For most people, one of the most common and frustrating signs of facial aging is sagging jowls. The once-crisp, well-defined jawline begins to soften and descend due to a combination of skin laxity, loss of volume, and repetitive muscle movement. This change can lead to a tired, aged, or heavier lower-face appearance, even in individuals who otherwise feel youthful and energetic.
Traditionally, surgical procedures like facelifts have been the go-to solution for lifting jowls. However, not everyone is ready, or willing, to undergo surgery. Increasingly, both patients and practitioners are exploring non-surgical interventions such as Botox, as well as at-home treatment for sagging jowls to combat the early signs of jowling.
But can Botox really help with sagging jowls? When is it the right approach, and what can it realistically achieve? In this guide, we’ll break down how Botox for sagging jowls works, when it’s a viable treatment for, and how medical aestheticians can optimize outcomes for their clients.
How Botox Works for the Lower Face
Botox, a neurotoxin derived from Clostridium botulinum, works by relaxing muscles that cause wrinkles or pull on the skin. When used in the lower face, Botox targets the platysma muscle—a thin, fan-like muscle that runs down the neck and pulls the jawline downward.
By injecting small doses of Botox into the platysma bands and along the jawline (a technique known as the Nefertiti Lift), practitioners can:
- Relax downward-pulling muscles
- Create a more lifted, defined jawline
- Soften neck lines and improve overall lower face contours
When Is Botox Appropriate for Sagging Jowls?
Botox can be a highly effective option for treating sagging jowls, but it isn’t a universal solution. It works best when muscle activity is the primary contributor to the sagging, rather than significant skin laxity or fat accumulation.
It is particularly appropriate for clients who are experiencing:
- Early signs of jowling, where skin laxity is minimal
- A strong downward pull from the platysma or DAO muscles, which can drag the corners of the mouth and jawline downward
- A desire for non-invasive, low-downtime treatments
However, Botox isn’t the best fit in cases where:
- There’s substantial loose or excess skin
- There’s significant volume loss or fat descent
- Skin elasticity is already compromised
In these scenarios, more structural support is needed. That’s where a multi-modality approach, including fillers, threads, or energy-based treatments, can make a dramatic difference.
To assess candidacy properly and avoid disappointing outcomes, practitioners can benefit from our Skin Tightening Training course.
Ideal Patient Profiles
The ideal Botox candidate for sagging jowls typically falls within the 35 to 55 age range, when collagen production begins to decline and the first signs of facial sagging appear. These patients often have:
- Mild to moderate sagging along the jawline
- Good skin elasticity, meaning the skin can still snap back when lifted
- Noticeable platysmal banding or muscle tension in the lower face or neck
They’re also likely to be patients who:
- Have already had Botox in the upper face and trust the treatment
- Prefer subtle, natural results over dramatic surgical changes
- Are exploring aesthetic procedures for the first time and want a gentle entry point
Understanding what causes sagging jowls is essential to tailoring the right treatment plan and ensuring patient satisfaction.
Results, Onset Time & Longevity
So what can patients expect once they’ve received Botox for sagging jowls?
- Onset: Most patients begin to see results within 3 to 7 days, with full effects visible around the two-week mark.
- Results: A subtle but noticeable lift in the lower face and improved jawline definition. Neck bands may also appear softened, contributing to an overall more youthful appearance.
- Longevity: Results generally last 3 to 4 months, though repeated treatments can lead to more sustained muscle relaxation and potentially longer-lasting results over time.
It’s important to set realistic expectations. Botox won’t completely eliminate jowls, but it can significantly reduce their appearance—especially when started early and maintained regularly.
Combining Botox with Other Treatments
For patients with more complex concerns or more advanced signs of aging, combining Botox with other non-surgical treatments can produce more dramatic and longer-lasting outcomes.
- Dermal Fillers: By restoring volume in the cheeks and along the jawline, fillers can help lift the jowls and balance facial contours. This combination is excellent for patients with volume loss contributing to sagging.
- PDO Threads: Threads provide a mechanical lift that complements Botox’s muscle-relaxing effects. While Botox addresses the downward pull, threads physically reposition tissue for a more structured outcome.
- Energy-Based Devices: Treatments like radiofrequency microneedling, ultrasound (like Ultherapy), or HIFU can tighten and firm the skin, addressing the underlying skin laxity that Botox alone can’t resolve.
