The real reason for sagging jowls, and what will and won’t help, according to an expert

For many people, sagging jowls — loose skin that develops along the lower cheeks and jawline — are one of the first unexpected signs of aging.

Dr. Shereene Idriss, a board-certified dermatologist and founder of Idriss Dermatology in New York City, spoke to Fox News Digital about the best practices for managing the downward “drag.”

To understand why jowls form and how to treat them, Idriss suggests visualizing the face as a piece of furniture.

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“I like to explain facial aging using a couch analogy: The bones are the frame, the fat and muscle are the cushions, and the skin is the fabric,” she said.

When a person notices the early stages of “jowling,” it is rarely just a skin (“fabric”) issue. Instead, it is typically a combination of loss of structural support and fat shifting downward with gravity, according to Idriss.

As the frame of the “couch” changes and the cushions compress, the fabric has no choice but to “naturally begin to drape differently,” she said.

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Even so, it’s never too late for non-invasive treatments, according to the doctor.

The key to success is a multi-layered strategy rather than a “miracle” fix, she said.

“It often feels like it happened overnight, but it’s really the accumulation of years of collagen loss and tissue movement.”

While the market is saturated with jawline sculpting gadgets, Idriss urges patients to manage their expectations when experimenting with these. 

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Facial rollers and massage may move lymphatic fluid to temporarily reduce puffiness, but they cannot eliminate true jowling, she said.

Idriss advises against getting buccal fat removal, a popular cosmetic surgical procedure that involves removing the natural fat pads in the cheeks to create a more contoured, hollowed look.

For many people, removing that fat can actually “accelerate [the formation of] jowls and age you faster,” she warned, noting that the goal should be to preserve the “cushions” of the face, not discard them.

Surgical options like facelifts have limitations because, according to Idriss, “a facelift repositions tissue and tightens skin, but it doesn’t rebuild the deeper structural changes that happen with aging.” 

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Some patients may feel their reflection changes almost overnight, Idriss noted, pointing out that there are specific “aging peaks,” including a scientifically documented shift in the mid-40s.

“That moment often feels like it happened overnight, but it’s really the accumulation of years of collagen loss and tissue movement,” the doctor said.

For individuals in their 20s or 30s, the focus should be on “maintaining the couch before the cushions start sinking.” 

This involves protecting collagen by consistently applying sunscreen, using retinoids (vitamin A-derived compounds that can help improve skin cell turnover and stimulate collagen production), and managing inflammation, according to Idriss.

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However, she noted, jowls are not a result of skincare failure. “It is quite literally your bone structure,” Idriss said.

The objective, according to the expert, is to address the root cause of the “drape” rather than chasing a fleeting trend. “Less is usually more — overtreating can create unnatural results.”