A: The answer is both! The jowl is actually a fat pad and will enlarge with weight gain; it also becomes more prominent with aging partly because facial volume in adjacent areas of the cheek can diminish relative to the jowl. The jowls are definitely part of the cheek and typically descend below the jaw line with aging, just as other areas of facial soft tissue sink because of gravity (referred to as “gravitational aging”).
The best solution to jowls that have descended is a face lift, which will reposition them. In most cases, reducing the jowl volume with liposuction should be done at the same time as a face lift. Liposuction in this area should be done with manual syringe aspiration to avoid removal of too much fat.
– Robert Langdon, MD