Jawline explained Copy

 Jawline

An under formed or weak jawline can be treated very effectively. Dermal Filler can be used on the jawline to create a jawline structure, define & strengthen the chin and lessen the look of jowls, for a tighter look to the lower face.

A celebrity favourite regularly endorsed on social media; in the last three years this treatment has become incredibly popular with clients chasing ‘Instagram ready’ pics!

High density dermal filler creates a defined, contoured & sharp look to the Jawline, for a more perfect looking profile.

Considerations for sculpting the lower face

The accurate placement of an appropriately selected hyaluronic acid (HA) dermal filler at the mandibular angle, in the chin and the peri-jowl region can recreate an aesthetically youthful and structured jawline.

When considering lower third facial treatments, if required we recommend re volumising the upper and middle thirds of the face first, providing superior volumetric support to the jawline.

The key areas to consider are the cheeks and preauricular regions.

It is important to recreate the angular contours as the face transitions inferiorly from the jawline to the neck. In contrast to the mid-face, where soft transitions make for the aesthetical ideal, the jawline should demonstrate relatively sharp and angular transitions to the neck, as a sharp jawline frames the lower third of the face.

To create this look, use a viscous product in (subdermal) layer, to accentuate desired angulations and shadowing.

Furthermore, a HA filler with good soft tissue integration is required to provide lift and superior support. Suitable for jawline treatment such as Revolax Deep and in some case Sub Q  Juvéderm Voluma Princess Volume, Belotero Volume and.

Jawline sculpting can be divided into three main treatment subunits: the angle of the mandible, the chin and the peri-jowl region.

Angle of the mandible

The angle of the mandible is often an overlooked and under treated area. It is on the lateral aspect of the face and is therefore less often noticed in self-portrait photography and patient self-reflection. The mandibular angle can be defined as an angle formed by the junction at the gonion (the midpoint) of the posterior border of the ramus and the inferior border of the body of the mandible.⁴

Radiological studies have demonstrated that females have an average gonial angle of 125 degrees however this is highly variable even between aesthetically attractive individuals. The angle of mandible is a superolateral structure relative to the jowl, and by creating shape and angulation with dermal fillers, volumetric support to the jowls is also provided. When sculpting the jawline, the aim should be to define and enhance a patient’s natural mandibular angle.

Technique– for theoretical reference only. Injection techniques are best observed during your practical training.

1. Identify any volume loss of the pre-auricular space
2. Palpate and mark the angle of the mandible
3. Create an entry point that is superomedial (often 0.5cm) to the angle of the mandible using a 23-gauge needle
4. Mark out the intended inferior border of the ramus and posterior mandibular body

5. Treat using a 25-gauge 5cm cannula and aspirate prior to injecting to check for intravascular entry
6. Perform slow retrograde threads of dermal filler, tightly approximated (0.1ml per thread) to a total of 0.5ml-1ml per side
7. Gentle palpation between the edge of two fingers helps to shape the product for ideal angular contour

Protractor is a great tool to help with the jawline 

Potential difficulties

The facial nerve and parotid gland are at risk during shaping of the posterior mandibular ramus as they are both deep structures, located deep to the superficial muscular-aponeurotic system (SMAS). They can be avoided by injecting in the subdermal plane. When injecting the inferior border of the ramus, be mindful of the facial artery as it courses along the anterior border of the masseter. It is palpable at this point and should be identified and protected prior to injection.

Summary

Goal: To define and enhance the angle of mandible

Depth: Superficial/subdermal

Volume: 0.5-1ml per side

Technique: Cannula technique & needle technique – depending on volume required

Complications

Although the most common complications are lumps, bumps, a blue hue from the Tyndall effect, and hypersensitivity reactions, some complications are more serious.

Swelling

Oedema around the eye is a major complication, and it is not entirely clear why it develops. Some patients are susceptible to it, perhaps because they have pre-existing oedema, and they may develop a little allergic swelling, or they happen to have hypothyroidism or heart disease or some systemic oedema, and they tend to get fluid or chronic allergic swelling. These patients can develop even more of a boggy oedema that can occur early or late after the injection.

CRAO

With dermal fillers in general, central retinal artery occlusion (CRAO) is the worst complication because it leads to permanent blindness. Although CRAO is very rare—believed to occur in only 1 in 10,000 injections—anyone who injects filler should keep this potential disaster in mind.

There are many reports of blindness. For example, a recent case series described CRAO resulting from dermal filler injection to the forehead,¹ and the Korean Retina Society reported on a retrospective study of 44 patients who developed occlusion of the ophthalmic artery or its branches after cosmetic facial filler injections. The authors of the latter study noted that “extreme caution and care should be taken during these injections.”

Most reported cases involve large boluses given within seconds. Patients experience sharp pain and lose vision immediately. It can happen with any filler, including fat, and in almost any area (glabella, nose, nasolabial folds). Recommendations are to inject slowly, don’t use a lot of force, and be aware of the patient’s response. “In the glabellar region (the highest risk area) stay superficial and away from the neurovascular bundles.