JOLT: A Noninvasive Solution for the Correction of the Jowl

Abstract

Background: Sagging and loss of elasticity of the facial skin and tissues leads to jowling and an aged appearance. Jowling is a common reason for aesthetic surgical consultations. Methods: Prospective open-label study of the JOLT (jowl lifting) technique using hyaluronic acid (HA) fillers in healthy women 40–65 years of age with Fitzpatrick skin phototypes II–IV (n = 8). To be eligible, patients had jowling grade 2–3 on the jowl appearance scale as assessed by both the physician and patient. Treatment was administered at the baseline visit and consisted of an average of 6mL of HA filler, 3mL per side. Efficacy was assessed at baseline, week 4, and week 12. Assessment measures included the jawline rating scale (JRS) and a five-point global aesthetic improvement scale performed by two independent observers. Success was defined as an improvement of 1–2 grades on JRS. Results: The mean JRS was improved from 2.75 at baseline to 1.53 at 90 days, which was considered a significant improvement. Mean global aesthetic improvement scale scores at 90 days were 1.44 ± 0.66 (range 1–3), indicating a “very much improved” appearance compared with baseline on both investigator and subject ratings. The procedure was well tolerated by all patients. Injection-related side effects (bruising and localized swelling) resolved spontaneously within 1 week of treatment. No other adverse events were reported. Conclusions: The JOLT technique effectively uses HA fillers to lift and tighten the lower face/neck and camouflage the remaining jowl, diminishing marionette lines, defining the mandibular border, and improving jowl sagging.