What Happens to the Lower Face as We Age?
Authors:
Zhang T, Quan Y, Liu L, Han B, Cao Z, Shen Y.
Title:
Quantitative Analysis of Age‑Related Changes in the Lower Face
Journal:
Aesthetic Plast Surg. 2026 Jun 12 Epub- ahead of print
This study, published in the journal Aesthetic Plastic Surgery (2026), reviews the quantitative changes to the lower face as we age.
When we look in the mirror over the years, most of us notice the lower part of the face—the area from the corners of the mouth down to the jawline—softening and losing its crisp shape. Skin sags, shadows appear, and the smooth line of the jaw starts to blur.
Until now, doctors have described these changes mostly with words like "mild" or "moderate." This study set out to actually measure them, so patients and surgeons could track aging more precisely and plan treatments at the right time.
How the Study Was Done
The team studied 200 healthy adults (100 men, 100 women), split evenly across five age bands from 21 to 70 years old. Anyone who had recently had Botox, filler, fat grafting, liposuction, or a facelift was excluded, so the results reflect natural aging. Each person was photographed under identical lighting and camera settings. Three experienced plastic surgeons then rated the photos, and a computer program measured specific features in millimeters and degrees.
The Three Areas They Looked at
1. The Jowls
The soft pouches of skin and fat that hang along the lower cheeks, just outside the corners of the mouth. Jowls form because the fat pads in your cheek gradually drift downward, the skin loosens, and the underlying jawbone slightly shrinks with age.
2. The Marionette Lines
The vertical creases that run from the corners of the mouth toward the chin, named after the hinged mouths of puppets. The researchers measured how long these lines got, how deep the shadow inside them became, and the angle they formed with the horizontal.
3. The Prejowl Sulcus
A less familiar but very important area. This is the small triangular dent that appears in front of the jowl and just beside the chin. As it deepens, the jawline looks broken up rather than smooth. The team created a brand-new zero to three rating scale for this region (zero = smooth, three = deep shadow with multiple wrinkles inside).
What They Found
All six measurements got progressively worse with age, and the relationship was very strong (correlation values of 0.81 to 0.90, where 1.0 would be a perfect match).
In everyday terms:
Your 20s: The lower face is essentially smooth. No visible jowl, no marionette line, no prejowl shadow.
Your 30s: The first hints appear. Faint marionette lines and a subtle jowl start to form—earlier and more noticeably in women.
Your 40s: Changes accelerate. Marionette lines nearly double in length, their shadow deepens sharply, and the prejowl sulcus becomes a visible dent.
Your 50s: This is the decade of the biggest jump for most features. Jowls become clearly defined, and the jawline visibly loses its crispness.
Your 60s: Changes continue but slow down. The face has settled into its aged pattern.
Interestingly, men and women followed very similar trajectories in the lower face, unlike the middle of the face, where aging tends to differ more between the sexes.
Take-Home Message
Lower-face aging is not one problem—it's three linked ones. Effective rejuvenation usually needs to address the jowl, the marionette line, and the prejowl sulcus together. Treating only one often leaves the face looking unbalanced.
The 40s and 50s are the highest-yield decade for intervention. That's when the measurable changes accelerate most quickly, so procedures done in this window — filler in the prejowl sulcus to restore the jawline, skin-tightening treatments, or a lower facelift — tend to make the most visible difference.
Objective measurement helps set realistic goals. By scoring your starting point and re-scoring after treatment, your surgeon can show you exactly how much improvement was achieved, rather than relying only on impressions.
The bottom line: aging of the lower face follows a predictable, measurable pattern. Understanding that pattern lets us plan the right treatment at the right time instead of guessing.
Learn More About Lower-Face Aging in Bluffton, SC
Signs of aging in the lower face are an incredibly diverse and individualized area of study. Therefore, an in-person consultation is the best way to learn about your facial anatomy and what to expect. Board-certified plastic surgeon Dr. Jarrod Little serves patients in Bluffton and the greater South Carolina area with compassionate patient care and advanced surgical and non-surgical techniques.
Reach out to Revive Palmetto Aesthetics and Plastic Surgery today to schedule a consultation with Dr. Little and his team. Call (843) 480-0060 or contact the experts online.
