skin and fat in order to choose an effective treatment. When it comes to facial aging, the discussion between provider and patient often shifts towards the possibility of surgery. Without surgery, all jawline treatments serve to camouflage rather than directly treat the issues that are present. As was discussed for younger patients, dermal fillers can similarly be used in patients with mild to moderate jowls in the area of the jawline. The reason for this is that dermal fillers work by camouflaging the irregular and sagging areas of the jawline, creating a “tenting” effect that smooths and stretches the skin to the ideal shape of the jawline. I have found that jawline fillers for this group of patients is a highly pleasing and successful treatment for all but those with a severe amount of loose skin. Prior to treatment, I encourage patients to be aware of the limitations of dermal fillers and to hold realistic expectations for their results. Oftentimes, an improvement is all that is needed to obtain a natural and pleasing jawline that balances the overall facial shape.     

The more advanced the degree of aging, the more likely is the role of surgery to specifically address the jawline. Where there is an excess of skin, fat, and jowl, a reductive procedure such as a facelift or neck lift is required to “tuck back” these tissues and tighten the fabric of the jawline. However, an appreciation for the underlying bone of the jaw is crucial to the overall treatment plan. With advanced aging, we often see variations in jaw size due to environmental causes such as loss of teeth, dental work, and normal remodeling of the jawbone itself. These minor changes have a cumulative effect on jawline aesthetics. Therefore, many patients have the compound situation of having both excess jowls and a weakened mandible. Such patients will additionally benefit from one of several types of chin implants, dermal fillers, or fat grafting along the jaw to support the desired final shape of the jawline. If you go back to my previous analogy, this would be an example of adjusting the dimensions of the hanger as well as the coat.  

The Jawline is Here to Stay

In the January 2020 edition of British Vogue magazine, the jawline made a stunning appearance as “the new cheek” to reveal a youthful appearance. In recent years, I can confirm more patients today seek jawline contouring than in the past. Patients who are jawline-focused have remarkably accurate insight into their facial appearance, likely due to mainstream media and advertisements putting the jawline at the forefront of beauty. We have entered a new era of facial aesthetics, one that answers to the beauty demands of a wider range of ages. In order to adopt the jawline as the newest member of our beauty wish-list, we must warm up to the notion that the jawline is unique. In light of the growing trends to contour this lower border of our faces, I encourage all readers to appreciate this feature today and in the years to come, as the jawline is definitely here to stay.

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