The new trends ands demands in terms of facial contouring

Dr Nicolas Georgieu

“In the aesthetics field, a medical or surgical procedure is deemed a success when it is not obvious a procedure has been performed.”

Why treat the chin and the jawline?

Aesthetically-speaking, the chin provides support for the lower face and reflects the light. The contours and shape of the jaw determine the harmony of the face. Its morphology has both emotional and psychosocial consequences, for example a well-defined chin and jaw are a sign of dynamism and even virility in men, especially in the USA. Conversely, any disharmony in the lower third of the face can have a negative impact on the face’s beauty index. In fact, when the aesthetic unit of the lower face is absent (retrogenia) or unsightly, it has repercussions on the face as a whole; it is a key factor for beauty and charm.

How to define an ideal lower face?

There are various cephalometric points of reference: The Jacobson’s angle, for example, evaluates the convexity or concavity of the face. This angle is formed between the glabella, the subnasal and the pogonion. Various lines – Steiner, Holdaway, Ricketts, Burton – also allow us to assess the profile.

Static and dynamic analyses:

Static analysis:

Highlight a fl aw in the bony support structure.
Measure the relationship between the upper lip/chin and the lower lip/chin.
Assess the lateral volume of the chin and the gonion.
Perform a profi lometric analysis using the reference lines.
Evaluate the occlusive, skeletal and dental relationships.
The total vertical proportion and the chin/lip proportion affect the profile’s harmony.
Objectify the relationship between the different lengths/ widths between men and women.
Evaluate the cervicomental angle: 121° in women/ 126° in men.

Dynamic analysis:

Differentiate between skin sagging and muscle hyperactivity (DAO) which accentuates the marionette lines.
Highlight any hypercontraction of the mentalis muscle which increases aging in the chin.
Make the master muscle contract.

Analyse aging: Aging occurs at all levels:

Skin:

Fewer collagen and elastin fibres.
Loss of elasticity and hydration.

Appearance of wrinkles “at rest”.

Fat:

The loss and migration of fat modify the volumes and shape of the face.
The middle third of the face collapses, the V becomes inverted.
Appearance of under-eye hollows, the tear trough, nasolabial folds and marionette lines become more severe, jowls appear, and the oval becomes less defined.

Muscle:

Repetitive movements, expressions and increased tonus at rest.
Accentuated wrinkles, furrows and hollows.

Bones:

Bone resorption which contributes to facial collapse.
The face hollows out.
The angles are eroded (cheekbones, lower jaw, chin).

Adapt to demand: Seniors

They tend to want to recover their facial harmony, for a boost of youthfulness. They want a more radiant, dynamic, less tired-looking face. They want a lift, to reshape any “sagging” volumes, and want to redefine their oval which highlights the face’s features. The keyword is “a natural appearance”. This is a demand we are used to hearing.

Influence of young people

Younger, “normal” patients, often Millennials, seek improvements that will beautify their face with natural and discreet results: correcting under-eye shadows, balancing out the lips, hydrating or plumping the lips (glossy lip), nose correction, mesotherapy for hydration or a radiance boost…

Millennials, Generation Y and Generation Z (born between 1985 and 2005), during the digital era, are addicted to injections and are highly influenced by fashion, reality TV and social media (YouTube, Instagram influencers, etc.).

What’s new?

The natural look is no more; Millennials are imposing new codes:

Exposing their face to the world: They film their procedures, take selfies, etc. and post them online (Instagram, Snapchat).
They have no fear of overdoing things; they want the work to be noticeable, to look more attractive, more photogenic.
They are obsessed with their own image, Millennials see them-selves through face-changing filters (Snapchat, TikTok, etc.).
They ask for corrections that are excessive in relation to our beauty standards and the face’s balance.
They have a considerable budget.
They are very well informed.

Young people’s demands in terms of volumes:

They want a “contouring” look, whose aim is to accentuate the existing volumes in the stronger areas of the face, to attract light:

More prominent cheekbones, cheeks in the shade
Perfectly straight nose• Lifted tip of the eyebrow
No visible under-eye shadowsJawline contouring is a trend from the USA.The aim is to make the jaw squarer, for a stronger face.This technique involves highlighting the angle of the jaw and thus making the chin project more.

What product to choose?

Hyaluronic acid that creates and restores volume and has the ability to lift the tissues, with high cohesiveness, visco-sity and elasticity. Subperiosteal injections into the pogonion and gonion under the jaw. Deep subcutaneous injection into the labial-chin furrow, expression lines, line of the jaw.

Amount:,Into the chin:

2 to 3 syringes for the chin in one or several goes.
Ideally using a needle.Into the Jawline
1 to 2 syringes
Inject using a cannula in a retrotracing pattern
Bolus into the gonion (0.5ml)

Allergan study: This study shows an average volume injection of 3ml for the chin area.In conclusion, this is an important area to be treated as it has a significant impact on the harmony of the face.There is currently a very high demand from younger patients. Is this a temporary trend or a long-lasting phenomenon? Should we fulfil these requests? Each doctor must judge according to their own vision, their own sensitivities, their own limits, but we must also act as advisors for these young patients, who we will be treating for many years.

Dr Nicolas Georgieu: Doctor Nicolas Georgieu is an aesthetic surgeon, qualified in plastic, reconstructive and aesthetic surgery. He has carried out both surgery and aesthetic medicine for 20 years on the Basque coast. A medical consultant, expert, trainer for laboratories.