Jowls, Jawline, Hollows and Fine Lines: Questions and Answers by Concern
Most people start with what they see in the mirror: jowls, a softer jawline, hollows, folds or fine lines. These answers go concern by concern, explain which layer usually causes each one, and set out what non-surgical treatment can and cannot do for it.
Jowls and Jawline
What helps early jowls without surgery?
For early jowls, where tissue has loosened but not dropped far, focused ultrasound such as Ulthera aimed at the SMAS along the lower cheek and jaw is a common choice. Thermage can add firmness to the skin over the area, and Sculptra may soften the hollow in front of the jowl that makes it look more prominent. Results are modest and gradual. Which mix fits depends on whether laxity, fat or lost volume dominates in your jowl. Ulthera
When are jowls too heavy for non-surgical treatment?
When tissue has clearly descended below the jawline, the skin hangs in folds, or lifting the cheek with your fingertips makes a large difference, devices usually give limited improvement. Non-surgical treatments firm tissue that is still roughly in place; they cannot reposition descended fat and SMAS or remove excess skin. In that situation a mini facelift or facelift is usually more effective, and Dr. Kim will say so, although he does not perform surgery at Violacell. When non-surgical lifting is not enough
Can Ulthera give me a sharper jawline?
It can help when loosened support or some excess fat softens the jawline, but how much depends on the cause. Dr. Kim writes that two people who both want a slimmer jawline may need different things: one needs the SMAS lifted, another the fat layer reduced, while the salivary glands and the chewing muscle change the plan again. If the width comes mainly from muscle or bone, Ulthera will change little. Ulthera for a slimmer jawline
My jaw looks wide rather than saggy. What could help?
A wide lower face often comes from a large chewing muscle (the masseter), a prominent salivary gland or the shape of the jaw bone rather than from aging. Muscle-relaxing injections can slim a large masseter gradually over weeks. Energy treatments help mainly when laxity or fat also contributes. The width of the bone itself cannot be changed by devices or injections, so identifying which of these applies is the step that decides the treatment.
Why is there a step or notch along my jawline?
A step usually appears where tissue held by ligaments meets tissue that has loosened and descended. The front of the jaw stays anchored while the jowl area drops, creating an uneven contour instead of a smooth line. A mild step may soften with firming of the SMAS and, in some cases, volume support in front of the jowl. A pronounced step, especially with loose skin, tends to respond better to surgical lifting than to devices.
Is one Ulthera session enough for jowls?
One session is the usual unit, with results developing over two to three months and possibly continuing up to about six. Whether it is enough depends on how far the tissue has descended and how your collagen responds. In his answers to patients Dr. Kim describes Ulthera's effect as typically holding for around six months, so maintenance is often discussed. If a well-planned session gives little change, more sessions are not always the answer; the cause may need a different approach.
Can Thermage alone fix a sagging jawline?
Usually not, if the sagging comes from deeper tissue. Thermage heats the dermis and the fibrous strands beneath it, firming the skin over the jaw, and it can make the contour look slightly smoother, especially when skin laxity is the main issue. Loosening of the SMAS is better addressed with treatment aimed at that layer, such as Ulthera. This is why the two are often combined when the jawline is the main concern.
Does Sculptra help jowls?
Sculptra does not lift a jowl, but it can make one look less prominent by restoring volume in front of and above it. The hollow beside the chin and flattening of the cheek often make a jowl stand out more, and rebuilding support there can soften the shadow. Placing volume in the jowl itself would usually make it heavier, so the product is placed around the jowl rather than into it. Sculptra
Will losing weight improve my jowls?
It depends on what the jowl is made of. If fat is a large part of it, weight loss may slim it. If laxity dominates, weight loss can make the loose tissue and skin more visible, and hollows may appear higher in the face. The effect varies from person to person. If you are planning significant weight loss, it is often sensible to reach a stable weight before starting lifting or volume treatment.
What causes marionette lines, and can they be softened?
Marionette lines run down from the mouth corners and come from several layers: descending tissue beside the jowl, loss of volume around the mouth, downward pull of the muscle that lowers the mouth corners, and changes in the skin. Treatment can combine firming of the lower face, volume support beside the chin and relaxation of that downward-pulling muscle. Dr. Kim notes that around the mouth the extent of muscle relaxation is set carefully, because speech and eating depend on it.
