Jowls without surgery: an honest look at the options
Mild jowls can look softer without surgery, but not every kind. Plastic surgeons describe three patterns: thinning fat, fat that has slid down, and fat spread over the jawbone. Filler suits the first; the other two are classic surgical problems. At Karisma, XERF radiofrequency is $1,500 a session. Kay offers no fillers and no surgery.
Published · Written by Kay Woodson · Results vary.What holds a jawline in place?
In 2008, plastic surgeons at UT Southwestern dissected 16 half-faces to map the fat along the jaw. They found separate pockets of fat above and below the jawbone, kept apart by a band of tissue they named the mandibular septum. That band ties the skin to the edge of the jaw. A jowl forms when the fat above it thins, slides, or spills past it.
Hormones speed this along. The AAD lists jowls among the changes that follow collagen loss in menopause, alongside sagging skin and deeper lines. Skin tone matters too: a 2016 review found that in Black patients, jowling tends to come more from the thickness and weight of the skin than from looseness, which changes what a tightening device can be expected to do.
Which kind of jowl do you have?
The three patterns described by Reece and Rohrich in Aesthetic Surgery Journal, 2008. Many jawlines show more than one.
| Pattern | What you see | How surgeons treat it |
|---|---|---|
| Fat atrophy | Thin skin and a jaw that looks hollow or bony, with little jowl | Replacing fat, by injection or with your own fat |
| Jowl that has dropped | Normal skin, but a bulge that has slid below the jawline | Surgery: releasing the septum and lifting the deeper layer |
| Fat over the jaw | A soft, continuous fullness that blurs the jawline | Surgery that also removes fat directly over the jaw |
The authors warn that treating a jawline without this diagnosis can leave it overdone or undertreated. A good consultation names your pattern before it names a treatment.
Non-surgical jowl options compared
Rows marked "not offered" are not available at Karisma.
| Option | What it can do | Honest limit | At Karisma |
|---|---|---|---|
| Facial exercises | In a 2018 JAMA Dermatology study, 30 minutes a day for 8 weeks, then every other day to 20 weeks, improved cheek fullness | 27 women enrolled, 16 finished, no control group, jawline not measured | At home |
| Retinol or peptide creams | The AAD says they may boost collagen | Surface texture, not a dropped fat pad | At home |
| Endermologie Face | LPG micro-pulsations over face and neck. Helps improve the appearance of soft or slack skin along the cheeks and jaw | One 2015 study of 30 people, cited by LPG. Results vary | $120 a session |
| XERF | Radiofrequency warmth in the deeper skin. Helps improve the appearance of mild loose skin | Two small studies. No untreated comparison group | $1,500 a session |
| Ultherapy | Focused ultrasound. FDA-cleared to lift lax tissue under the chin and on the neck | Its clearance does not name the jowl itself | Not offered |
| Fillers | Restore volume where fat has thinned | Does not lift a jowl that has dropped | Not offered. Medical practice |
| Lower facelift and neck lift | Repositions fat and the deeper layer, removes extra skin | Surgery, with scars and recovery time | Not offered. Plastic surgeon |
Ultherapy wording from FDA 510(k) K243035. Karisma prices from GlossGenius, October 2026. Karisma offers no fillers, threads or injectables.
What the clearance and the studies say
The FDA cleared XERF in August 2025 (510(k) K251327) for electrocoagulation and hemostasis in dermatologic and general surgical procedures, for prescription use. That is not a clearance for lifting jowls or tightening skin. The larger human study, Weiss and colleagues in Cureus in March 2026, gave 39 people two sessions 4 weeks apart on the face, under the chin and the neck. It was supported by the maker and enrolled skin types I to IV only; its authors say results for types V and VI are uncertain. A second study looked back at 16 women after one session. If your skin is deeper in tone, or your jowl has dropped rather than loosened, say so at the consultation and expect a straight answer.
If you want to try a non-surgical option at Karisma
- 1Consultation, $150Kay assesses your jawline, your health history and your goals, and tells you plainly if a plastic surgeon is the better first visit. The fee is credited to your first XERF session.
- 2XERF, $1,500 a sessionTwo booked together are $3,000. For the jawline, Kay says a client may need all 3 sessions of a typical series, depending on how loose the skin is. [TO CONFIRM: spacing between jawline sessions, Kay]
- 3Or a lower-cost routineEndermologie Face is $120 a session and covers the face and neck in one visit.
Questions about jowls
Is it possible to tighten jowls without surgery?
For mild loose skin along the jaw, devices may soften the look, and results vary. A jowl that has dropped below the jawline, or fat spread over it, is what surgeons usually treat with surgery, by repositioning or removing that fat.
Does losing weight get rid of jowls?
It depends on the pattern. Less fat over the jaw may sharpen it. But if your jowl comes from thinning fat, losing more can make the jaw look hollower. Fast loss can also change the whole face; see Ozempic face.
Do jowl exercises work?
The study most often cited on facial exercise, in JAMA Dermatology in 2018, found fuller-looking cheeks after 20 weeks in 16 women. It did not measure jowls, and it had no comparison group. Exercise is free, so there is little harm in trying.
Can fillers fix jowls?
Filler can replace volume where fat has thinned, which can make a jawline look smoother. It cannot lift a jowl that has slid down. Karisma does not offer fillers; see a board-certified dermatologist or plastic surgeon.
- Reece EM, Rohrich RJ. The aesthetic jaw line: management of the aging jowl. Aesthetic Surgery Journal, November 2008
- Reece EM, Pessa JE, Rohrich RJ. The mandibular septum: anatomical observations of the jowls in aging. Plastic and Reconstructive Surgery, April 2008
- Alam M et al. Association of facial exercise with the appearance of aging. JAMA Dermatology, January 3, 2018
- Facial exercises help middle-aged women appear more youthful, Northwestern University, January 3, 2018
- Caring for your skin in menopause, American Academy of Dermatology, last updated November 24, 2025, read October 29, 2026
- Vashi NA, Maymone MB, Kundu RV. Aging differences in ethnic skin. J Clin Aesthet Dermatol, January 2016
- FDA 510(k) K243035, Ulthera System, indications for use, read October 29, 2026
- FDA 510(k) K251327, XERF, Lutronic Corporation, cleared August 11, 2025
- Weiss RA et al. Dual-frequency noninvasive monopolar radiofrequency for facial laxity, a prospective multicenter study. Cureus, March 2, 2026
- Erlich, Dahan, Wolf. Retrospective evaluation of XERF. Lasers in Medical Science, August 18, 2026
- Humbert P et al. Mécano-stimulation of the skin improves sagging score. Clinical Interventions in Aging, 2015, read October 29, 2026
- LPG Group, face treatment: smooth wrinkles, checked October 29, 2026
- Karisma Esthetics booking page and prices, GlossGenius, checked October 29, 2026