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Jawline Sculpting 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.
3. Peri-jowl region
By treating the angle of mandible first, followed by the chin, the soft
Upper tissues surrounding the jowl area (superolaterally and inferomedially)
third
will be slightly tensioned. Hence, less product is required when
focusing our attention to the jowls directly. In my experience, three
Middle perpendicular dermal filler threads can adequately shape the inferior
third
edge of the mandibular ramus.
Lower
third
Technique
1. Identify the borders of the jowls and be mindful not to
Figure 2: The division of the face into vertical fifths and horizontal thirds8
volumise the area (Figure 3)
2. Palpate and mark the pogonion of the chin and the angle of
2. Chin contouring mandible
For ideal facial proportions, the face is generally divided into equal 3. Mark out lines that connect the angle of mandible to the
vertical thirds (upper, middle, lower) and horizontal fifths. The ideally pogonion of the chin, representing the inferior edge of
proportioned chin width is said to occupy the central horizontal fifth of ramus
the face.7 A one third to two thirds ratio should exist for the distance 4. Aspirate to check for intravascular cannulation
between the nasale and superior upper lip border to the inferior lower 5. Slow retrograde threads tightly approximated of dermal filler
lip border to the pogonion.7 When contouring the chin, start with a product of 0.1ml per thread to a total of 0.5ml per side
focused assessment of chin length, anterior projection and the depth 6. Gentle palpation between the edge of two fingers helps to
of the pre-jowl sulcus region. Rickett’s Esthetic Plane connects the tip shape the product for ideal angular contour
of the nose to the pogonion of the chin and states that the upper lip is
an average distance of 4 mm to this line and the lower lip is an average Potential difficulties
distance of 2 mm.9 I use Ricketts’ Esthetic Plane9 as an assessment Be careful not to place any volume within the jowls as, in
guide to the overall relationship between the tip of the nose, the lips my experience, this will act to worsen the pre-jowl sulcus.
and pogonion of the chin for lower third facial harmony. The rule of The mental artery, nerve and the facial artery must also be
facial thirds can be applied to determine if the chin requires elongation.7 considered during treatment of this subunit and have been
However, as a general principle, ageing causes mandibular resorption previously discussed.
and is associated with hyperactivity of the mentalis.2 These factors all
contribute to a shortened chin and a less projected lower facial third. Summary
Goal: To straighten and sharpen the jawline by camouflaging
the jowl
Technique Depth: Subdermal
1. Assess the contour deformity in the pre-jowl sulcus, the Volume: 1ml total
mental crease, and the mentalis muscle Technique: Cannula for subdermal
2. Palpate and mark the pogonion of the chin Products of Choice: Restylane Volyme or Restylane Lyft
3. Improve the projection and length of the chin with deep
dermal fillers via sharp needle using a high G prime product
in the deep periosteal plane
4. For cannula treatment, choose an entry point that allows
access to the pre-jowl sulcus
5. Aspirate to check for intravascular cannulation
6. Slow retrograde threads, in a spread fanning technique
(0.1ml per thread) to a total of 0.5-1ml per side
7. Gentle palpation helps to smooth the treated area
Be careful not to place any
Potential difficulties
volume within the jowls as,
The inferior alveolar artery and nerve exiting from the mental
foramen are the main dangers in this area. The mental foramen
in my experience, this will
is commonly located between the first and second premolar
teeth and should be protected from direct injections.10
act to worsen the pre-jowl
Summary
sulcus
Goal: To shape and contour the chin
Depth: Subdermal and periosteal
Volume: 1-2ml total
Technique: Cannula for subdermal and needle for periosteal
Products of Choice: Restylane Volyme or Restylane Lyft
Figure 1: The cannula entry points and the filler thread placement. The arrows indicate the Figure 3: The pre-marking of the jowls. It is important not to volumise the jowls, represented
direction of the cannula. by the area between the lines. The white dots represent the cannula entry points.