Under the Chin and Neck
What can help a soft area under the chin?
It depends on whether fat, loose skin or muscle is the cause. Ulthera is FDA-cleared for lifting tissue under the chin and on the neck and can firm a mildly loose area. Where a localized pocket of fat dominates and the skin is firm, fat reduction or liposuction may suit better. When the skin hangs loosely, surgery is usually more effective, and an examination of how the area feels and moves decides which applies. Liposuction: a plastic surgeon's guide
Can neck bands be treated without surgery?
Vertical neck bands come from the edges of the platysma muscle. Muscle-relaxing injections can soften active bands temporarily, and Ulthera can firm the tissue of the neck mildly. Pronounced bands with loose skin usually respond partly to non-surgical treatment. Dr. Kim has written that the platysma is one of the muscles that pull the face downward, which is why relaxing it can also support a lift of the lower face.
What helps horizontal lines on the neck?
Horizontal neck lines come from creasing of thin neck skin, often deepened by posture and genetics. Skin-focused treatments such as radiofrequency and skin boosters may soften them modestly by improving the dermis. Lines that are deep and longstanding usually improve partly rather than fully. Because neck skin is thin, energy and injections are placed conservatively, and daily sun protection on the neck helps prevent further damage.
Does Ulthera work on the chest (décolleté)?
Ulthera is FDA-cleared to improve lines and wrinkles of the décolleté, the area of the upper chest. The skin there is thin, so the plan uses suitable depths and conservative energy. Results are gradual and modest, as they are on the face. Whether it is worth including depends on how much the area bothers you compared with the face, and it can be discussed at consultation.
Does a heavy neck mean I need a facelift?
Not necessarily. A heavy neck can come from fat under the chin, loose skin, platysma bands or a low position of the deeper neck structures. Mild cases can respond to non-surgical treatment aimed at the dominant layer. When loose skin and bands are marked, a neck lift, often done as part of a facelift, is usually the more effective answer. Dr. Kim can explain where your neck falls, although he does not perform surgery at Violacell. Facelift: a plastic surgeon's guide
Why does my neck look older than my face?
Neck skin is thinner, has fewer oil glands and is often less protected from the sun than the face. The neck also lacks the firm anchors that hold facial tissue in place, and the platysma can separate into bands. Many people treat and protect the face but forget the neck, which makes the contrast more visible. Including the neck in sun protection and, where appropriate, in treatment plans keeps the two more consistent.
Hollow Temples, Cheeks and Under-Eyes
What helps hollow temples?
Hollow temples usually reflect lost fat and support, so volume treatment fits better than tightening. Sculptra is often placed deep, close to the bone, at the temples to rebuild support gradually over months, while hyaluronic acid filler gives a faster result that behaves differently. Energy devices are used cautiously at the temple, because the tissue there is thin and a nerve branch to the forehead crosses the area. Sculptra
Why do my cheeks look flatter than before?
Flattening of the cheek often comes from loss of the deep fat that supports it from below, together with changes in the bony frame and some descent of tissue. The front of the cheek loses projection and the fold beside the nose may deepen. Gradual volume support such as Sculptra suits broad flattening, while lifting devices help the looseness that often comes with it. Which change dominates in your face decides the mix.
Can hollow cheeks be filled without looking puffy?
Yes, that is the aim of gradual volume support. Sculptra rebuilds collagen over months and is typically given over two or three sessions, which lets volume be added in steps and assessed between them. Overfilling in one session, or placing volume where the face is already heavy, is what tends to look puffy. Dr. Kim's 2026 lecture to clinicians described keeping volume natural while planning the lift around each person's skeleton and tissue layers.
What helps hollowness under the eyes?
It depends on the cause. A groove at the edge of the eye socket from lost volume, puffiness from fat bulging forward, thin dark skin and shadows from the bony rim each need a different approach. Skin-focused treatment can improve thin, crepey skin, and Dr. Kim's column on Re2O lists hollowing under the eyes among the concerns it may suit for people who would rather avoid surgery or filler. Fat that bulges forward is usually a matter for surgery. Dr. Kim on Re2O
Is Sculptra injected under the eyes?
