A well contoured jawline frames the face and defines both youth and beauty. Thus, jawline shaping is an in-demand nonsurgical treatment. In this article I am sharing my approach to jawline contouring with dermal fillers, providing experienced injectors with guidance on applying hyaluronic acid (HA) fillers to optimally enhance and rejuvenate the lower face.
Aging’s impact on facial shape
The result of lower face aging is blurring of the sharp contours and angle of the jawline. Significant resorption of the face’s structural hard tissues that support the mid and lower face occurs as early as the fourth decade. These critical support zones include the maxillae, the mentum and the mandibular angle. Furthermore, fat atrophy and skin deterioration contribute to the descent of aging tissue from the midface to suspend over the mandibular ligament producing the jowl – a herniation over the ligament and beneath the mandible. This causes the youthful face to transform from an inverted triangle to a rectangle.
Patient assessment for jawline contouring
A nonsurgical approach to contouring the jawline can enhance the lower face and reverse age-related blunting of the angle of the jaw and jowling.
When designing the treatment plan it is important to consider the global facial shape and structure, as well as the status of the maxillae, mandibular angle and mentum.
An individualized assessment of the degree of facial aging can help set priorities for correction. When significant age-related volume loss has occurred in the midface, it may be necessary to begin sculpting and revolumizing the lateral maxillae and maxillary eminence.
Other important mid-facial regions that may need to be prioritized before the jawline include, the temples, preauricular region and tear trough. While ideally transitions between the convexities and concavities of the mid face are subtle, sharp angles and contours optimally frame the lower face and define the jawline from the neck.
A three step approach to jawline contouring
There are three critical sites that must be addressed to restore and optimize a youthful, structured jawline. These regions are: the mandibular angle, the pre-jowl sulcus and the mentum. Each area requires a distinct technique, appropriate product selection and as always, an individualized approach.
Step 1. The mandibular angle:
The gonial angle is located at posterior border of the ramus and the inferior border of the mandible. The ideal angle is variable, but for a female the jawline angle should approach 125°. A high G-prime structural filler is used to create the sharp contour of this angle and yield a dramatic volumetric lift to the jowl by injecting deep boluses in the pre-auricular region.
Step 2. The pre-jowl sulcus:
The pre-jowl sulcus is defined by the mandibular ligament, which suspends sagging tissue to contribute to the jowl from behind the marionette furrow descending beneath the jawline. The furrow is already diminished in Step 1 (above) by the volumetric lift such that less product will be required in the pre-jowl region. From a carefully selected point, just above the mandible and anterior to the sulcus, a cannula is used with retrograde threading technique to revolumize using a high-integration HA dermal filler. From one entry site, threads applied in three directions can resuspend the oral commissure and lower lip, smooth the deep mental crease and contour the mandible toward the chin.
Step 3. The mentum:
The Golden Ratio defines the optimal chin shape with respect to the facial width, the lower facial height and the lips. The chin should occupy one-fifth of the facial width with a smooth contour that is neither pointed nor protruding. The optimal profile can be defined by Ricketts’ Aesthetic Plane for a harmonious relationship with the nasal tip and lips.
Aging causes resorption of the mentum and hyperactivity of the mentalis muscle leading to the appearance of a heavy horizontal crease and dimpling of the skin over the chin. Pre-treatment with neurotoxins can produce a smoother appearance and also prolong the result of filler.
A deep periosteal injection of high G prime fillers delivered with a needle can reshape the degree of lateral and inferior projection of the chin. It is important to note, the chin must be carefully shaped to harmoniously connect to the already reflated contours of the pre-jowl sulcus.
Facial contouring with dermal fillers has become one of the most sought after cosmetic procedures. Today’s robust portfolio of HA dermal fillers makes it is possible to enhance features (such as the lips) and contour to improve shape and proportions of the face and jawline.
About the author
Jennifer Pearlman, MD CCFP FAARM ABAARM NCMP CFA
Dr. Pearlman is an internationally recognized expert in women’s health, aging and cosmetic medicine. She is owner and medical director of PearlMD Rejuvenation in Toronto, Canada and staff physician at Mount Sinai Hospital in Toronto.