Jowls, Marionette Lines and the Day Your Jawline Starts to Change.

There comes a day — and I suspect many women will recognise it — when you look in the mirror and think:

Jowls and marionette lines have a habit of creeping up on us. One day you look in the mirror and suddenly think: When did that happen?

Your face is still your face. Your eyes are the same. Your smile is the same. But the jawline that once looked fairly straight suddenly isn't quite so straight anymore.

There's a little softness either side of the chin.

The lines running down from the corners of your mouth — marionette lines — seem deeper, almost as though a downward smile has been etched onto your face even when you're not actually frowning.

And in certain lighting, particularly the brutally honest lighting of a bathroom mirror, it can almost look as though the lower half of your face has started to slide downwards.

Welcome to jowls.

They're one of the most normal features of facial ageing and, judging by the number of treatments promising to "snatch", "sculpt" and "lift" our jawlines, one of the things we're apparently supposed to be terrified of.

But before throwing money at them, I wanted to understand something.

Why do we actually develop jowls — and which treatments genuinely make a difference?

Because there are an awful lot to choose from.

Why does our jawline change?

It's tempting to think facial ageing is simply a case of our skin becoming loose.

It isn't.

Our faces are complex three-dimensional structures involving skin, fat, muscle, ligaments and bone — and all of them change as we age.

Collagen and elastin in the skin change. Facial fat isn't simply "lost"; different fat compartments can lose volume, enlarge or change position. The tissues supporting the face change, while the underlying facial skeleton itself continues to remodel as we get older.

In other words, the foundations are changing as well as what's sitting on top of them.

Then menopause joins the party.

Falling oestrogen levels are associated with changes in skin collagen, thickness, hydration and elasticity, which can make some signs of facial ageing more noticeable during and after menopause.

So when we see jowls developing, we're not necessarily looking at one problem requiring one solution.

We're looking at several layers of ageing happening together.

And that matters enormously when we're deciding whether a treatment is worth paying for.

So what can we actually do about jowls?

Search online and you could be forgiven for thinking virtually anything can rebuild your jawline.

I've come across:

• Gua sha and facial massage

• Face tape

• Micro current

• Radio-frequency

• Micro-needling and RF micro-needling

• Ultrasound treatments such as HIFU

• Thread lifts

• Dermal fillers and other injectables

• And, of course, surgical facelifts

The prices range from a few pounds for something you can do at home to many thousands for surgery.

But here's the important bit:

They're not interchangeable treatments.

Some primarily work on the skin.

Some affect muscle activity or tone.

Some add or restore volume and structure.

Some attempt to reposition tissue.

And some create little more than a temporary cosmetic effect.

So rather than asking, "What's the best treatment for jowls?", perhaps the better question is:

What exactly is this treatment capable of changing?

Gua sha: lovely ritual or genuine facelift?

I like the idea of Gua sha.

Massage can feel wonderful and may temporarily change puffiness and the appearance of the face. Interestingly, a small recent study even found measurable changes in facial contour after regular Gua sha massage over eight weeks.

So I'm not going to dismiss it as doing absolutely nothing.

But we're a very long way from proving that repeatedly massaging your jawline with a stone can permanently reposition established jowls.

A temporarily less-puffy or subtly altered face can certainly look more defined.

That's not the same thing as lifting significantly descended facial tissue.

So enjoy the ritual — just don't confuse a Gua sha stone with a surgeon.

Face tape: the five-minute facelift?

Then there's face tape.

Social media videos can be remarkably convincing. Pull the skin backwards, strategically hide the tape beneath the hair and suddenly the jawline looks tighter.

And technically, it works.

While you're wearing it.

What it hasn't done is reverse the structural changes responsible for facial ageing.

It's camouflage rather than treatment.

For photographs or an evening out? Perhaps.

As a long-term solution to jowls? That's a rather different claim.

Micro-current

This is particularly interesting to me because I use micro-current myself.

Devices such as NuFACE and ZIIP deliver low-level electrical current, and users may notice changes in facial appearance and contour.

I enjoy micro-current and think it has a place in my routine.

But the evidence base for home beauty devices varies considerably, and I think we have to be realistic about what an at-home micro-current device can achieve.

If the underlying issue is significant skin laxity, changing fat compartments and alterations to the deeper supporting structures of the face, an electrical current isn't going to magically put everything back where it was twenty years ago.

That doesn't make micro-current useless.

It simply means maintenance and cosmetic improvement are very different things from physically lifting descended tissue.

And that distinction is one we're going to come across repeatedly.

Radio-frequency

Radio-frequency is where things become more interesting.

RF treatments deliver energy into tissue to generate controlled heating, with the aim of producing changes including collagen remodelling and improvements in skin firmness and laxity.

There is clinical evidence that professional RF treatments can produce improvements in facial skin laxity and firmness.

But "improvement" is the important word.

We're generally talking about modest tightening and improved skin quality, not taking a significantly sagging lower face and returning it to where it sat twenty years ago.

There are also professional RF treatments and home RF devices, and we shouldn't assume that the results from one automatically apply to the other. They can operate at very different energy levels and treatment parameters.

