One of the first places we start to notice signs of aging is often the jawline. There are numerous reasons why this area is so quickly affected, and fortunately there are also numerous treatment options. Dr. Sabrina Guillen Fabi, an internationally recognized leader in cosmetic dermatology from Cosmetic Laser Dermatology in San Diego, walks us through the aging process and the various modalities used to restore youthful definition to the lower face and neck in her recent webinar, Jawline and Neck Contouring.

Changes Come Early

Dr. Fabi warns that changes begin long before we are ready for them. She explains that in our youngest years, our faces don’t have the bone structure to support the skin and fat. This produces the adorable baby cheeks we love to pinch. The skull actually expands during childhood and teen years, causing our faces to fill out and look more mature. 

Not long after our skulls grow to full size, bone deterioration begins. We start to experience bone loss as early as 25, with significant reduction by the time we celebrate our 35th birthday. This lack of support causes the muscles of the lower face to begin to pull, which leads to the formation of marionette lines and a loss of definition along the jawline. 

Other factors begin to affect the appearance as well. Fat tissue may begin to drop, repositioning in the lower face to form jowls along the jawline and submental fat underneath the chin. Collagen and elastin, two essential building blocks in the dermal structure, also begin to break down, leading to thinner, looser skin. 

liposculpture in san diego, CAHow the Lower Face Changes

The process may be natural, but it’s typically unwanted and tends to affect the lower face first. Some of the effects of aging in this area might include: 

  • Skin discoloration (dyschromia)
  • Widening of the neck 
  • Submental fullness under the chin
  • Flattening of the chin
  • Blunting of the jawline
  • Platysmal neck banding

But there’s good news. Treatments are available to address every one of these changes, refreshing your appearance and boosting your confidence level. 

The Treatment Protocol that Works

In her webinar, Dr. Fabi introduced a treatment protocol designed to address the various effects of aging on the lower face and neck. The four steps include: 

  • Reduce
  • Restore
  • Relax 
  • Redrape

She sometimes adds a fifth step, which she called resurfacing. She explained that sometimes laser resurfacing is included to boost collagen within the dermal structure and create thicker, smoother skin from the inside out. However, the first four steps are the ones she primarily relies on to produce the dramatic effects her patients typically want. 

botox to the massesters in San Diego, CAReduce

Dr. Fabi often focuses on fat reduction first, since removal of stubborn fat provides the enhanced contour that can be further improved through the subsequent steps. Fat reduction can be performed in a variety of ways: 

Tumescent Liposuction

This procedure is performed using local anesthesia and requires about five days of downtime. Micro-cannulas are inserted into the treatment area using tiny incisions. The cannulas gently loosen and suction away the fat. A single treatment can produce a 60-70% fat reduction. 

Dr. Fabi often combines liposuction with a skin tightening treatment known as ThermiRF. This procedure uses tiny probes inserted deep in the tissue to boost collagen and produce firmer skin. Dr. Fabi controls the temperature under the surface to achieve the best result without disturbing the outer layer of skin. 


This nonsurgical method of fat reduction uses controlled cooling (cryolipolysis) to destroy fat cells so they can be eliminated naturally by the body. Dr. Fabi explained that it is essential to work with an experienced practitioner who knows how to overlap the applicator cups to create the best possible results. A single treatment session can offer 20-30% fat reduction.


Dr. Fabi was an investigator for this product and has been performing the treatment since 2012. Multiple injections are made underneath the chin, administering deoxycholic acid to the area. This ingredient breaks down fat cells so the body can eliminate them. The injections take just a few minutes, and patients typically have about seven days of swelling afterward. With two sessions spaced three months apart, patients will see a 20-30% reduction in fat. 


Once the fat is removed, Dr. Fabi turns to fillers to address bone loss that might contribute to an aged appearance. Fillers are an effective, nonsurgical way to build out the jawline, sometimes with quite dramatic results. Results can extend for many months or even years in some cases. 

Dr. Fabi warns that this procedure requires a great deal of expertise to perform properly. Your doctor needs to understand the correct proportions to create a natural look for both men and women. In the hands of an inexperienced injector, a woman can end up looking more masculine or a man can appear more feminine. A man’s jawline should be even with the cheeks, while a woman’s lower face should produce more of a V-shape.


The next step in the rejuvenation process is to slim the lower face by relaxing muscles that could have become enlarged through overactivity. Studies have shown that 67% of people in Western countries clench or grind their teeth. This can lead to enlargement of the masseter (chewing) muscle, as well as the platysma muscle in the neck. 

facial contouring in San Diego, CA

Injections of a neuromodulator like Botox, Dysport, Xeomin, and Jeuveau relax the muscle, which also reduces its size. While the results are temporary, they can last up to six months after a few treatment sessions have been completed. The effects can make a substantial difference in the overall proportions of the lower face. 


The final step is to redrape or tighten the skin to put the finishing touches on the new contour. Our skin loses collagen at a rate of 1% per year throughout our adult lives. Less collagen results in skin laxity, so the best way to treat loose skin is to restore collagen levels.

In addition to ThermiRF, which Dr. Fabi often uses in combination with liposuction, she might recommend Ultherapy as a skin tightening treatment. This procedure delivers ultrasound energy deep into the connective tissue to create constriction and boost collagen levels. Ultrasound imaging allows the physician to target the specific areas of tissue that will produce the greatest effect. Dr. Fabi is considered a leading authority on Ultherapy and has pioneered many of its current applications.

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Ultherapy is performed without anesthesia. However, patients are often given a form of Nitrous oxide or “laughing gas” before the procedure to ensure their comfort throughout the extended session. There is no required downtime after treatment. 

Expert Provider, Superior Results with our San Diego Skin Care Clinic

While any one of these treatments offers positive results, Dr. Fabi explains that a combination approach usually provides the optimal outcome. She added that an experienced physician will know how to pinpoint the various culprits behind the age-related changes so treatments can be customized to the precise needs of each patient. 

Are you ready to refresh your look? Now is the time to contact Cosmetic Laser Dermatology in San Diego, California to discover the personalized treatment plan that will produce the best results for you. 


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