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As with all aesthetic treatments, it is important to understand the anatomy of the treatment area (and the underlying anatomy of aging) thoroughly. Anatomical knowledge is essential to the success of an aesthetic treatment. When treating the jawline of male patients, doctors should take a systematic approach while considering the underlying anatomy. This allows any potential issues to be managed in a controlled manner, ensuring the safety of patients.
Formed from two halves that are fused in the mandibular symphysis midline, the mandible establishes the foundation of the jawline. In terms of anatomy, it is made of a curved tooth -bearing body that extends from the midline symphysis (with the mental protuberance), inferiorly, to the ramus, laterally. Consisting of two lateral mental tubercles and a central depression, the mental protuberance forms the chin. The ramus is known to project superiority with two different processes, namely the condyle process and the coronoid. The condyle process is topped by the articular surface and it forms the temporomandibular joint (or specifically, its mandibular part). On the other hand, the coronoid process is where the temporal muscles attach to. The mandibular notch can be found between the two processes of the ramus. The large masseter muscle is the main component of the fleshy part of the lateral jawline (which is palpable on examination). It is attached to almost the whole surface of the ramus of the mandible. The bulk of the masseter usually decreases with age.
Furthermore, the body of the mandible can provide an attachment or origin for a number of tissues. This includes the orbicularis oris originating from the incisive fossa and mentalis. The depressor labii inferioris and depressor anguli oris are attached to the oblique line superiorly, while the platysma muscle is attached to the line inferiorly. On each side, there are two important foraminae which transmit the inferior alveolar branches (located at the mandibular branch of the trigeminal nerve). The nerve goes into the mandible through the mandibular foraminae of the ramus, from behind the deep surface of the lateral pterygoid muscle to the masseter’s deep surface.
The nerve travels in the mandibular canal in the body of the mandible. It forms the branches that supply sensation to the teeth and exits the bond as a mental nerve (along with the mental blood vessels) through the mental foramen, supplying sensation to the lower lip and chin. Located lateral to the mental tubercles, the mental foramen changes its direction with age. It is anterior-facing during childhood, and posterosuperior during adulthood.
When it comes to injectables for jawline contouring, doctors should also consider the salivary glands of the face and the superficial fat pads. The size of parotid gland differs among patients, and it is superficial to the masseter and the ramus of the mandible. Often, the parotid gland extends to the deep surface of the ramus posteriorly. The gland consists of a parotid duct (which pierces the buccinator muscle to open at the level of the second maxillary molar into the vestibule of the mouth). Furthermore, it contains the main branches and trunk of the facial nerves.
Superficial lamina of the deep cervical fascia is superficial to the gland. Posteriorly, it is in close proximity with the greater auricular nerve. The lateral temporal cheek fat pads, on the other hand, lie superficially to the parotid gland (and anteriorly to the middle fat pad compartments). The inferior and superior mandibular (or jowl) lie anteriorly over the anterolateral surface of the mandible body. The fat pads are separated by several important ligaments and septae that are responsible for the major signs of aging observed in the lower part of the face. This includes the mandibular cutaneous ligament (which tethers the skin anteriorly to the jowl fat pads and the bone, resulting in the groove anterior to the jowl with the descent of the fat pads), and mandibular septum (which is attached to the anterior surface of the mandible body and splits the neck fat from the jowl fat pads).
The facial artery branch of the external carotid runs over the superficial surface of the mandible deep to the zygomaticus major, risorius and platysma. It lies rather superficially and is crossed superficially by the facial nerve branches. The facial artery branch of the external carotid is also found deep in the superficial fat pads of the face, running superomedially in a tortuous manner across the face.
In order to minimize the risk of damage, it is important to consider the direction and location of the nerves when choosing the most appropriate injection techniques and tools (e.g. needle or cannula).
When treating the male jawline with injectables, doctors should always note and mark the point at which the branch crosses the mandible border, as this area tends to palpate easily. This is to prevent damage/intraarterial injection.
When injecting into this area, doctors should also consider the marginal mandibular branch of the facial nerve. The branch runs deep to the depressor anguli oris and the platysma and is always superficial to the anterior facial vein and facial artery. Furthermore, it is known to cross the mandible border from the neck around three centimeters anterior to the angle of the mandible. The marginal mandibular branch is involved in the communication with the inferior alveolar nerve. At the same time, it helps to provide motor supply to the mentalis, depressor anguli oris and depressor labii inferioris.
Developmentally speaking, all faces start as female phenotypically. Then, under the influence of testosterone (which increases significantly during puberty in male), secondary characteristics will develop.
This includes generally more muscle bulk, increased definition of the ramus and angle of the mandible, and a substantially stronger, larger, and heavier-set jawline. In general, the chin of a male individual is more square and wide (rather than V-shaped commonly seen in women). When performing contouring procedures, it is important to individualize the treatment through careful assessment. More importantly, doctors should take a different approach when treating male patients. They should keep in mind that the desirable jawlines in male and female patients are fundamentally different. This will help to prevent inadvertent feminization of the jawline features.
Women tend to seek cosmetic treatments more frequently than men, which often leaves medical professionals less experienced in treating male patients. Many doctors tend to apply the same treatment technique as they would for women, resulting in a feminine jawline. Unless specifically requested by patients themselves, doctor should avoid feminizing the jawline in male patients.
In both males and females, the lower face will undergo several changes due to the natural aging process. This includes increased skin laxity; mandibular bone resorption (especially with the loss of dentition with advancing age); descent of mandibular fat pads into the neck; dehiscence of the mandibular septum; descent of the jowl fat pads; loss of volume and descent of the mid face structures. The descent due to volume loss can be accelerated by the downward pull of the strong platysma muscle and gravity. Jawline contouring is able to improve these undesirable signs of aging, significantly enhancing the overall facial appearance.In both males and females, the lower face will undergo several changes due to the natural aging process. This includes increased skin laxity; mandibular bone resorption (especially with the loss of dentition with advancing age); descent of mandibular fat pads into the neck; dehiscence of the mandibular septum; descent of the jowl fat pads; loss of volume and descent of the mid face structures. The descent due to volume loss can be accelerated by the downward pull of the strong platysma muscle and gravity. Jawline contouring is able to improve these undesirable signs of aging, significantly enhancing the overall facial appearance.
The second goal of the treatment is to correct the overall signs of aging. This can be done by replenishing the lost volume. Regardless of gender, jawline contouring is an effective way of enhancing the overall facial aesthetics. In male patients, a jawline treatment helps to create a more masculine, defined look. Apart from enhancing the definition of the mandible, jawline contouring creates a strong, square chin (which is a desirable feature in men). In contrast, contouring treatments with injections for female patients are mainly used to create an almond-shaped face.
As previously mentioned, the treatment priorities for the lower face are to add and augment anatomical deficits and to correct aging-related volume loss. Therefore, the use of injectables in the lower face should be based on the doctor’s perception of the volumetric three-dimensional starting point (which varies among patients). There are a number of projection lines that may be used as guide for chin projection. For example, an imaginary continuous line in the sagittal plane which starts from the menton to the most anteriorly projected part of the lips. The ideal chin should be able to reach this line.
The jawline slope in the frontal view should be almost parallel to a line that extends from the nasal alae to the lateral canthus of the eye. There should be a maximum 15° downward deviation from the line.
For treatment tips, read part two of Contouring the Male Jawline.