Lower Face & Jawline Thread Lift

What Is a Lower Face & Jawline Thread Lift?

In a lower face and jawline thread lift, medical threads with small barbs on their surface that grip the tissue are placed under the skin along the lower jawline, and the sagging tissue is supported upwards and backwards. The aim is to reduce the sagging that gathers outside the corners of the mouth and to make the edge of the jawline defined again.

In a thread lift, barbed threads are placed along set lines and lift the superficial layer of muscle and connective tissue in the face (SMAS, superficial musculoaponeurotic system). In one technique described for the lower jaw border, the threads are passed along the septum of the lower jaw using a thin, hollow tube called a cannula. The inner and outer sides of the jawline are treated together, and the platysma-auricular ligament is used as an anchor point.

Clinical data specific to this area are scarce. A pilot study included eight people with mild to moderate sagging along the jawline, who had a lift with threads containing poly-lactic acid and polycaprolactone. After the lift, a significant improvement was reported in three-dimensional photographic measurements of the distances from the tragus (the small projection in front of the ear) to the marionette line (the line running down from the corner of the mouth) and to the jowl. Patients were followed up for an average of 8.16 months. The study is small and observational, and it has no control group; its results are not enough to generalise to a wide group of patients.

This clinic uses dissolvable threads (PLLA/PDO). ‘Thread lift’ is the general name for lifting treatments carried out with threads; the French Thread Lift is one of the techniques within these methods. A lower face and jawline thread lift is the form of this general approach aimed at the lower face and jawline.

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What Do ‘Jowls’ and ‘Jawline’ Mean?

‘Jawline’ means the line of the lower jaw; ‘jowls’ are the sagging that forms over this line, just outside the corners of the mouth. They are not the same thing: one describes a line, the other the excess tissue that breaks up that line.

The jawline runs from the tip of the chin along the lower edge of the jawbone to the angle of the jaw in front of the ear. Turkish has no single established word for ‘jowl’; the Turkish version of this page calls it ‘çene kenarı sarkması’ (sagging at the edge of the jaw). According to an anatomical description based on a cadaver study, jowls lie in the tissues over the jawbone, just outside the level of the corners of the mouth. As jowls become more noticeable, the straight edge of the jawline is broken up and looks interrupted.

According to the same study, visible jowls are one of the reasons people consider lower face rejuvenation surgery. Non-surgical methods are also considered for this problem. Which approach makes sense depends on how severe the sagging is, and this is determined at a consultation, not from a photograph.

A double chin is a separate area: it refers to fullness under the chin (the submental area) and is not what this treatment addresses. Thread lifting of the neck and the area under the chin, with its own anatomy and limits, is described on the Neck Thread Lift page.

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How Do Jowls Form?

Jowls are an excess of skin and subcutaneous tissue that forms outside the corners of the mouth as the connective tissue under the skin stretches with age. An anatomical study on cadavers showed that jowls form in the subcutaneous layer, over the rear part of the lower jaw ligament (mandibular ligament).

According to the same study, the tissues in this area are built to move largely independently of the lower jaw, so that the mouth can open wide. The connective tissue under the skin, which is short and elastic in youth, stretches and loosens with age; as a result, excess forms in the skin and the tissue beneath it. According to the researchers, jowls are this excess itself; in other words, they are linked more to the stretching and excess of tissue than to a lack of volume.

Jowls also have a lower boundary. Another study on cadavers showed that the septum of the lower jaw (mandibular septum) and the platysma-mandibular ligament form one continuous structure that acts as a support, limiting how far jowl fat can descend towards the neck. For this reason, jowls and fullness under the chin lie in neighbouring but separate compartments.

A study of tissue mechanics points to a similar picture: in computer models, jowls formed only when age-related softening of the cheek skin and the subcutaneous tissue was combined with changes in the skin’s connecting structures; none of these was enough on its own. This suggests that jowls are not a single-layer problem. However, the finding comes from a computational model; it does not directly show which treatment will work, or to what extent.

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Corners of the Mouth and Marionette Lines

The lines running down from the corners of the mouth (marionette lines) often appear together with jowls, but they do not have a single cause. According to a review of these lines, bone loss, gravity, changes in the fat compartments, muscle pressure, the pull of ligaments and skin ageing all play a part together.

The options listed for this area are fillers, botulinum toxin, surgery to reduce fat and thread lifting. Botulinum toxin, which weakens certain facial muscles, can reduce the downward pull. These procedures require care around structures such as the facial artery and the mental nerve (the nerve that supplies feeling to the skin of the lower lip and chin).

