Volume Rejuvenation of the Lower Third, Perioral, and Jawline

Abstract

This is the third and final article discussing volumetric rejuvenation of the face. The previous two articles, Rejuvenation of the Upper Third and Management of the Middle Third, focused on the upper two-thirds of the face while this article focuses on the lower face, including the marionette area, jawline, and neck. Again, the authors of the previous two articles have provided a summary of rejuvenation utilizing a product of which they are considered an expert. Robert Glasgold has provided volumetric analysis of the region as an introduction.

Using injectable fillers for chin and jawline rejuvenation

“…Radiesse is manufactured in prefilled 0.3, 0.8, or 1.5 ml syringes with a gel composed of 30% CaHa microspheres suspended in 70% aqueous solution. Injection volumes and techniques vary with the location of the site and desired effect, however, administration of CaHa is similar to the methods described above for HA 27 . Factors favoring the use of CaHa over HA include thick skin at the site (i.e., near the chin region) and the goal of bony structure definition, as CaHa's incompressible characteristic allows for structural augmentation compared to the more elastic HA filler 28 .…”

“…To improve patient comfort during the procedure, using a massager while injecting has been reported to reduce the sensation of pressure around the prejowl area. 27 After initial modifications to the manufacturing and purification process, adverse events associated with Bellafill are now rare. From…”

“…Using the fanning technique to inject PMMA along the prejowl sulcus, chin, marionette lines, and mandibular region allows for a relatively equal distribution of the filler. To improve patient comfort during the procedure, using a massager while injecting has been reported to reduce the sensation of pressure around the prejowl area 27 …”

Contouring Plus: A Comprehensive Approach of the Lower Third of the Face with Calcium Hydroxylapatite and Hyaluronic Acid

“…The combination of anterior and posterior mandibular volume loss, in conjunction with jowl descent, become more pronounced at the mid-mandibular border, converting the youthful shape jawline to an irregular “W” shape. 7 A genetically underdeveloped chin is also associated with an early loss of definition of the jawline. 11 …”

“… 5 A well-contoured jawline is an aesthetically agreeable feature in both women and men. 6 Among the hallmarks of a youthful lower face include a well-defined jawline coursing smoothly from the mandibular angle to the chin, uninterrupted by the jowl or post-jowl and pre-jowl sulcus, 7 whilst sagging along the jawline is said to be an indicator of facial aging and can have a significant impact on the overall appearance. Hence, rejuvenation of the jawline is becoming part of routine aesthetic practice, and number of procedures targeting this area have increased in the past years.…”