The Facial Shapes in Planning the Treatment with Injectable Fillers

Abstract

Introduction The facial beauty is not easy to define, yet it is paramount to assess the needs of each patient to propose an appropriate treatment plan that will provide beautification or rejuvenation in a natural-looking fashion. One of the beauty aspects easily recognized is the face shape, which can give a perception of age, gender, and attractiveness, and reflects the facial anatomical structure. Because addressing the structure of the face is the basis for the aesthetic approach with dermal fillers, we find the identification of the patient's face shape to be a very good starting point in the facial assessment. Objective To discuss important aspects of facial beauty, the characteristics of the different facial shapes (oval, heart, round, and angular), and a method of planning the aesthetic treatment with injectable fillers based on the strengths and weaknesses of each morphology of the face, that is called the AB face technique. Methods In this study, we describe seven clinical cases: two cases each of oval, heart, and round, and one case of angular shape. Results The evaluation of the face shape can help us define the priorities of the aesthetic approach, determining the areas that need to be restored in the aging face, as well as which areas could be enhanced in the younger patient. Conclusion This approach can be helpful in proposing the aesthetic treatment plan with injectable fillers to provide beautification, rejuvenation, and enhancement of the facial structure, which may benefit facial contours through aging.

Keywords: botulinum toxin; dermal filler; face; facial rejuvenation; nonsurgical.

Fig. 1

The face shapes: angular, heart, oval, and round. It is important to mention that the angular shape does not refer to a specific geometrical figure, as the angles may vary.

Fig. 2

AB face structure: the anatomical areas of treatment. In the midface, the appropriate injection depth is subcutaneous deep and superficial. The possible planes of injection in the mental and prejowl areas are subcutaneous deep and superficial, whereas the jawline and jaw ramus should be treated as subcutaneous. The recommendation is to use a 22-gauge cannula.

Fig. 3

The aging process in the different face shapes. This image illustrates that each face shape ages differently. This is the reason that the treatment plan varies among the distinct shapes.

Fig. 4

The treatment plan for the oval face shape: it is possible to structure it into a more angular shape, or the treatment with injectable filler may be used to enhance the oval, aiming to improve the facial contours. In general, the volume of filler is distributed in the following proportion: 45 to 50% in the middle third and 65 to 50% in the lower third.

Fig. 5

Clinical case of a patient with an oval face shape treated with the AB face technique to structure the face into a more angular shape. Hydryalix ultradeep hyaluronic acid with high elasticity was used in the following areas: malar lateral (0.8 mL), malar prominence (0.8 mL), zygoma medial (0.8 mL), zygoma lateral (0.6 mL), mental (0.8 mL), prejowl (1.2 mL) (total: 5 mL; four syringes). Harmonyca, two syringes of 1.25 mL was used in the jawline (1.25 mL) and ramus (1.25 mL). The refinement technique was performed with Hydryalix deep, with medium elasticity, 1.25 mL in the nasolabial and labiomental folds. Total volume used: 8.75 mL.

Fig. 6

Clinical case of a patient with an oval face shape treated with Harmonyca using the AB face structure technique to rejuvenate the face. Total volume used was 7.5 mL: 2.5 mL in the midface and 5 mL in the lower face (malar lateral: 0.6 mL; malar prominence: 0.6 mL; zygoma medial: 0.6 mL; zygoma lateral: 0.6 mL; mental: 1 mL; prejowl: 1.2 mL; jawline: 1.5 mL; ramus: 1.3 mL). The AB face refinement was not performed in this case.

Fig. 7

AB face technique treatment plan for the heart-shaped face. It is possible to restore the volume and enhance beauty without changing the shape or alternatively to structure into a more oval or angular face shape. In general, the volume of filler is distributed in the following proportion: 20% in the middle third and 80% in the lower third of the face.

Fig. 8

Clinical example of a patient with a heart-shaped face treated with Harmonyca using the AB face structure technique. 8.75 mL of the product was used (seven syringes), 1.75 mL in the midface and 7 mL in the lower face: malar lateral (0.6 mL), malar prominence (0.6 mL), zygoma medial (0.6 mL), mental (1 mL), prejowl (1.4 mL), jawline- (2.4 mL), and ramus (2.2 mL). The refinement was performed with Hydryalix deep, 1.25 mL in the nasolabial and labiomental folds. Total volume used: 10 mL.