A retrospective study of 369 people looked at two groups: one had a thread lift and the other a short-incision facelift. In the thread lift group, satisfaction differed depending on where the threads were placed: satisfaction with the appearance of the marionette line area was higher than with the nose-to-mouth lines (nasolabial folds). This is a group average; it does not predict your result.

Whether a line comes from sagging, volume loss or muscle movement cannot be told at a glance, and they are not all treated the same way. If sagging is the main factor, a thread lift may be discussed; if volume loss is, fillers; if muscle pull is, botulinum toxin. Most faces have a combination of these; the distinction is made at a consultation.

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How Is It Different from Jawline Filler?

A jawline thread lift and jawline filler are used along the same line but address different problems: the thread lift aims to support tissue that has shifted, while filler aims to support lost volume and contour. One concerns the position of the tissue, the other its amount.

According to a review of filler use in the chin and jawline, skin laxity and soft tissue sagging in the lower jaw area can lead to jowls, a drooping chin tip and reduced forward projection of the chin. This review covers different filler materials, including hyaluronic acid and collagen stimulators (substances intended to increase the skin’s collagen production); in other words, sources in the filler field also recognise sagging as one of the problems in this area.

The hollow just in front of the jowls (the prejowl groove) is a good example of this distinction. A retrospective review comparing two groups of 25 facelift patients each concluded that the hollowing in this groove is more likely to come from thinning of the tissue under the skin than from the pull of a ligament. In the same study, adding volume was associated with more improvement in the jowls and fewer unwanted results than releasing the ligament. However, the study was done in surgical patients and used fat transfer; it does not give a direct result for fillers.

The same face can have both sagging and volume loss. Which one is the main factor, and which methods may be considered, in what order or in combination, is determined at a consultation.

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How Is It Different from the Nefertiti Lift?

In the treatment known as the Nefertiti lift, no threads or filler are placed along the jawline; the aim is to relax the platysma muscle in the neck with botulinum toxin. In everyday language, the substance is often called Botox®, which is a product name; its medical name is botulinum toxin. Although the two treatments aim for a visible result along the same line, they target different structures.

According to an expert consensus (an agreed view reached by a group of experts) on the use of botulinum toxin in the lower face muscles, the uses described for the platysma muscle are neck bands, reshaping the jawline and improving skin texture. The same study stresses that, because the lower face muscles have important functions, treatment in this area is difficult and increases the risk of side effects and complications.

In short, the three methods work through different mechanisms along the jawline: a thread lift targets the position of the tissue, filler targets volume and contour, and botulinum toxin targets muscle pull. Which one stands out in your case depends on why your jawline has changed. If only threads are planned where muscle pull is the main factor, or only a muscle-relaxing treatment where sagging is the main factor, the result may not meet expectations.

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What Does the Evidence Say, and How Long Does It Last?

Data on the effect of thread lifting in the lower face and jawline are limited, and it is unclear how long the effect lasts. According to a systematic review of the subject, no substantial evidence supporting the method’s effectiveness or safety has been added in the past ten years; in the publications reviewed, except for two studies, the lifting effect lasted only for a very limited time. The two studies with positive results were supported by the companies that make the threads.

A later review reached a similar conclusion: although the method looks promising, no new evidence supporting its use has been added. The researchers stress that anyone considering this procedure should be well informed about side effects, how long the effect lasts and the limited data on effectiveness.

More recent studies based on measurements are also small or observational. In a study comparing photographs of a total of 143 people taken sitting up and lying down, the shift of soft tissue between the two positions, seen from the front, measured 14.1% in the group who had a thread lift and 20.8% in the untreated group. The groups were made up of different people. The finding shows that the tissue moved less with changes in position; it does not show how much the sagging improved or how long the effect will last.

In the retrospective study of 369 people, which included a thread lift group and a short-incision facelift group, the effect of thread lifting was found to be limited at an average follow-up of two and a half years; the researchers expressed this as looking about 2.3 years younger. In the pilot study specific to the jawline, the average follow-up was around eight months. These figures are not a promise of how long the effect will last; they do not tell you how long it will last for you.

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Limits of this treatment

A lower face and jawline thread lift supports sagging along the jawline only to a limited extent; it does not get rid of pronounced jowls or excess skin. A thread lift usually does not require surgical incisions, and no skin is removed; anatomically, however, jowls are the excess in the skin and subcutaneous tissue itself.