Generally not in the area immediately around the eyes. The labeling advises against injecting Sculptra close to the eyes, because muscle movement and thin skin raise the risk of nodules there, and Dr. Kim also writes that dynamic areas such as the lips and around the eyes should be avoided with collagen stimulators. Sculptra may be placed in the cheek below, which can indirectly support the area, but the under-eye itself is treated with other approaches.
Why does my face look hollow after weight loss?
Facial fat compartments shrink with weight loss, especially at the temples, the cheeks and around the eyes. Skin that was supported by that fat may also look looser. Together these changes can make a face look older than expected. Gradual volume support can rebuild some of what was lost, and firming treatments can address the looseness. Waiting until your weight is stable before treating helps keep the plan accurate.
My cheeks are already hollow. Should I avoid Ulthera?
Not necessarily, but it should be planned with care. Ulthera is not designed to remove fat and the evidence on fat loss is limited and mixed, yet deep energy in an already lean area could contribute to a leaner look in some people. In thin faces Dr. Kim takes this into account, using shallower depths, fewer lines or none in hollow areas. When hollows dominate, volume treatment may be the better place to start. Can Ulthera make the face look hollow?
What helps a sunken look around the mouth?
Volume loss around the mouth and chin can deepen shadows and make the area look sunken. Dr. Kim has written that fine lines and deeper volume loss around the mouth call for different products: lighter collagen-stimulating products for fine lines, and stronger volume products, Sculptra among them, to restore volume between the skin and the muscle. The lips themselves are avoided with Sculptra. He stresses overall balance of the face rather than treating one area in isolation.
Why does my face look tired even when I sleep well?
A tired look usually comes from structure rather than sleep. Hollows under the eyes and at the temples, a heavier brow or upper eyelid, a flatter mid-cheek and downturned mouth corners all create shadows that read as fatigue. Each of these sits in a different layer. Identifying which ones dominate in your face, and treating those, tends to help more than a general refresh aimed at the skin alone.
Folds Around the Nose and Mouth
What helps deep nasolabial folds?
The fold running from the nose to the mouth corner deepens through loss of midface support, descent of the cheek and changes in the skin. Filling the fold directly can help a little, but restoring support higher in the cheek and firming the lower face often address the cause better. Sculptra is approved in many countries for nasolabial folds, though folds caused by heavy descended tissue respond less to any non-surgical treatment.
Why does filling my smile lines make my face look heavy?
Because the fold is often a border rather than a hole. Tissue above the fold has descended and rests against the firmly held area beside the mouth. Adding volume directly into the fold can make the area beside the mouth fuller without lifting the tissue above, which looks heavy. Restoring support in the cheek and addressing laxity of the lower face usually looks more natural, softening the fold instead of filling it.
Why are my nasolabial folds deeper when I smile?
Smiling raises the upper lip and pushes cheek tissue up against the firmly held area beside the mouth, so every fold deepens with expression. A fold that appears mainly when you smile is normal and is not a sign that treatment is needed. The part that matters is the fold you see at rest, which reflects lost midface support, descended tissue and changes in the skin. Treatment aims at that resting fold rather than trying to erase expression, which would look unnatural.
What helps vertical lines above the upper lip?
These lines come from thin skin creased by repeated movement of the muscle around the mouth, sun exposure and smoking. Dr. Kim has written that fine lines around the mouth respond to lighter collagen-stimulating products and to energy treatments that stimulate the dermis, such as Ulthera's 1.5 mm depth. Muscle-relaxing injections here need care because speech and eating depend on that muscle. Sculptra itself is not placed in the lips.
Can Thermage help smile lines?
Thermage can firm the skin of the lower face, which may make fine lines look softer, but it does not fill a deep fold or restore volume. When a smile line is mainly a crease in the skin, skin-focused treatment helps more. When it is a deeper fold from descended tissue and lost support, Thermage provides part of the improvement at most. It is therefore often combined with treatments aimed at the deeper layers. Thermage and Re2O
Why do my mouth corners turn down?
Downturned mouth corners result from descent of tissue beside the mouth, loss of volume around the chin and pull from the muscle that lowers the mouth corners. Dr. Kim names this muscle among those that pull the face downward and writes that relaxing such muscles can support a lifting effect. Volume support beside the chin and firming of the lower face may also help. The extent of any injection around the mouth is chosen carefully.
