Contouring the Male Jawline Part 2

Traditionally, women have been the main demographic of aesthetic treatments, making up the majority of patients seeking jawline contouring procedures. However, in recent years, the number of male patients has been increasing rapidly. In last year alone, there was a 10 to 15 percent increase in men who seek filler injections. This could be driven by an increased media coverage (especially on social media), or increased awareness of the use of fillers in general. The most popular aesthetic treatments among male patients include mid face treatments, lip fillers and chin and jawline contouring treatments.

Considering the rising popularity of jawline contouring in male patients, it seems logical to explore the treatment in depth. In this article we will discuss the main treatment modalities used for jawline contouring.

Selecting patients for jawline treatment

As with all cosmetic procedures, appropriate management of expectations and patient selection are the keys to treatment success. In most cases, male patients who seek jawline contouring treatments are those who are highly body conscious. Most of the patients take their body image very seriously. Not surprisingly, some patients may exhibit

symptoms of body dysmorphia.

Body dysmorphia (or body dysmorphic disorder) is a psychological condition characterized by obsessive thoughts about real or perceived flaws. Patients with body dysmorphic disorder are unable to control their negative thoughts, which tend to cause significant emotional distress to the point that their daily functioning is severely interrupted. Prior to the procedure, it is essential to educate patients about the limitations of the treatment. Therefore, it is important to check their medical history thoroughly. Doctors should screen a patient for body dysmorphia when deemed necessary.

Consultation

During the consultation, doctors should discuss patient expectation, and set up a realistic treatment goal. When treating the jawline using dermal fillers, patients should be made aware that further corrections may be required after treatment to improve the results. Patients should also understand that the expected treatment outcomes are not necessarily guaranteed. At the same time, they should be aware of the limitations of dermal fillers in correcting any underlying asymmetry. Doctors should also explain why a gradual approach is more appropriate for jawline contouring treatment. Similarly, when contouring the jawline using a HIFU or radiofrequency treatment, patients should be reminded that the results are generally subtle; thus, no particular result can be guaranteed. Patients should only proceed with the treatment if they find these limitations acceptable.

Non-surgical techniques of enhancing the male jawline

Even with the ideals of the male mid face set out (and the ideal angles and proportions in mind), choosing the right products and techniques has proven quite challenging. Due to the unique facial features of each patient, it is important to individualize the treatment and select the techniques and products based on their needs. As with other aesthetic treatments, it is best to take a combination approach when it comes to jawline contouring. For best results, it is recommended to use skin surface treatments in combination with filler injections. When performing the treatment, practitioners should keep in mind whether they are augmenting or replacing volume. This helps to estimate how much filler is needed. As a rule of thumb, less product is required when augmenting facial volume in younger patients.

For jawline contouring treatments in male patients, it is recommended to use a filler with a higher G prime (or G'). This is because the filler will subject to several deforming forces during its lifetime (especially when administered to the masseteric area). G prime, or elastic modulus, refers to the ability of a dermal filler to recover and return to the original shape after shear deformation. A high G prime usually indicates a high viscosity and elasticity. Most practitioners recommend Juvederm Voluma for deep jawline contouring, as it has a high G prime and is reversible. Other fillers such as Teosyal RHA 4 and Restylane Lyft are also recommended for male jawline contouring. Collagen-stimulating fillers are rarely used. Unlike hyaluronic acid fillers, their results are not reversible. This could be troublesome if vascular compromise occurs after treatment.

While injection techniques can be chosen based on personal preference, it is often necessary to use a combination of cannula and needles techniques when it comes to jawline contouring treatment. This is particularly the case for areas around the facial arteries, where some doctors prefer using a cannula. Furthermore, it is oftentimes desirable to perform a gradual augmentation. In order to prevent overfilling, most doctors would space the treatment over several sessions.

Considering the fact that every patient is unique, it is not possible to have a standard rule for jawline contouring in males. Some practitioners prefer to administer boluses of fillers via deep intramuscular injections onto the periosteum in the area of the angle of the mandible. This is usually performed using a needle. Typically, when using two 1ml syringes, 0.3 to 0.5ml should be injected into each side in 2 to 3 points. Alternatively, a bolus of about 0.1 to 0.2ml can be used bilaterally (just anterior to the retaining ligament in the mandibular) for correction of slight defects (if any). It should be emphasized that this is a deep injection. A deep bolus of 0.1 to 0.2ml should be placed onto the surface of each side of the mental process. This helps to square the chin for a more masculine appearance. Sometimes, it is advantageous to use small amount of fillers slightly more superficially with a cannula in the subcutaneous plane along the region of the body of the mandible. Be aware that this may not be appropriate for all patients. Due to the presence of the marginal mandibular branch of the facial vessels and the facial nerve, this is considered a high-risk zone. Injection into this area should only be performed by experienced doctors (and when absolutely necessary).

In addition, neurotoxins (e.g. botulinum toxin) can also be used on this area, especially if drooping of the jowl fat pads is observed. To use neurotoxins, doctors would ask the patient to grimace. This results in the full activation and contraction of the platysma. Then the bands will be marked. The strongest bands are usually that posterior to the retaining ligament of the mandibular. Next, the doctor will inject along the bands. While doing so, make sure that the most superior injection point is at least one centimeter below the jawline. This helps to prevent any accidental relaxation and spread of the mouth depressors. In most cases, a botulinum toxin dose of 20U to 25U is suffice for this area. Please note that this is an off-label use of botulinum toxin and patients should be made aware of this before undergoing the procedure. Similarly, a small dose of neurotoxin can be administered into the mentalis to enhance the chin area. When treating older male patients, consider the laxity of the SMAS and skin. Energy-based treatments including radiofrequency (non-ablative and ablative) and HIFU can be used as adjunctive therapies to mid-face treatment (or injections in this area).

Conclusion

Given the rising popularity of male jawline contouring treatments, doctors should have a good understanding of the desirable facial features in men.

There is no “one size fits all” product and technique when it comes to male jawline contouring treatment. Therefore, it is important to perform a careful assessment and determine the most appropriate treatment based on their needs. Doctors should always individualize the treatment, as each patient is unique and has different facial features. For best results, it is recommended to use a combination of treatment techniques when contouring the male jawline.

As with all aesthetic procedures, appropriate management of patient expectation is the key to a successful treatment. It is important that patients understand the limitations of the treatment and have a realistic, attainable treatment goal.

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