Figure 4: Before jawline sculpting and after treatment. Results show improved Figure 5: Before jawline sculpting and after treatment. Results demonstrate a lessening
angulation, contours and definition. Angle of mandible: 1ml Restylane Lyft per side (2ml of the jowls and a sharper, more youthful jawline. Angle of mandible: 1ml Restylane
total) chin contouring: 0.5ml Restylane Lyft per side (1ml total). Defyne per side (2ml total) chin contouring: 0.5ml Restylane Lyft per side (1ml total)
peri-jowl treatment: 0.5ml Restylane Lyft per side (1ml total).
Considerations and complications Dr David Ong is the medical director and masterclass
Jawline sculpting is a demanding treatment area. The heaviness trainer at the Facial Aesthetics Centre for Excellence
(FACE) Academy in Brisbane, Australia. He graduated
and descent of the upper two thirds influence the lower third,2
from the University of Western Australia in 2009 and
often requiring the cheeks, temples and pre-auricular regions to proceeded to specialise in cosmetic injectables in
be pre-treated. It is a large treatment area, requiring a sufficient California in the US before returning to Australia.
volume of dermal filler for complete treatment. This is reflected
REFERENCES
in higher financial cost to patients, who will in turn be looking for 1. Stuzin JM, Baker TJ, Gordon HL. The relationship of the superficial and deep facial fascias: relevance
a higher aesthetic outcome. It should only be attempted after to rhytidectomy and aging. Plast Reconstr Surg. 1992; 89: 441-451.
2. Reece EM, Pessa JE, Rohrich RJ. The mandibular septum: anatomical observations of the jowls in
adequate training. aging-implications for facial rejuvenation. Plast Reconstr Surg. 2008; 121(4): 1414-1420.
The risk of intravascular injection can be minimised by remaining 3. Coleman SR Grover R. The anatomy of the aging face: volume loss and changes in 3-dimensional
topography. Aesthetic Plast Surg 2006; 26: S4-S9.
in the superficial (subdermal) plane or the deep (periosteal) 4. Mandibular Angle. (n.d.). In Merriam-Webster’s Online Medical Dictionary retrieved from <https://www.
planes. Furthermore, I believe aspiration prior to injection can also merriam-webster.com/medical/mandibular%20angle>
5. Pirgousis P, Brown D, Fernandes R. Digital measurements of 120 mandibular angles to determine the
minimise intravascular risk. A benefit of performing treatment with ideal fibula wedge osteotomy to re-create the mandibular angle for microvascular reconstruction. J
HA dermal fillers is the ability to reverse treatment with the use of Oral Maxillofac Surg. 2013; 71 (12): 2169-75.
6. Taleb NSA, Beshlawy ME. Mandibular Ramus and Gonial Angle Measurements as Predictors of Sex
hyaluronidase. Practitioners should be well versed in the use and and Age in an Egyptian Population Sample: A Digital Panoramic Study. J Forensic Res. 2015; 6: 308.
application of hyaluronidase when treating the jawline. 10.4172/2157-7145.1000308
7. Zhang, David et al. Typical Facial Beauty Analysis in “Computer Models for Facial Beauty Analysis.”
Springer International Publishing. 2016.
Conclusion 8. Milutinovic J, Zelic K and Nedeljkovic N. Evaluation of Facial Beauty Using Anthropometric
Proportions. The Scientific World Journal. 2014; 2: 1-8. 10.1155/2014/428250
A straight, youthful jawline is a treatment area commonly requested 9. Ricketts RM. Esthetics, environment, and the law of lip relation. Am J Orthod: 1968; 54:272-289.
by aesthetic patients. At the same time, it is a demanding area 10. Currie CC et al. Determination of the mental foramen position in dental radiographs in 18–30 year
olds. Dentomaxillofac Radiol. 2016; 45(1): 20150195.
that should be approached by experienced injectors with suitable
training. The jawline sculpting technique describes a treatment
progression from the angle of the mandible to chin contouring and
to the peri-jowl region. With a focus on anatomical dangers, this
technique can provide a safe treatment guide to achieving a good
aesthetic outcome for patients.