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. 2023 Jun 14:16:1521-1532.
doi: 10.2147/CCID.S405639. eCollection 2023.

Assessment and Treatment Strategies for the Aesthetic Improvement of the Lower Face and Neck

Annie Chiu  1 , Vince Bertucci  2 , Daniel Dal'Asta Coimbra  3 , Dan Li  4
Affiliations

Assessment and Treatment Strategies for the Aesthetic Improvement of the Lower Face and Neck

Annie Chiu et al. Clin Cosmet Investig Dermatol. .

Abstract

Background: Interest in aesthetic rejuvenation of the lower face and neck is growing, but published expert guidance is limited.

Objective: Review aesthetic concerns of the lower face and neck and provide expert guidance on evaluation and treatment.

Methods: Twelve international experts participated in an advisory board on lower face and neck aesthetic treatment. They completed a premeeting survey and met twice, reviewing responses and discussing patient evaluation and treatment strategies. They developed decision tree algorithms on patient assessment and treatment planning and sequencing, using clinical cases as a reference.

Results: Treatment concerns include neck and lower face skin laxity, structural bone deficiency, insufficient or excess volume, submental fat, jowls, platysma bands, and masseter muscle prominence. Advisors agreed that the lower face and neck may be the most challenging areas to assess and treat; treatment goals include lower facial contour and overall facial harmony/balance. Advisors recommended first ruling out a surgical approach, then determining whether midface treatment is needed to support the lower face, and lastly evaluating the lower face for significant submental fat, excess or insufficient volume, and structural bone deficiency. To treat the lower face and neck, an anatomical layer approach, moving from deep to superficial layers, beginning with structural support, was recommended. Assessment and treatment decision trees were based on this approach.

Conclusion: The lower face and neck are important but underrecognized areas of aesthetic concern. This article provides expert guidance and a suggested algorithm for assessment and treatment aimed at achieving satisfying and harmonious facial aesthetic results.

Keywords: Chin; algorithms; decision trees; jaw; patient satisfaction; plastic surgery; treatment outcomes.

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Conflict of interest statement

Vince Bertucci: advisory board member, paid consultant, clinical trial investigator, and/or speaker for Allergan Aesthetics, an AbbVie Company, Cutera, Evolus, Merz, Galderma, Prollenium, Revance, and Teoxane. Annie Chiu: advisory board member, paid consultant, speaker, and clinical trial investigator for Allergan Aesthetics, an AbbVie Company, Galderma, Revance, Merz, Cynosure, BTL Aesthetics, and Solta Medical. Daniel Dal’Asta Coimbra: advisory board member and speaker for Allergan Aesthetics, an AbbVie Company, and Galderma. Dan Li: advisory board member for Allergan Aesthetics, an AbbVie Company. The opinions expressed in this article are those of the authors. The authors received an honorarium for their participation in the advisory board but received no honorarium or other form of financial support related to the development of this article.

Figures

Figure 1
Figure 1
An alphabetical listing of the aesthetic concerns of the lower face and neck in clinical practice.
Figure 2
Figure 2
Considerations for initial clinical evaluation of patients for aesthetic treatment of the lower face and neck.
Figure 3
Figure 3
Nonsurgical treatment options for the lower face and neck.
Figure 4
Figure 4
(A) Decision tree illustrating considerations for initial clinical evaluation of patient candidacy for surgical correction of lower face/neck; (B) case example of a Hispanic female, 59 years of age, with neck and lower facial aesthetic concerns, which may be most effectively addressed by a combination of nonsurgical (eg, chin retrusion and poorly defined gonial angle) and surgical treatment (eg, skin laxity, mandibular bone loss, blunted mandibular angle, and prominent melomental folds, jowls, and submental fat). Photos courtesy of V. Bertucci, MD.
Figure 5
Figure 5
Decision tree illustrating considerations for clinical evaluation of patient candidacy for initial midface treatment.
Figure 6
Figure 6
(A) Decision tree illustrating considerations for clinical evaluation of structural bone deficiency in the lower face of patients; (B) case example of a female patient 53 years of age with structural bone deficiency in the lower face. Photos courtesy of D. Li, MD.
Figure 7
Figure 7
Continued.
Figure 7
Figure 7
(A) Decision tree illustrating additional considerations for clinical evaluation of aesthetic concerns and potential treatments in the lower face/neck; (B) case example of female patient 44 years of age with masseter muscle hypertrophy, parotid hypertrophy, skin quality issues, chin retrusion, and excess fat. Photos courtesy of D. Li, MD.
Figure 8
Figure 8
Case example of Caucasian male patient 32 years of age treated for aesthetic concerns in the lower face and neck (A) before treatment and (B) 60 days after filler treatment to address structural bone deficiency. The patient received hyaluronic acid injections (Juvederm® Volux™, Voluma™, and Volift™; Allergan Aesthetics, an AbbVie Company, Irvine, CA) in the lower face according to the schematic shown in (C). Photos courtesy of D. Coimbra, MD.
See this image and copyright information in PMC

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