Facial plast Surg 2016; 32(05): 513-519
DOI: 10.1055/s-0036-1592100
Review Article
Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.

Augmenting the Prejowl: Deciding between Fat, Fillers, and Implants

Fred G. Fedok
1  Fedok Plastic Surgery, Foley, Alabama
2  Department of Surgery, University of South Alabama, Mobile, Alabama
3  Division of Otolaryngology-Head and Neck Surgery, Department of Facial Plastic and Reconstructive Surgery, Milton S. Hershey Medical Center, Pennsylvania State University, Hershey, Pennsylvania
Harry Mittelman
4  Mittelman Plastic Surgery, Los Altos, California
› Author Affiliations
Further Information

Publication History

Publication Date:
28 September 2016 (online)


The prejowl sulcus is a complex anatomic structure that results from several age-related changes in the lower face. These changes include the localized atrophy of a segment of the mandible inferior to the mental foreman, fat atrophy, and dehiscence and laxity of the ligamentous and muscular components of the region. The correction of the prejowl sulcus is rarely accomplished through rhytidectomy alone. Instead, the volume deficit of the sulcus usually requires the replacement of volume. Solid implants, fillers, and fat transfer may be used to improve the contour of the lower face. These can be used in isolation and in conjunction with rhytidectomy. The decision of what method to be used depends on the severity of the deformity, the patient's adjacent anatomy, the patient's wishes, and the skill set of the surgeon.