I often see patients who complain of their jowls. People often request liposuction to remove the fat from the jowl. On the surface this seems like a good idea but often it actually is not a good idea. The jowl is the result of many factors including a loss of volume to the midface, laxity of the facial muscles, a loss of bony structure in the chin region which is known as the pre-jowl sulcus, and a small amount of fat accumulation in some people. Liposuction alone only removes the fat and in some people there is absolutely no excess fat in that region. In those people removing the fat will create permanent divots and dents that cannot be repaired. Liposuction to the jowl in some people can give a slight improvement in a safe way but the person has to be a good candidate for the procedure to make sure they will not develop problems. The gold standard for treatment of the jowl requires a multifactorial approach that depends on the patient’s particular anatomy. Some people may require midface elevation with injectable fillers, fat, implants or a cheeklift. Some people may require a specialized implant to the chin to fill the pre-jowl sulcus known as a pre-jowl implant. Some people with an excess of fat in the region may require liposuction or a direct excision of jowl fat to reduce the volume of that region. Other people with significant jowling require a lift to jowl directly with a vertical facelift. Many people will require a combination of some or all of the above techniques. For those people who are good liposuction candidates I will often use the Lipolite system by Syneron, Inc. It is a 1064 nm wavelength laser that is passed under the skin and into the jowl region. This laser will actually melt the jowl fat to make it easier to remove it in a smooth way but more importantly this laser will tighten the skin from the underlying surface. This creates a tightening to the area so that the skin doesn’t sag after the fat is removed. This Lipolite system is an excellent system and the results are good for the right person, but honestly most people with significant jowling require the surgical techniques mentioned above.