Thank you for your question.
You submitted several photos and you report in your question that you underwent having
2 syringes of Juvederm Voluma placed in the pre-jowl area.
And you're expressing a description where you feel like you still see jowls and that
the areas are lumpy after undergoing this procedure and you are asking of course, in
addition, whether or not it is normal to do this.
Well, I can give you some perspective on how I evaluate patients like yourself and recommendations
about what I would do with your situation and hopefully give you a little bit of explanation
as to probably what your physician was thinking when you had this treatment.
A little bit of background, I'm a Board-certified cosmetic surgeon and Fellowship-trained oculofacial
plastic and reconstructive surgeon.
I've been in practice in Manhattan and Long Island for over 20 years.
I do a lot of injectable fillers in my practice.
In fact we do something called structural volumizing in which we use a fair amount of
hyaluronic acid fillers that are thicker such as Juvederm Voluma.
So I can give you a little bit of understanding of first what the anatomy is that probably
your doctor was trying to help you with and give you an explanation of what may be of
value beyond what you had done.
So, what exactly is a jowl?
Well, a jowl is represented in terms of what most people describe as a lack of continuity
of the jawline.
And what that means is essentially when you follow from the chin back to the angle of
the jaw, you'll see a relative indentation and then a little bit of a sag and that is
referred to as a jowl.
So that relative indentation is referred to as the mandibular notch.
The mandibular notch is an actual notch in the bone structure where it accentuates any
sag or loss of tone and volume in the jawline.
So a strategy is, if you have an indentation, is to fill that indentation and I think that
is what your doctor was trying to do.
By filling that indentation, they are hoping for you to see an improvement in the overall
appearance.
Now of course, seeing your doctor who performed it and taking some photos would probably help
you understand the level of improvement.
I am sure that when you saw your doctor, the doctor did not say that your jowls will be
eliminated but typically a doctor will say that your appearance of your jowl will be
improved.
Now having said that, the question arises, is there anything else that can be done short
of surgery?
The answer is yes.
We live in a time when we have a combination of numerous less invasive options to help
people like yourself who may not even be a candidate for surgery.
So understanding that, I can tell you a little about how we use Voluma in situations like
yours.
As I mentioned, we do something called structural volumizing.
Structural volumizing is a different strategy in which the material, the filler, is being
placed under muscles and adjacent to the bone structure.
That makes a lot of sense particularly in the pre-jowl area because that's an area
where you need volume at the bone level.
Very often, it is a good strategy and a reasonable strategy to place the material just below
the skin to blend that area and that also has value.
Very often, we actually do both because there is still value in doing things in multiple
levels.
In addition, we can actually place the filler, the material like Juvederm Voluma, in the
chin.
It appears, in your photos, that your chin is a little bit back.
We often refer to it as a retrusive chin and that can further accentuate the pre-jowl area.
So what we can do with filler is actually place it in the chin and increase the projection
of the chin.
So now you improve the pre-jowl area and the chin and very often that is enough to give
you significant improvement.
Beyond that, you can actually add filler at the angle of the mandible and that further
adds some stretch and some definition.
There are also non-surgical thermal energy devices that can help tighten the skin around
the jowl area and help define the jawline and that is another strategy.
There are also minimally invasive approaches that use some surgical principles to vertically
lift jowls.
Again, if we are talking about fillers as a solution to help you with this area, then
I think your doctor is on the right track.
It is likely there would be a value in additional filler and possibly filler to help further
define this area.
In fact, even Botox® can be applied strategically to also help the jawline.
So as you can see, there is a lot of different ways to maximize the benefit of a non-surgical
approach for this type of issue.
And I think that although you may not be fully satisfied with your result, I would suspect
that your doctor probably made an improvement and now there's probably room to maybe further
improve this area so that you will feel better about your final result
So I hope that was helpful, I wish you the best of luck and thank you for your question.
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