Direct jowl excision: a novel technique for targeted lower facial contouring

Aging of the jawline commonly results in jowl deformity due to skin laxity and descent of subcutaneous tissues. Traditional correction methods, including rhytidectomy, can effectively address these issues but often involve substantial invasiveness and recovery time. A less invasive, targeted approach for isolated jowl correction is desirable. We present a novel surgical method of direct jowl excision using a triangular full-thickness wedge excision combined with local flap advancement. The excision was meticulously planned along relaxed skin tension lines, avoiding underlying muscular and neural structures, and was followed by layered closure. In our case, a 66-year-old woman who was previously dissatisfied with the outcomes of conventional rhytidectomy underwent direct jowl excision. At the 12-month follow-up, the patient demonstrated marked improvement in jowl prominence and jawline contour, with minimal scar visibility along the mandibular border. No complications or adverse outcomes occurred, and patient satisfaction was notably high. Direct jowl excision offers a focused, minimally invasive alternative for patients with isolated jowl deformities. It provides significant aesthetic improvement with low morbidity, rapid recovery, and acceptable scar formation. This technique should be considered a viable adjunct in the surgical toolkit for facial rejuvenation in carefully selected patients.