This is particularly interesting to me because I already use RF as part of my own approach to ageing skin.

For me, the question isn't simply:

"Does RF work?"

It's:

How much tightening can it realistically produce, how long does it take, how long might the improvement last — and does that justify what I'm being asked to pay for it?

Micro-needling — and RF micro-needling

Micro-needling deliberately creates controlled microscopic injuries in the skin, triggering the skin's wound-healing response.

There is evidence supporting micro-needling for aspects of facial rejuvenation, particularly things such as wrinkles, texture and photoageing, although studies aren't always standardised.

RF micro-needling goes a step further by delivering radio-frequency energy through the needles into the tissue.

Recent reviews suggest RF micro-needling can improve skin texture and tightening, and this makes it an interesting treatment for ageing skin.

But once again:

Improving the quality and firmness of the skin isn't necessarily the same thing as physically repositioning significantly descended tissue.

This is where before-and-after photographs can sometimes lead us astray.

Lighting, facial expression, head position, camera angle and even how recently the treatment was performed can make a modest improvement look considerably more dramatic.

When I'm looking at a treatment costing hundreds of pounds, I want more than an impressive Instagram photograph.

I want to know what the clinical evidence actually shows.

HIFU

High-intensity focused ultrasound — HIFU — is another treatment marketed for tightening and lifting without surgery.

Unlike skincare applied to the surface, focused ultrasound can deliver energy at selected depths beneath the skin.

There is evidence that ultrasound treatments can produce moderate improvements in facial and neck rejuvenation for some people.

And that word matters again.

Moderate.

Not a facelift without the surgery.

Results vary, treatment can be uncomfortable and expensive, and risks and limitations deserve considerably more attention than they sometimes receive in glossy clinic advertising.

For someone with mild-to-moderate laxity who isn't ready for surgery, it may be worth investigating.

But I'd want realistic expectations before handing over my credit card.

Threads

Thread lifts sound wonderfully straightforward.

Insert threads beneath the skin, use them to reposition tissue and, depending on the type of thread, potentially stimulate a tissue response while they gradually dissolve.

A facelift without a facelift?

This is where I'd become considerably more cautious.

Thread lifts can produce an initial lifting effect, but the evidence for how well that effect lasts isn't particularly convincing. Reviews have repeatedly called for better-quality, longer-term studies.

And although serious complications appear to be uncommon, this isn't a risk-free beauty treatment.

Reported problems include swelling, bruising, dimpling, palpable or visible threads, altered sensation, infection and thread extrusion or migration.

So this is an invasive medical procedure, not an advanced facial.

And if you're going to put something beneath my skin and pull my face around with it, I'd quite like some robust evidence about how long I'm going to enjoy the result.

Injectables

This is where things become more complicated.

Dermal filler can restore lost volume and alter facial proportions in ways that may improve the appearance of the jawline, chin, pre-jowl area and marionette lines.

But adding filler directly into an area that's already looking heavy isn't automatically the answer.

Sometimes restoring support or volume elsewhere can improve the overall balance of the lower face. That's why treating facial ageing isn't as simple as pointing at a line and asking somebody to fill it.

And fillers have their own risks, including rare but potentially serious vascular complications.

Depending on your individual anatomy, an experienced medically qualified practitioner may approach your face very differently from the way you imagined after staring at yourself in the bathroom mirror.

This is absolutely an area where who is holding the syringe matters as much as what's inside it.

And then there's the facelift

Eventually, we reach the treatment that almost everything else tends to be compared with.

Surgery.

A facelift can reposition deeper facial tissues and redrape or remove excess skin in a way that non-surgical skin-tightening treatments simply cannot replicate.

But it's also surgery.

That means recovery, expense, scars, anaesthesia and the possibility of complications.

Which is why comparing every non-surgical treatment with a facelift doesn't really make sense.

Gua sha isn't competing with a facelift.

Neither is your home micro-current device.

They're doing completely different jobs.

The real question is:

How much improvement do you actually want — and how much treatment, risk, downtime and money are you prepared to accept to achieve it?

Perhaps we need to stop trying to erase every sign of ageing

Writing about jowls raises another question for me.

At what point did a changing jawline become something that needed fixing?

I'm interested in ageing well. I use skincare technology. I use retinol. I experiment with treatments, and I'm certainly not going to pretend that I don't care about what I see in the mirror.

I do.

But I don't want to spend the next twenty years at war with my own face either.

Perhaps there's a middle ground.

We can understand what's happening to our faces.

We can use treatments that have genuine evidence behind them if we choose to.

We can question exaggerated claims.

And we can still accept that a 60-year-old face isn't supposed to have the jawline of a 25-year-old.

For me, that's what My Future Face is really about.

Not desperately trying to look twenty-five again.

It's about understanding what is happening as I age, deciding which treatments might genuinely help and working out which ones deserve my money.

So I'm going to investigate these treatments one by one — looking at what they actually target, what the evidence says, how long the results last, the risks involved and, importantly, whether they're worth the money.

Because I'm quite happy to give my jawline a helping hand.

I'm just not prepared to spend hundreds — or thousands — of pounds on something that only lifts my bank balance.