Can folds come back after treatment?
Yes. Non-surgical treatments improve folds gradually, and the effect fades as aging continues. Ulthera and Thermage results are commonly reassessed within about a year, and Sculptra's volume, though longer-lasting, also changes over time. Folds that return quickly after repeated treatment can be a sign that the cause has moved beyond what non-surgical tools can address, and a different approach may then be discussed.
Fine Lines, Crepey Skin and Texture
Which non-surgical treatments help fine lines?
Fine lines sit in the skin, so treatments that reach the dermis help most. In his answers to patients, Dr. Kim notes that radiofrequency devices such as Thermage suit fine wrinkles and skin elasticity better than focused ultrasound. Skin boosters such as Re2O aim to support skin quality, and Ulthera's shallow depths can also stimulate the dermis. Lines caused by repeated muscle movement may also need muscle-relaxing injections. Thermage and Re2O
What helps crepey skin on the cheeks?
Crepey skin, which looks thin and finely wrinkled like crepe paper, reflects loss of collagen and elastic fibers in the dermis. Treatments aimed at the skin layer suit it: radiofrequency to firm the dermis and skin boosters to support its thickness and texture. Dr. Kim's Re2O column lists fine lines with loss of elasticity and rough texture among the concerns it may suit. Results are gradual and vary, and sun protection helps prevent further damage.
Can anything make enlarged pores smaller?
Pores look larger when the skin around them loses firmness and when oil production is high. Treatments that firm the dermis or improve skin quality can make pores look smaller, and Dr. Kim's Re2O column lists enlarged pores among the concerns it may suit. Results are usually modest, and pores cannot be closed permanently. Oil control and daily sun protection also play a part in how pores look.
Why does my skin look dull even with good skincare?
Dullness often reflects changes beneath the surface: a thinner dermis, slower renewal of the outer skin and uneven texture that scatters light. Skincare acts mainly on the surface. Treatments that stimulate the dermis, such as radiofrequency, or skin boosters aimed at quality can help skin look more even. Dr. Kim has written that energy treatments work through the body's own repair response, which slows with age, so improvement builds gradually.
Are fine lines around the eyes treated differently?
Yes, because the skin there is very thin and the eye is close. Thermage has a small eye tip for the eyelids and surrounding area, used with protective eye shields. Ulthera is used superficially in selected areas around the eyes, staying outside the bony rim, and collagen stimulators such as Sculptra are generally avoided right around the eyes. Lines from smiling may also respond to muscle-relaxing injections. Thermage around the eyes
What helps forehead lines?
Forehead lines come mainly from repeated contraction of the forehead muscle, combined with thinning skin. Muscle-relaxing injections soften lines caused by movement, while skin-focused treatment can improve lines that remain at rest. Caution is needed, because the forehead muscle raises the brows, and relaxing it too much can make a low brow or heavy eyelids feel heavier. People who raise their brows to keep their eyes open often have deeper lines for this reason. Forehead lift: a plastic surgeon's guide
Can a skin booster replace a lifting device?
No, they do different jobs. Skin boosters are injected into the skin to support hydration, texture and thickness, while lifting devices firm the deeper support layers. A booster can make skin look healthier but will not tighten a loosened jawline. Dr. Kim describes pairing Re2O with Ulthera or radiofrequency so that lifting and dermal repair happen together. When the concern is skin quality alone, a booster by itself may be enough.
Does sleeping on one side cause lines?
It can. Sleep lines form when the face is pressed into a pillow night after night, creasing the skin in the same places, and they are often more visible on the preferred sleeping side. They can deepen with age as skin loses elasticity. Changing position or using a smoother pillowcase may reduce new creasing, while established sleep lines are skin-layer changes that respond to skin-focused treatment rather than lifting.
Brows, Eyelids and Forehead
What helps a heavy brow without surgery?
