Lower Face Rejuvenation: Addressing the Jowls with Deoxycholic Acid
Rejuvenating the lower face often involves treating the submentum and the jowls.
Energy-based devices, including lasers, radiofrequency, radiofrequency microneedling, CoolSculpting, and ultrasound, have traditionally been used to tighten the neck and jowls.
Deoxycholic Acid: A Noninvasive Injectable for Submental and Jowl Fat
Currently, the only noninvasive injectable approved for reducing submental fat is deoxycholic acid (Kybella). Deoxycholic acid works by inducing adipocyte lysis, followed by a localized tissue response involving neutrophil infiltration, septal thickening, neocollagenesis, and neovascularization.
Importantly, these changes occur within the subcutaneous layer without harming the dermis or epidermis. This treatment shows a dose-dependent response and proves highly effective for submental fat reduction and jawline contouring.
Off-Label Use of Deoxycholic Acid for Jowl Reduction
In my practice, I have found that multiple consecutive treatments with deoxycholic acid effectively and permanently reduce jowl overhang with minimal adverse effects. Jowl fat is a common cause of sagging in the lower face. Few alternatives exist outside of surgery or liposuction. Jowl overhang results from several aging-related factors, including skeletal resorption, subcutaneous atrophy, fat pad displacement, and mandibular septum dehiscence, allowing fat to migrate into the neck.
Study Results Supporting Deoxycholic Acid for Jowl Fat
A prospective study published this year evaluated 66 adults with excess jowl fat. Patients received deoxycholic acid injections at 2 mg/cm². Treatment targeted individuals with “pinchable fat on the jawline” and minimal skin laxity. Injection volumes averaged 0.8 mL, with doses spaced approximately 1 cm apart.
After six months, 98% of patients experienced improvement with a mean of 1.8 treatments. Reported adverse events included edema, numbness, tenderness, and bruising, all common for injection sites.
Optimizing Injection Technique for Best Results
In my experience, injection volumes between 1.0 mL and 1.5 mL per jowl deliver effective results with minimal adverse events when anatomical landmarks are properly respected. Selecting the right patient is crucial one with minimal skin laxity. During injection, practitioners must pinch the fat and skin away from underlying muscles and nerves to avoid injury, particularly to the marginal mandibular nerve.
Volumes less than 1.0 mL often produce minimal visible improvements and typically require more than three to four sessions to achieve optimal outcomes.
Deoxycholic Acid for Jowl Contouring and Marionette Lines
Jowl contouring with deoxycholic acid with or without concurrent submental fat treatment should be considered for lower face rejuvenation. I often observe marked improvements in patients presenting prominent marionette lines who remain dissatisfied with traditional fillers.
Frequently, significant jowl fat overhang creates marionette lines, and hyaluronic acid fillers only offer temporary, often unsatisfactory results. Deoxycholic acid provides a highly effective alternative by directly reducing displaced fat pockets, improving the lower face’s contour and minimizing marionette lines associated with aging.
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