Patients of estheticians often complain about the age unevenness of the line of the lower part of the face oval. Aging of the face – the result of atrophy of adipose tissue and volume loss due to bone resorption and downward displacement of soft tissues.
The expression of jowls may be exacerbated by weakening of the mandibular septum, which entails descent of the upper and lower jaw fat compartments. Dr. David Ong presents his three-step technique for correcting and lower facial contouring with HA fillers.
Correction of the lower part of the face oval with fillers: key points and zones
Through the precise insertion of a properly selected HA-based dermal filler into the mandibular angle, submental and maxillary region, the aesthetic appeal and youthful appearance of the lower face oval can be recreated.
For the lower third of the face, the author recommends first revolumizing the upper and middle thirds to provide volumetric support from above. Main target areas – temporal, buccal and preauricular.
In contrast to the middle third of the face, where soft borders are aesthetically ideal, the transition from the jaw line to the neck is characterized by sharper angles and lines, which are important to recreate during the correction.
To achieve this effect, the author introduces a highly elastic filler into the superficial (subdermal) layer. To provide lift and support from above, a HA-based filler with good tissue integration should be used.
Through the precise insertion of a properly selected HA-based dermal filler into the mandibular angle, submental and maxillary region, the aesthetic appeal and youthful appearance of the lower face oval can be recreated.
Author's choice of drugs for this procedure – Restylane Volyme, Restylane Lyft and Restylane Defyne. Alternatively, Princess Volume, Belotero Volume and Juvéderm Voluma fillers can be used.
Correction of the lower part of the face oval can be divided into three main stages of work with:
1. The angle of the lower jaw.
2. Chin zone.
3. Perimaxillary zone.
First stage: correction of the angle of the mandible
The angle of the lower jaw is formed by the connection of the posterior border of the branch and the lower edge of the body of the jaw.
X-ray studies have shown that, on average, the mandibular angle in women – 125 degrees, however this value varies even in aesthetically pleasing patients.
The main goal when correcting the lower part of the face oval – emphasize and make more pronounced the natural mandibular angle of the patient.
Technology
1. Determine the loss of volumes in the preauricular space.
2. By palpation, find and mark the angle of the lower jaw.
3. Use a 23 gauge needle to create an entry point superomedial (often 0.5 cm) to the mandibular angle.
4. Mark the future lower border and the back of the body of the lower jaw (Fig. 1).
5. Use a 25 gauge (4 cm) cannula to aspirate to avoid intravascular injection of the filler.
6. Using a linear retrograde technique, inject the filler (0.1 ml per line) in a volume of 0.5–1 ml in each direction.
7. Shape the product to achieve the perfect angled contour by gently palpation between the tips of two fingers.
Potential Risks
During the correction of the posterior branch of the mandible, the facial nerve and the parotid gland are at risk, since these two structures are located deep. You can not affect them by injecting the filler into the subdermal plane. When introducing the product into the lower edge of the jaw branch, it must be remembered that the facial artery runs along the anterior edge of the masticatory muscle. It must first be palpated and excluded from the injection zone.
Short description:
Goal: to sharpen the mandibular angle.
Depth of insertion: superficial/subdermal.
Volume: 0.5–1ml per side.
Technique: cannula.
Products of Choice: Restylane Defyne, Restylane Volyme or Restylane Lyft
Second stage: contouring of the chin area (H3)
To determine the ideal proportions of the face, it is usually divided into three equal horizontal thirds and five vertical sectors (Fig. 2). Ideally, the chin occupies the central vertical sector.
Read also: Vertical division and injection techniques for facial contouring
The distance between the tip of the nose and the border of the upper lip and between the lower border of the lip and the pogonion should be related as 1/3 to 2/3.
Chin contouring should begin with measuring its length, anterior projection, and the depth of the premaxillary sulcus. The Ricketts aesthetic plane connects the tip of the nose with the pogonion of the chin and determines that the average distance from this line to the upper lip is 4 mm, and to the lower lip – 2 mm.
The Rule of Thirds can be applied to determine whether chin lengthening is appropriate. However, aging leads to resorption of the mandible and is associated with hyperactivity of the mentalis muscle. These factors lead to a shortening of the chin and a decrease in the projection of the lower third of the face.
Technology
1.
2. Palpate and note the pogonion of the chin.
3. Increase the projection and length of the chin by deep insertion of a highly elastic filler into the deep periosteal plane (use a sharp needle for injection).
4. When working with cannulas, select an entry point that allows access to the premaxillary sulcus.
5. Aspirate to avoid intravascular injection of the product.
6.
7. Align the treated area by palpation.
Potential Risks
The inferior alveolar artery and nerve from the mental foramen represent the main hazard in this area. The mental foramen is usually located between the first and second premolars; it is important to avoid direct injection of the drug into this structure.
Short description:
Purpose: Shaping and contouring of the chin.
Depth of insertion: subdermal and periosteal.
Volume: total 1–2 ml of preparation.
Technique: subdermal cannula and periosteal needle.
Products of Choice: Restylane Volyme or Restylane Lyft
Third stage: work with the premaxillary zone
After correcting the angle of the mandible and chin, the soft tissues surrounding the jowl area (superior-lateral and infero-medial) will be slightly tightened. Therefore, directly when working with bryly, less product will be needed. Based on the experience of the author, three perpendicular lines of filler can properly shape the lower edge of the mandibular ramus.
Read also: Tighten sagging cheeks: effective methods for correcting jowls
Technology
1. Mark the borders of the jets and do not volumize this area (Fig. 3).
2. Palpate and note the chin pogonion and mandibular angle.
3. Mark the lines that connect the angle of the lower jaw with the chin pogonion – lower edge of the jaw branch.
4. Aspirate to avoid intravascular filler injection.
5. Inject the filler slowly using the retrogard-linear technique, the number of fillers per line – 0.1 ml (total 0.5 ml of filler per side).
6. For a perfect contour, gently palpate the area with the tips of two fingers.
Potential Risks
Volumization of the jets will deepen the premaxillary sulcus. When working with this area, care must be taken not to damage the mental and facial arteries, as well as the mental nerve.
The risk of intravascular injection of the drug can be minimized by working in the superficial (subdermal) or deep (periosteal) planes, as well as performing aspiration test before the injection of the filler.
Short description:
Goal: to straighten and define the jawline by hiding the jowls.
Depth of insertion: subdermal.
Volume: 1 ml of filler only.
Technique: subdermal cannula.
Products of Choice: Restylane Volyme or Restylane Lyft.
Correction of the lower part of the face oval with fillers based on hyaluronic acid – difficult procedure. The condition of the lower third of the face is affected by the volume and omission of the soft tissues of its middle and upper parts. Therefore, before rejuvenation of the lower part of the face, it is often necessary to perform a correction of the zygomatic, temporal and preauricular zones.
The risk of intravascular injection of the drug can be minimized by working in the superficial (subdermal) or deep (periosteal) planes, as well as performing aspiration test before the injection of the filler.
Adapted from Aesthetics
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