These combination approaches are not only more effective—they’re also customizable. Medical aestheticians can build patient trust by offering personalized treatment plans that take into account all layers of aging, from muscles to skin.
Check out our sagging jowls before and after piece to see real-world examples of how combination treatments elevate Botox results
Safety, Side Effects & Considerations
While Botox is generally considered safe when administered by trained professionals, treating the lower face, especially around the jowls, requires extra skill and anatomical knowledge. This area is more complex due to its proximity to critical muscles involved in facial expression, speech, and eating.
Botox works by relaxing specific muscles, and if injected incorrectly, it can unintentionally weaken muscles that control important functions. That’s why understanding facial anatomy and tailoring the dosage and injection points is critical to avoiding complications.
Potential Risks and Side Effects
Some of the most common and manageable side effects include:
- Mild bruising or swelling at the injection site
- Temporary redness or discomfort
- Minor asymmetry that typically resolves as the product settles
More serious but rare complications include:
- Mouth drooping or crooked smile if the depressor anguli oris (DAO) muscle is overly relaxed
- Difficulty speaking, eating, or expressing emotions if adjacent muscles are inadvertently affected
- Facial asymmetry that may require touch-up adjustments
How to Minimize Risk
To ensure safety and optimal outcomes, medical aestheticians should:
- Use ultra-conservative doses for first-time lower face patients
- Have a detailed consultation to assess muscle activity and facial balance
- Ask patients to return for a follow-up within two weeks for evaluation and potential adjustments
- Clearly explain realistic expectations and temporary nature of results
Patients should also be advised to:
- Avoid touching or massaging the treated area for at least 24 hours
- Stay upright for a few hours post-treatment
- Wait a day or two before resuming vigorous exercise
Continuing education is key to staying current on best practices. Our Skin Tightening Training Course and other aesthetic learning resources at HubMedEd’s Aesthetic Medicine Platform offer in-depth instruction on lower face Botox techniques, complication management, and facial harmony assessment.
When performed thoughtfully, Botox for sagging jowls can be not only safe but transformative, especially when supported by the right training and patient communication strategy.
Things to Know
How to fix jowls with Botox
Botox injections into the platysma and DAO (depressor anguli oris) muscles can help reduce the downward pull and lift the jawline.
How much does Botox for neck sagging cost?
Prices vary based on location and dosage but typically range from $300 to $600 per session.
What are the risks of Botox for jowls?
Incorrect placement may cause asymmetry, difficulty with facial movement, or poor results. Always consult a trained professional.
What is the best age to get Botox for jowls?
Many patients start in their late 30s to early 50s, but the best age is based on muscle strength and skin quality, not just years.
FAQ
What is the best cosmetic procedure for sagging jowls?
It depends on the severity of sagging. Botox is great for early jowls; fillers, threads, and RF devices are ideal for more advanced cases.
Will Botox help sagging jowls?
Yes, particularly when caused by muscle pull and in the early stages of skin laxity.
Where do you inject Botox for sagging jowls?
Common areas include the platysma bands along the jawline (Nefertiti Lift) or DAO muscles.
Can Botox lift the lower face?
Yes, Botox can subtly lift the lower face by relaxing muscles that pull downward.
Is it worth having Botox at 60?
It can be! While results might be more subtle, Botox can still offer improvement when paired with other treatments.
Can jowls be lifted without surgery?
Absolutely. The best procedures that's non-surgical for sagging jowls options include Botox, dermal fillers, threads, RF microneedling, ultrasound tightening, and exercises for sagging jowls.
Sources
- 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 https://pubmed.ncbi.nlm.nih.gov/18236245/
- Carruthers J, Fagien S, Matarasso SL; Botox Consensus Group. Consensus recommendations on the use of botulinum toxin type A in facial aesthetics. Plast Reconstr Surg. 2004;114(6 Suppl):1S-22S. doi:10.1097/01.PRS.0000144795.76040.D3 https://pubmed.ncbi.nlm.nih.gov/15507786/
- Vartanian AJ, Dayan SH. Complications of botulinum toxin A use in facial rejuvenation. Facial Plast Surg Clin North Am. 2005;13(1):1-10. doi:10.1016/j.fsc.2004.04.008 https://pubmed.ncbi.nlm.nih.gov/15519923/