Jowls: why do they form, and how do you get rid of them?
Beside the corners of the mouth, just above the jawline, flesh can gather into a bulge that makes a face look sulky. Koreans call this spot “simsulbo”. It isn't a medical term, and papers usually say jowl. People often ask me whether losing weight will get rid of jowls, but they aren't only a matter of fat.
The short answer
Many anatomy studies say jowls form as cheek tissue comes down with age and the connective tissue under the skin beside the mouth loosens. That's why removing fat alone, or having Botox alone, seldom solves it. Treatment studies looking directly at jowls are small. Hyaluronic acid filler has 8 people, diluted calcium filler a chart study of 22, and neither has a control group. I couldn't find a study testing Botox on jowls. I start by working out which comes first: sagging, fat or hollowing. I can look at this with you at Miso Clinic, 4F Bombom Building, 125 Dongdeok-ro, Jung-gu, Daegu (Exit 1, Kyungpook Nat'l Univ. Hospital Station), +82-53-428-2700. We don't do liposuction.
Why do jowls form?
Each anatomy study explains it a little differently. A Korean study of 10 cadavers saw the main cause in the cheek fat compartment coming down, more than in the mandibular ligament loosening. A study of 72 cadavers pointed to the structure behind the mandibular ligament, where the platysma is loosely attached to the jawbone. A study of 49 cadavers explained it as the result of tissue under the skin, which moves freely so the mouth can open wide, stretching with age.
As I understand it, the three studies are looking at the same thing from different layers. They do agree on something: the area in front of the ligament is held in place and flesh pools behind it, so the jawline looks broken. But the cadavers averaged around 75 years old and the 72-cadaver study was almost entirely white, so this is hard to apply as it stands to a young Korean.
Korean authors also wrote in 2026 that in Asians the modiolus sits outward and below the corner of the mouth, which makes the corners look turned down more easily.
Will Botox get rid of jowls?
I couldn't find a study testing whether Botox into the jowl itself shrinks it. Botox is a drug that rests muscle. It doesn't lift tissue that has come down, and it doesn't remove fat.
So why do people look for it? In someone with prominent pull from the muscles that drag the mouth corners down, or from the platysma along the jawline, the expression can look a little lighter. We do Botox on all areas, but if your jowls come from sagging, it isn't what I'd suggest first. Masseter Botox can also reduce side volume and make things look more saggy, so I look at that too.
Should I remove fat, or do I need lifting?
| Method | Studies I checked | Where I would use it |
|---|---|---|
| Hyaluronic acid filler | 8 people, average 6 mL, scale 2.75→1.53 at 12 weeks, no control group | Hollowing in front of the jowl, connecting the jawline |
| Diluted calcium filler | 22-person chart study, 2 sessions, reduced jowl volume at 150 days, no control group | When skin firmness has dropped as well |
| Absorbable threads | Mainly technique descriptions; I couldn't find numerical comparisons | When sagging comes first |
| Fat-dissolving injections | Mentioned in a literature guideline; I couldn't find a trial in Koreans | A consultation only when fat is clearly the issue |
| Botox | I couldn't find a direct trial | When muscle pull is prominent |
A 2024 treatment guideline paper also proposes sorting out the cause first, then choosing among collagen-stimulating materials, devices, fat-dissolving injections, threads and filler. But that's a proposal combining the literature and the authors' experience, not a trial comparing methods against one another.
I'm wary of going after fat when there isn't much fat there. Lose the volume and the loose skin can stand out more. We don't do liposuction, so if that looks like what you need, I'll tell you to consult somewhere that does that surgery.
→ More: Jawline sagging in Daegu: the order for choosing lifting devices and boosters
What about a thread lift?
It's one of the methods I bring up when sagging is the main part of the jowl. On the evidence: the 2026 paper I found describes a technique, with no numbers comparing how many people improved or by how much. I don't tell people threads will remove jowls either.
We use only absorbable threads, and before the procedure I show you the thread's material and approval information. For people aged 50 and over I keep the plan conservative, and for some weeks afterwards I ask you to hold off on massage and on opening your mouth wide.
→ More: Thread lifting in Daegu
Can massage or losing weight reduce them?
I couldn't find a study where massage reduced jowls. An 8-week gua sha trial reported contour distances falling by 2–3 mm, but with no control group that can't be told apart from a change in puffiness.