Fig. 9

Clinical example of a patient with a heart-shaped face treated with Harmonyca and Hydryalix ultradeep, deep, and gentle (hyaluronic acid filler of high, medium, and soft elasticity, respectively), using the AB face technique (structure and refinement). Hydryalix ultradeep was used in the middle third (1.25 mL): malar lateral (0.45 mL), malar prominence (0.4 mL), and zygoma medial (0.4 mL). Harmonyca was used in the lower third (3.75 mL): mental (0.6 mL), prejowl (0.6 mL), jawline (1.25 mL), and ramus (1.25 mL). Hydryalix deep, 1.25 mL, was used in the nasolabial and labiomental folds. Hydryalix gentle, 0.6 mL, was used in the nasojugal groove. Total volume used: 6.85 mL After the treament, with a more angular face shape.

Fig. 10

AB face technique treatment plan for the round-shaped face. The treatment with injectable fillers enhances the structure without changing the shape or may elongate the face into a more oval shape. In general, the volume of filler is distributed in the following proportion: 30% in the middle third and 70% in the lower third of the face.

Fig. 11

Clinical example of a patient with a round-shaped face treated with Harmonyca and Hydryalix deep and Hydryalix lips, hyaluronic acid filler, using the AB face technique (structure and refinement). After the treament, with volume restoration, improved contours of the face and a more oval face shape. Five syringes of Harmonyca, 6.25 mL, were used In the midface (1.85 mL): malar lateral (0.45 mL), malar prominence (0.4 mL), zygoma medial (0.6 mL), and zygoma lateral (0.4 mL). In the lower third (4.35 mL): mental (1 mL), prejowl (1 mL), jawline (1.2 mL), and ramus (1.2 mL). Hydryalix deep, 1.25 mL, in the nasolabial and labiomental folds. Hydryalix lips, 1.25 mL, in the superior and inferior lips. Total volume used: 8.75 mL.

Fig. 12

Clinical example of a younger patient with a round shape face treated with Harmonyca and Hydryalix deep using the AB face technique (structure and refinement). After the treament, with improved proportions and contours of the face and a more oval face shape. Five syringes of Harmonyca, 6.25 mL, were used. In the midface (1.9 mL): malar lateral (0.4 mL), malar prominence (0.6 mL), zygoma medial (0.6), and zygoma lateral (0.2 mL). In the lower face (4.4 mL): mental (1.4 mL), prejowl (1 mL), jawline (1 mL), and ramus (1 mL). Hydryalix deep, 1.25 mL, was used in the nasolabial and labiomental folds. Total volume used: 7.5 mL.

Fig. 13

AB face technique treatment plan for the angular shape face. The technique can be used to restore volume loss and enhance beauty, keeping the angular shape or to soften into a more oval shape. In general, the volume of filler is distributed in the following proportion: 40% in the midface and 60% in the lower third of the face.

Fig. 14

Clinical example of a younger patient with an angular shape face treated with Harmonyca and Hydryalix deep and gentle, using the AB face technique (structure and refinement). A total of 3.75 mL of Harmonyca were used. In the midface (1.6 mL): malar lateral (0.6 mL), malar prominence (0.4 mL), zygoma medial (0.3 mL), and zygoma lateral (0.3 mL). In the lower face (2.2 mL): prejowl (0.6 mL), jawline (1 mL), and ramus (0.6 mL). Hydryalix deep, 1.25 mL, was used in the nasolabial and labiomental folds. Hydryalix gentle, 1.25 mL, in the nasojugal groove and eyelid cheek junction. Total volume used: 6.25 mL.

Fig. 15

The treatment areas are shown in colored spherical and elliptical figures. The size of each figure relates to the relative volume of filler needed for the treatment compared with the other areas. The larger the figure, the larger the amount of product needed for that particular region. Of note, there is a different treatment plan for each shape in terms of priorities. For example, the priorities in the heart shape are in the lower face, whereas in the angular shape, the priorities are in the midface. In the round face, the whole jawline is generally not treated.

Fig. 16

The anatomical facial areas that can be treated in the refinement approach with fillers, AB face refinement. The recommendation for this technique is to use 22- to 25-gauge cannulas.