When the area beside the corner of your mouth or above the jawline bulges and sags, the whole face can read as heavy and tired. In Korean it gets called the “sulky pouch” because it looks displeased in repose, or the “bulldog pad” because the sides of the mouth drop the way a bulldog’s do. In English we simply call them jowls.

This area does not respond well to dieting, and massage tends to leave it feeling lighter only briefly. The reason is straightforward: jowls are not explained by “cheek fat” alone.

This article separates the options — exercise, massage, liposuction, injectable fat reduction, lifting, filler — and sets out which approach reads more naturally in which situation.

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Where exactly are jowls?

The term covers the area beside the corner of the mouth, below the nasolabial fold, bulging down over the jawline. It is less a fixed diagnosis than a description of an impression created by several structures at once.

Related terms include deep buccal fat and the marionette line. The three are not interchangeable.

From the outside all three look like “flesh beside the mouth,” but the underlying cause differs. Some people have volume. Some have skin that has descended rather than fat. For others, the crease and the hollow around the mouth are the larger problem.

So there is no single method. The first step is separating out what is actually driving it in your face.

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Why do they form?

Usually several reasons act together rather than one.

First, as skin elasticity declines, the fat layer below the cheek descends. With age, the support from skin and ligaments weakens, and gravity leaves the area beside the mouth looking heavy.

Second, a thick subcutaneous layer below the cheek — or a prominent deep fat layer — increases the bulge. Here, even a small weight gain makes the lower face read as heavy and blurs the jawline.

Third, hollowing around the nasolabial fold and marionette line makes jowls stand out more. Even without much volume, a hollow beside it makes what is there project.

Fourth, habitual expression and posture play a part. Corners of the mouth that often turn down, resting your chin on your hand, a head that sits forward — repeated over time, these change the tension along the jawline and around the mouth.

In the end this is not a fat problem but a problem of fat, skin, ligament, crease, and hollow appearing together. Which is why an approach built only on removing volume can leave the face looking more sagged, not less.

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Can exercise or massage remove them?

People look up facial exercises, gua sha, lymphatic massage, and face yoga. These can help to a degree with fluid retention and muscle tension.

If you eat salty food often and swell easily, then hydration, sleep, light cardio, and stretching through the neck and jaw can make the line of the face read lighter. If you clench, work that reduces muscle tension helps too.

But a fat layer that has already descended, skin that has lost elasticity, and established creases and hollows will not be reversed by exercise. If the following apply, home care alone is likely to reach its limit.

• The bulge beside the mouth stays even after losing weight
• Flesh looks caught and folded above the jawline
• There is fat below the cheek and the skin has also descended
• The marionette line looks deep even when you are not smiling
• Massage helps briefly and it returns quickly

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Fat-dominant jowls: suction or injectable reduction

If the area beside the mouth and above the jawline pinches with clear thickness, and the lower face gets heavier as your weight shifts, fat is likely the main driver.

Reducing the fat layer helps here. But the face has a thinner layer and a finer structure than the body, so removing as much as possible is not the approach. Take too much from below the cheek and the skin can read as more sagged, or the creases around the mouth can stand out further.

There are broadly two options.

• Injectable fat reduction: suits a thinner fat layer where surgery feels like too much, for a lighter refinement of the line
• Facial liposuction: worth considering where the fat layer is clearly present and the jawline or double chin is involved

In either consultation we confirm the fat layer and skin thickness with ultrasound first.

Related: facial liposuction

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Laxity-dominant jowls: lifting has to be part of it

Where the problem is closer to laxity than fat, procedures that only reduce volume tend to disappoint. With skin that has already descended, removing fat can leave the remaining skin folding or creasing more.

Lifting belongs in the plan here. Thread lifting, HIFU, radiofrequency, and injectable lifting are chosen according to skin elasticity and the degree of descent.

Laxity-dominant jowls often look like this:

• The cheek descends and the jawline blurs
• The face reads as heavy and sagged rather than fuller
• After weight loss, the area below the cheek feels looser rather than smaller
• The nasolabial fold and marionette line deepen together
• Lifting the skin upward visibly reduces the bulge

We confirm the skin layer, the fat layer, and muscle position with ultrasound, then consider which combination of suction, injection, and lifting reads most naturally.

Related: lifting

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Sometimes the hollow is the problem, not the volume

What looks like jowls is sometimes a marionette line — hollowing and creasing — doing most of the work. When the area below the mouth corner reads as hollow, the volume beside it projects by comparison.

In that case, filler to restore the hollow naturally, botulinum toxin to ease overactive muscles around the mouth, or treatment aimed at skin texture and fine lines may suit better than removing fat.

Filler is not a matter of adding as much as possible, either. The area around the mouth moves constantly, and overfilling reads as unnatural or heavy. Separate out whether fat, laxity, or hollowing dominates before choosing.

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Do not treat jowls and deep buccal fat the same way

Searches for jowls turn up buccal fat removal too. They can look like the same place, but the location and the approach differ.

Jowls are about subcutaneous fat, descent, and bulging around the retaining ligaments — visible from outside. Deep buccal fat sits in a deeper layer, accessed from inside the mouth. Different depths mean you cannot approach them the same way.

Removing too much deep fat can leave the face hollowed or aged. Conversely, if subcutaneous fat and laxity are the problem and only the deep layer is addressed, the jawline will not resolve as hoped.

So the most important step is establishing exactly where the problem sits.

• Whether the superficial fat is the issue
• Whether the deep layer is the issue
• Whether skin laxity is the larger factor
• Whether hollowing and creasing around the mouth matter more
• Whether the double chin and jawline are involved as well

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A checklist for your own type

The table below gives a rough read. Causes often mix, so treat it as a guide rather than a conclusion.

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The method follows the cause

Jowls do not form simply because there is more fat in the face. Subcutaneous fat, deep fat, skin laxity, retaining ligaments, the marionette line, and hollowing around the mouth usually appear together.

Exercise and massage help with fluid and muscle tension, but they have limits when it comes to a fat layer that has descended and elasticity that has gone. Fat-dominant cases point toward injectable reduction or facial liposuction; laxity-dominant cases toward lifting; hollow-dominant cases toward filler or botulinum toxin.

What matters is establishing which type your face is first. At Line Culture Clinic, in a private space near Exit 3 of Apgujeong Station, we confirm the facial fat layers and skin condition with ultrasound and discuss which direction is actually needed.

Results, recovery time, swelling, bruising, scarring, pigmentation, and discomfort all vary from person to person. If you cannot tell which type you are, bring a photograph and we will look at it together.