Studies specific to the jawline have been done in people with mild to moderate sagging; what threads can do in advanced sagging has not been tested in these studies. A review of facelift and neck lift methods describes surgical approaches to the platysma muscle and the structures beneath it for correcting the contour of the jawline and neck; facelifts and neck lifts are treated as the main methods of facial rejuvenation.

Comparative data point in the same direction. In the retrospective study of 369 people, which included a thread lift group and a short-incision facelift group, satisfaction on social and psychological function scales was higher in the short-incision facelift group. However, the groups were not randomly assigned; so the finding is not firm proof that one is better, but a pointer from a comparison.

Whether you might consider surgery in the future also needs to be discussed. In a retrospective study in which a single surgeon reviewed 180 neck lift operations, patients who had previously had non-surgical neck treatments, including thread lifts, showed fibrosis (hardening of the tissue), loss of the planes between tissue layers and unpredictable fat distribution during surgery, and the operations took longer. Because the study looked at more than one type of treatment together, these findings are not specific to threads.

A thread lift does not replace lost volume and does not relax the pull of the platysma muscle; these are the role of fillers and botulinum toxin. The treatment is not a substitute for a surgical facelift. These limits do not mean the method should not be used; they help you set your expectations realistically. Your doctor assesses you; the decision is yours.

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Nerves, Blood Vessels and Glands in This Area

Near the layer the threads pass through along the jawline lie a branch of the facial nerve, the facial artery and the salivary glands; much of the safety of a thread lift depends on the position of these structures. A review of the anatomical basis of thread lifting stresses the need for care around blood vessels, branches of the facial nerve, fat compartments and retaining ligaments; nerve injury can result in facial weakness or paralysis. Another review of complications lists injury to the parotid gland (the large salivary gland in front of the ear) among problems that are rare but difficult to treat.

The key structure in this area is the marginal mandibular nerve, which works the facial expression muscles around the lower lip. A meta-analysis (an analysis combining data from many studies) covering 1,861 sides of the face found that in 39% of cases at least one branch of this nerve dipped below the lower edge of the jaw. A review of the nerve’s course stresses that this course varies from person to person and that the usual distance rule does not reliably protect the nerve.

A study on cadavers reported that, at the level of the angle of the jaw, this nerve passes beneath the septum of the lower jaw and becomes deeper at the front edge of the chewing muscle (masseter), and that the risk of injury may be higher at this point. For the thread technique aimed at the lower jaw border, particular care is also recommended around this nerve and the blood vessels near the notch on the edge of the lower jaw (antegonial notch).

This information is not given to put you off, but to show why this area needs care. Which layer the threads are placed in, in which direction and how many are used depends on the doctor’s assessment and technique; you can ask about the reasons for this decision at your consultation.

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Known risks

The most common side effects of a thread lift are swelling, bruising and tenderness. Visible or palpable threads (threads you can see or feel under the skin), skin dimpling and thread migration (the thread moving out of place) can appear later on. A meta-analysis combining 26 studies and 2,827 patients reported swelling in 34%, bruising in 26%, visible or palpable threads in 10% and skin dimpling in 7%; the variation between the studies’ results was high.

In a systematic review of dissolvable threads only (19 studies, 1,406 patients), the least frequently reported problems were haematoma, a collection of blood under the skin (0.64%), altered sensation (1.14%) and infection (2.49%). The same review found that barbed threads were associated with more complications than smooth threads or threads with cones, and threads that were not anchored with more complications than anchored ones.

A retrospective study reviewed 2,000 thread lift cases using polydioxanone (PDO) threads, randomly selected from 105 institutions, and found an overall complication rate of 12.4%. The most common complications were the skin being drawn inwards, asymmetry and pain. A higher number of threads and older age were identified as independent predictors of complications.

A review of complications lists infection, granuloma (inflamed tissue that forms in reaction to a foreign body), thread migration, nerve damage and injury to the parotid gland as problems that are rare but difficult to treat. The jawline lies next to the salivary glands: in a case series of 11 patients who developed obstructive inflammation of a salivary gland after facial rejuvenation procedures, most needed more than one endoscopic procedure (a procedure done with a thin camera). In a single case report, stones and inflammation developed in the parotid gland three years after a thread lift, and thread fragments were found inside the stones. These reports do not show how often this happens; they show that the risk exists.

Before the procedure, you will be asked about blood thinners (anticoagulants), antiplatelet medicines (which stop blood platelets from clumping together) and supplements that can affect bleeding. Do not stop any prescribed medicine on your own. If needed, the procedure is planned or postponed after consulting the relevant doctor. This is why it is important to tell us at your consultation about all the medicines and supplements you take.

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