A mildly low or heavy brow can be raised slightly. Ulthera is FDA-cleared to lift the eyebrow, and muscle-relaxing injections in the muscles that pull the brow down can raise it a little. The effect is small and works when the drop is mild. When the brow has fallen onto the upper eyelid, a forehead lift is usually the more effective answer, and Dr. Kim can explain where your brow falls. Forehead lift: a plastic surgeon's guide
Are my heavy eyelids caused by the eyelid or the brow?
Often the brow plays a larger role than people expect. If lifting the brow gently with a fingertip makes the eyelid look much better, a low brow contributes; if excess eyelid skin still rests on the lashes with the brow in place, the eyelid itself is the main cause. Sometimes it is both. Dr. Kim can assess this, though at Violacell he offers non-surgical treatment and does not perform eyelid or brow surgery. Upper blepharoplasty or forehead lift?
My upper eyelids feel heavy. Is a device enough?
For mild looseness, possibly. Thermage with the eye tip can make upper eyelid skin look slightly firmer and soften fine lines, and Ulthera can raise the brow a little. Neither removes excess eyelid skin or lifts a brow that has clearly dropped. When skin rests on the lashes or narrows your field of vision, upper eyelid surgery or a forehead lift is usually the more effective answer. Upper eyelid surgery: a plastic surgeon's guide
Why do my brows look lower than they used to?
With age the forehead tissue loosens and the brows, especially at their outer ends, tend to descend. The forehead is held by anchors mainly at the sides and around the eyes, and the brows move constantly, so heaviness tends to come down from the forehead to the brow and then to the upper eyelid. A low brow can make the eyes look smaller and more tired. Treatment depends on how far the brow has dropped.
What helps drooping at the outer corners of the eyes?
Drooping at the outer corners can come from the outer brow descending, loose skin under the outer brow, or changes in the upper eyelid itself. A mild drop may respond to a small brow lift from Ulthera or to muscle-relaxing injections. When excess skin under the brow is the cause, surgical options such as a brow lift or removal of skin just below the brow may be discussed. Identifying the source is the key step.
Is there a non-surgical option for hooded eyes?
Mild hooding from a slightly low brow or lax skin may improve a little with Ulthera's brow lift, Thermage around the eyes or muscle-relaxing injections. Significant hooding, where skin folds over the eyelid crease or rests on the lashes, usually needs surgery to remove skin or lift the brow. Non-surgical options give modest change, so it helps to know where you fall before choosing. Eyelids and brows: questions and answers
Can frown lines between the brows be treated?
Frown lines come mainly from the muscles that draw the brows together, so muscle-relaxing injections are the usual treatment. Dr. Kim notes that the frown muscle also pulls the brow and forehead downward, so relaxing it can slightly support the brow as well. Deep lines that remain at rest may improve with skin-focused treatment over time. Injections in this area are placed with care because of nearby blood vessels.
What helps hollow temples and a low outer brow together?
When the temple hollows, the outer brow loses some support and can look lower. Restoring volume at the temple with deep, gradual support such as Sculptra can soften the hollow and indirectly support the outer brow. A small brow lift from a device can be added if the brow is also low. Because the temple has thin tissue with important vessels and a nerve branch, treatment there is placed carefully.
Several Concerns at Once
I have jowls, hollows and fine lines. Where do I start?
Start with the change that bothers you most and has the clearest cause. Often that is laxity of the lower face, addressed with a device aimed at the SMAS, or volume loss, addressed with gradual support. Skin quality can be added once the structure has been addressed. A layer-by-layer plan may treat several concerns over a few months rather than all at once, so each step can be judged. Combining treatments: questions and answers
Is there one treatment for every sign of aging?
No. Each concern sits in a different layer: fine lines and texture in the skin, hollows in the fat and deep volume, jowls in the SMAS and fat, and some contour changes in the bone. A treatment aimed at one layer cannot reach all the others. A plan that promises to fix everything with one device or product usually overlooks part of the problem, while matching tools to layers gives a more predictable result.
Which concerns are better addressed by surgery?
Typical examples are excess skin that hangs in folds, heavy jowls well below the jawline, a brow resting on the upper eyelid, eyelid skin on the lashes, marked neck bands with loose skin, and fat bulging under the eyes. Non-surgical treatments give limited change in these situations. Dr. Kim trained in facial surgery and can explain when surgery fits, although his practice at Violacell is non-surgical. Surgery or non-surgical lifting