Ptosis or droopiness of the jowls is in many cases the earliest sign of aging, anticipating many years to other stigmata such as wrinkling, sagging face or the eyelids bags.
The anatomy of deep facial rejuvenation (excludes skin aging and wrinkles) is divided into three thirds or units, which partially overlap to each other. The upper third (excludes the eyelids) or frontal, eyebrow and orbital complex along with the cheekbones and the upper part of the cheek, the middle third or cheekbones, cheek, nasolabial region and mandibular profile, and the lower third that extends from the mandibular edge to the lowest part of the neck.
Jowls droopiness is a simplified way of naming the gravitational aging of the transitional area between middle and lower thirds of the lower face and upper neck, including platysma muscle flaccidity, fatty deposits and skin sagginess leading to the deletion of the mandibular profile, which due to aging migrates inferiorly.
Although there are cases of jowls droopiness in middle aged people due to familiar hereditary factors which may require corrective treatment, the most common scenario is patients showing a marked degree of jowls droopiness from the 60s and on, often as the only remarkable sign of facial aging or associated with neck or eyelids aging.
In most cases, the patients suffer at the same time from jowls droopiness along with a greater or lesser degree of skin excess on the middle and lower thirds of the face and neck, so it is usual to simultaneously perform the treatment of both problems.
Best state of the art treatment for the saggy jowls is the deep face and neck lifting with SMAS and platysma anchor and plasties.