A Unified Approach to Facial Contours and Volume Correction: The Role of the Cheek and the Chin

Abstract

Background: Facial proportions and contours influence perceptions of beauty and youthfulness. In particular, the shape and definition of the midface and lower face impact the overall appearance of the face.

Methods: This review provides anatomical evidence to support a holistic approach to facial analysis and rejuvenation that starts with assessment and treatment of the midface and lower face to create an aesthetically desirable facial balance.

Results: The cheek and chin can be considered "anchors" or starting points within full-face treatment because of the noticeable impact of their treatment on the definition and contour of the entire face. Age-related changes in the cheek and chin affect overall facial appearance and can produce unintended facial emotional attributes such as looking tired, angry, or sad. Patients seek facial aesthetic treatment typically for a global improvement such as revitalization or genderization of facial features. Best practices in aesthetics have evolved from treatment of individual areas to a holistic paradigm that uses multimodal therapy to improve overall facial emotional attributes. Hyaluronic acid fillers are useful for volume replacement and smoothing abrupt transitions that develop with age throughout the midface, chin, and jaw. A combination of hyaluronic acid filler for volume restoration and sodium deoxycholate and/or onabotulinumtoxinA for volume reduction where appropriate may optimize lower facial contour.

Conclusions: This review highlights the importance of facial angles and contours as well as the significance of panfacial assessments and treatment, focusing on the relationships within areas of the face, specifically the midface and lower face, to optimize results.

Fig. 1.

The “triangle of youth” is a paradigm for facial proportions and contours associated with youth and beauty. A, The upside-down triangle signifies a full and wide midface at the base of the eyes spanning from either side of the cheeks and leading down to a defined chin angle as emblematic of the youthful face. B-C, As aging progresses, the lower face widens from the descent of facial skin, fat, and muscle, reversing the triangle.^,,

Fig. 2.

Contour of the lower face. Changes in facial contour that develop with aging, as illustrated by the midface and lower face, (A) youthful and (B) aged. The youthful cheek exhibits fullness and a smooth, round, uniform shape. The junction from the lower lid to the cheek has a fluid contour with a concave shape. In contrast, the aged cheek is characterized by the formation of grooves resulting from descent of cheek skin, muscle, and fat, revealing segmentation between lid-cheek (brown), malar (red), and nasolabial (yellow) segments. Ogee curve restoration is a typical treatment goal.^,– The youthful lower face is characterized by fixed underlying fat pads, including the anterior of the malar (red) and nasolabial (yellow) fat; firm, elastic skin; and a well-defined jawline (black dashed line). In the aged lower face, jowls and labiomandibular folds, absent in youth, emerge. Jowls form as the skin loses elasticity and the inferior jowl fat pad (dark blue) descends beneath the jawline. Labiomandibular folds arise from the distension of weakened masseteric ligaments and inferior displacement of buccal fat (medium blue).

Fig. 3.

Anatomical landmarks for cheek and chin/jaw rejuvenation.

Fig. 4.

Potential outcomes of cheek and chin treatment. Case example of a Hispanic woman aged 25 years (A–D) before and (E–H) 2 weeks after treatment for aesthetic concerns of the midface and lower face. The patient had chin retrusion with a lack of lip–chin transition, an asymmetric lower face with a smaller angle of the mandible on the right side, and a hypoplastic midface. Fillers were administered as follows: each cheek, VYC-20L HA injectable gel 2 mL (Allergan Aesthetics, an AbbVie Company, Irvine, Calif.); chin, VYC-25L HA injectable gel 2.3 mL (Allergan Aesthetics, an AbbVie Company); right jawline, VYC-25L 0.8 mL; and left jawline, VYC-25L 2 mL. Posttreatment results demonstrated improved facial balance and harmony through better vertical alignment of the forehead, nose, and chin; improvement in the facial profile; improved midface projection; and improved lower facial symmetry and definition. Photographs courtesy of A. Moradi, M.D.