Jowl Sagging (Mouth Corner Drooping), How Can It Be Treated?

If sagging is the main cause, lifting is the priority; if localized fat buildup around the mouth corner is the main cause, fat reduction is the priority, and this distinction must be made through diagnosis. If the entire cheek has drooped downward, an approach that tightens the skin tissue is the priority. Ultherapy PRIME®, which delivers ultrasound energy to the SMAS layer at approximately 4.5 mm depth, and Thermage® FLX, which uses radiofrequency (RF) to induce collagen remodeling in the dermis at about 1–2 mm depth, are used depending on the depth of the sagging.

On the other hand, if fat is locally bunched up beside the mouth corner and feels thick to the touch, a small amount of fat reduction may be helpful. There are two main methods of fat reduction: fat-dissolving injections, or, if the amount of fat is large, LSSA, which directly pulverizes and removes the fat in that area using ultrasound. In clinical practice, jowl sagging often involves both sagging and localized fat, and since the mouth corner is a sensitive area where excessive fat reduction can actually worsen hollowing and sagging, it is generally approached in balance with lifting rather than fat reduction alone.

Yes, filling the hollowed areas on either side of the jowl to smooth out the contour difference can help soften the drooping appearance. While the bulging part itself may be the cause of prominent jowl sagging, it is often due to the height difference with the surrounding area (the marionette line groove, the hollow along the jawline). Filling the hollowed groove with HA Filler, Sculptra, or RADIESSE® to create a smooth boundary can reduce shadows and wrinkle lines.

When volume loss is widespread, in addition to HA Filler, which provides immediate volume, an approach such as Sculptra or RADIESSE®, which stimulates autologous collagen production to gradually restore volume and elasticity, may be needed.

Yes, injecting a small amount of botulinum toxin into the depressor anguli oris (DAO) muscle, which pulls the mouth corner downward, can help alleviate the appearance of a drooping mouth corner. When the pulling force of this muscle weakens, the action of the muscle that lifts the mouth corner becomes relatively dominant, and you can expect the effect of a slightly lifted mouth corner and a softer expression even when your face is at rest.

However, since toxin acts on muscle movement, it cannot reverse already sagging skin or volume loss itself, and the effects are generally known to last about 3–4 months, requiring repeated treatments for maintenance. The area around the mouth is directly related to speech and facial expressions, so it is important to administer a small amount after a precise muscle evaluation.

If you have moderate to severe jowl sagging where sagging, hollowing, and muscle action are all observed, a combination approach is more effective than a single treatment. Since jowl sagging is the result of aging in multiple layers simultaneously, combining treatments that target each cause by role tends to yield greater improvement.

For example, a typical sequential approach is to first tighten the foundation of sagging with lifting, then refine any remaining contour differences with dermal filler, and finally balance the mouth corner muscles with toxin. The right combination and sequence depend on the overall aging pattern of the face, so we recommend establishing a personalized plan through a consultation with a dermatologist.