If you carry a lot of weight, losing it can sometimes make your face look lighter. But in an older person, losing a lot can expose loosening instead. If you can't tell which it is in the mirror, gently lift your cheek upward. If the bulge disappears when you do, sagging may be the likelier cause. That's not a diagnosis, only a simple thing to observe before a consultation.
Jowls: frequently asked questions
Can you get jowls in your 20s or 30s?
Yes, they show up. Some people carry more fat there or have that jawbone shape. The anatomy studies mostly used elderly cadavers, and I couldn't find data measuring how much each cause contributes in younger people.
Does one jowl treatment do it?
It depends on the method. The studies were designed differently too, with 1 session of filler and 2 of calcium filler, and I couldn't find a long-term comparison. Rather than fixing a number in advance, I decide as we see how it goes.
Do jowls and nasolabial folds come together?
They often do. But I couldn't find a study measuring how far the causes overlap. We sort out whichever bothers you first.
Where can I get a jowl consultation in Daegu?
At Miso Clinic, 4F Bombom Building, 125 Dongdeok-ro, Jung-gu, Daegu (Exit 1, Kyungpook Nat'l Univ. Hospital Station), +82-53-428-2700. Weekdays 11:00–19:00, Saturday 10:00–16:00, closed Sundays and public holidays.
Read next
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Related treatments: Lifting · Thread lifting · Jawline sagging
Who wrote this
Written and reviewed by Lee Chi-Hak, MD, director of Miso Clinic, Daegu. The treatment standards and injection design set out here are the ones we use in practice.
| Medical director | Lee Chi-Hak, MD |
|---|---|
| Address | 4F Bombom Building, 125 Dongdeok-ro, Jung-gu, Daegu, South Korea · Exit 1, Kyungpook National University Hospital Station |
| Phone | +82-53-428-2700 |
| Hours | Weekdays 11:00–19:00 (lunch 13:00–14:00) / Saturday 10:00–16:00 (no lunch break) / Closed Sundays and public holidays |
| Columns | All clinical columns |
| Reference library | All booster and device references |
References
- Anatomy of the jowl — Kang MS et al. J Craniomaxillofac Surg 2016;44(9):1126-30. PMID 27427339 (10 cadavers) / Suwanchinda A et al. J Cosmet Dermatol 2018;17(4):625-31. PMID 30091282 (72 cadavers) / Minelli L et al. Aesthetic Plast Surg 2023;47(1):170-80. PMID 36050569 (49 cadavers).
- Small study of hyaluronic acid filler — Rosengaus F, Sicilia NC. JOLT: A Noninvasive Solution for the Correction of the Jowl. Plast Reconstr Surg Glob Open 2024;12(6):e5856. PMID 38868621. 8 people.
- Chart study of diluted calcium filler — Durairaj KK et al. Sculpting the Midface and Lower Face. Aesthet Surg J Open Forum 2025;7:ojaf104. PMID 41376672. 22 people, 150 days, no control group.
- Thread lifting technique — Hong GW et al. Marionette Line Correction Using Threads. Arch Plast Surg 2026;53(5):390-4. PMID 42836256. Technique description.
- Proposed treatment order — Magacho-Vieira FN et al. Revitalizing the lower face. J Cosmet Dermatol 2024;23(6):1969-72. PMID 38450900. Based on the literature and the authors’ experience.
- Randomised trial of rollers and gua sha — Ahn SH et al. J Cosmet Dermatol 2025;24(6):e70236. PMID 40439289. 34 people, 8 weeks, comparing the two methods.
- Korean medical advertising law — Korean Medical Service Act Article 56(2) (no treatment testimonials, no comparisons with other clinics, no superlatives). This is why this column carries no prices, reviews or before-and-after photos.
- Miso Clinic practice guidelines — for hollow cheeks, dissolvable hyaluronic acid filler is considered first; no RF treatment that day if there are metal or electronic implants, pregnancy or skin inflammation; only absorbable threads are used and their material and approval information is shown to the patient; the plan is kept conservative for patients aged 50 and over; liposuction is not performed.
Everything in this column is general information and does not replace medical diagnosis or treatment. Effects and side effects vary with individual skin condition, age and underlying illness, and the same result is not guaranteed for everyone. Any decision to proceed should be made in an in-person consultation with a physician.