Dr Giulia D’Anna, director of Dermal Distinction Academy, discusses the importance of the chin and jawline in achieving facial harmony and enhancing masculine and feminine characteristics.
The lower third of the face, which includes the chin and jawline, plays a crucial role in defining overall facial aesthetics and balance. A well- contoured jawline is desirable in both men and women, giving a perception of beauty and youth. It is also key to sexual dimorphism, defining masculine and feminine characteristics.
In this article, we discuss the anatomy of the lower third of the face, facial assessment, ageing process, and treatments of the chin, prejowls and mandibular line and angle with injectable fillers.
My background is a little different than most cosmetic practitioners as I am a dentist, but this is still very relevant to aesthetic patient assessment and treatment.
As a dentist, we learn to manipulate the appearance of the lower third through dental treatment and orthodontics, but there needs to be options available for those patients who do not wish to undertake this journey. It is important that a cosmetic practitioner also considers these options.
The nonsurgical correction, rejuvenation and beautification of the lower third of the face is becoming more frequent – where previously the traditional options of a surgical approach in more extreme cases was the only choice. Injectable fillers can reshape the jawline, lift soft tissues and improve facial proportions, effectively improving the appearance of the area.
‘IT IS IMPORTANT TO PERFORM ANY MID-FACE VOLUME CORRECTION OR RESTORATION PRIOR TO THE LOWER FACE TREATMENT, AS THIS HELPS IN REPOSITIONING AND PULLING THE SOFT TISSUE UPWARD.’
Facial proportions & assessment
As with any treatment, it is paramount to understand the facial anatomy and perform a thorough facial assessment in order to propose a proper aesthetic treatment plan. The aesthetic goal of the rejuvenation approach is to redefine the mandibular angle and chin prominence.
In younger patients, beautification can be achieved through correction of constitutional deficit due to an under-developed maxilla, or where loss of premolars has occurred, or enhancement of the contour of the face, improving the facial shape. Orthodontics is key in these patients, but there are patients that still desire further correction where the outcomes have not met their ideals, or perhaps even our own hopes.
In the older patient, it is imperative to possess knowledge of facial anatomy and the ageing process in order to deliver effective and safe results.
I do love phi calculations and measuring angles of the structure of the face as part of my treatment assessment. However, a beautiful face cannot be defined by a mathematical formula, but instead reflects the bone structure, position and volume of the subcutaneous tissue, skin quality and the personality of each person. The harmonious proportions of the facial thirds and other features such as eyes, nose, lips and neck are paramount for an attractive face.
The lower third plays an important role in the appearance of an aesthetically pleasing face. Men have sharper angles on their faces than women, with a sharp jawline and a more pronounced jaw angle. Women may have a defined mandibular angle, but the mandibular jawline and chin angles should be more delicate, providing a more oval facial shape, with a V-shaped chin.
The chin is of great importance in men’s attractiveness. It is larger and stronger in men, falling under the width of the lips, whereas in women it is rounder and subtle, about the width of the nose.
The ageing process & changes in the lower face
The facial ageing process is multifactorial, resulting from changes in all skin layers, the soft tissue and underlying skeleton, which occur at a different pace among individuals. There is skin atrophy, subcutaneous fat redistribution, and bone remodeling and resorption.
In the lower face, the mandible undergoes an anterior and inferior resorption, which can be aggravated by the loss of teeth or retroclined (backward leaning) teeth, or perhaps even the loss of vertical dimension through life. The angle of the mandible increases with age, as a result of resorption in its inferior border. The chin becomes more anterior and shorter with ageing.
There is atrophy of superior and inferior mandibular fat compartments and dehiscence of the mandibular septum, causing the fat pads to move downward to the neck.
These changes, together with skin atrophy, result in loss of the jawline definition and formation of the jowls. The depressor labii inferioris, depressor anguli oris and platysma muscles contribute to the worsening of the jawline contour, as they pull the soft tissue downwards. It is a great asset to your patient to implement botulinum toxin neuromodulation to alter the depressor nature of these muscles. Ultimately this can ward off the need for a facelift in some patients.
A congenitally small or recessed chin may contribute to early loss of the jawline definition as the structure of the face is missing or deficient.
Non-surgical treatment for the lower third & patient suitability
The nonsurgical rejuvenation and beautification of the lower third of the face have become commonplace, as they can effectively restore and improve the appearance of the area.
Different methods and modalities can be used to address the different clinical aspects, such as microfocused ultrasound, ablative and non-ablative lasers, radiofrequency, botulinum toxin and injectable fillers.
To deliver effective and safe results, it is critical to perform a good facial assessment and possess knowledge of facial anatomy to propose the priorities of treatment, using the proper techniques, in order to achieve the optimal outcomes.
A global facial evaluation must be performed, analysing the shape, balance and symmetry.
It is important to perform any mid-face volume correction or restoration prior to the lower face treatment, as this helps in repositioning and pulling the soft tissue upward. Revolumisation of the tissues is key here, so that structure is regained in the face.
On the other hand, many patients are not able to understand their lower face deficiencies. Therefore, when treating the mid-face of a patient, the lower third should also be evaluated to optimise the facial proportions. Attention should be given to the chin projection, length and width, labiomental sulcus, mandible angle, prejowl sulcus, jowls and cervicomental angle.
When planning aesthetic treatment, it is crucial to understand the patient’s complaints and set realistic expectations.
The ideal indications are the presence of light-to-moderate loss of facial contour, light-to-moderate loss of volume, including patients with constitutional deficiencies in this region. The treatment can also be indicated for male patients, to enhance masculine characteristics, such as a well-defined chin or jawline, in addition to female patients with oval or heart-shaped faces, to strengthen the lower third, improving the facial contour.
In severe cases of laxity, loss of contour and volume deficiencies, a surgical approach must be considered. In the case the patient is not eligible or refuses surgery, the limitations of the modality should be discussed, along with the combination of other methods of treatment, such as laser devices, microfocused ultrasound and radiofrequency, to optimise the results.
Prior to the injection, it is paramount to assess the patient’s clinical history, allergies, prior injectable treatments and use of medication. In the case of any dental problems or procedures in the previous 15 days, the injection should be postponed. AMP
For practitioners seeking to enhance their skills in facial aesthetics, including the lower third, visit www.dermaldistinction.com for a variety of courses and training opportunities available.
