Botox
22 June 2022
It is well known that the proportions and symmetry of the face have an impact on our perception on a person’s appearance. An easy way to analyse facial proportions is by using the rule of facial horizontal thirds and vertical fifths. The horizontal thirds of the face are divided into the upper third (hairline to glabella), middle third (glabella to subnasale) and lower third (subnasale to chin). The facial thirds are approximately equal.
The neoclassical canon of facial proportions divides the frontal face vertically into fifths, with the width of each eye, intercanthal distance (distance between both eyes), and nasal width all measuring one-fifth one fifth equally.
In Asia, a V shape jaw and chin are seen as feminine beauty ideals. Besides being regarded as beautiful, a V shape jaw and chin are also markers of youth. A youthful appearance is distinguished by the triangle of youth which eventually gives way to the pyramid of age. The triangle of youth is characterised by the following 3 features:
· High cheekbones · Cheek fullness · Well defined jawline
As we age, the soft tissues of the face lose their elasticity, tone and volume. The facial skeleton loses volume and undergoes remodelling of its shape. Fat pads in the face which give the appearance of fullness in youth start to descend, causing fullness between the neck and chin. These changes that occur with aging lead to formation of jowls, saggy skin and poor definition of jawline and this gives rise to the features of the pyramid of aging as characterised by:
· Flattened cheeks · Prominence of the nasolabial folds · Poor jawline definition
Hence, this “V” shape of the triangle of youth gives way to an inverted “V” of the pyramid of age. The base of this pyramid is supported is now defined by a poor jawline definition and saggy jowls.
What are the options for people who wish to correct the appearance of their lower face for a sharper and a younger look? In this post, I will discuss the non-surgical options for a V-shape face. These options range from energy based devices to injectables and threadlift and read on to learn more about their depth and mechanism of action!
There are 2 main types of energy based devices for jaw and chin slimming- High Energy Focused Ultrasound and Radiofrequency
HIFU uses ultrasound to penetrate deep below the skin surface for skin tightening and lifting in a very precise manner without causing damage to the skin. Examples of machines using HIFU technology are Lifthera and Ulthera. Sagging skin along the jaw and jowls are lifted for a sharper and more defined jawline and V shaped face. By reaching layers deep to the skin, the collagen fibres are stimulated and tightened, causing a lifting and tightening effect. Facial felts can also be melted away, causing further enhancement of lifting and jowl reduction.
HIFU also the ability to target different depths (1.5, 3.0 and 4.5mm) to tailor the treatment for patients. At 1.5mm, the dermis is targeted, which eliminates fine lines. At 3.0mm, the deeper dermis and connective tissue is treated for tightening and lifting. At 4.5mm, the superficial musculoaponeurotic system (SMAS) layer that is attached to facial muscles is treated. This is the layer that is treated during a surgical facelift.
After cleansing the face, numbing cream is applied for 20 minutes to reduce discomfort during the treatment. An ultrasound gel is next applied to improve contact and transmission between the HIFU handpiece and the skin. The HIFU applicator tip is then applied to the skin to target the various layers of the skin.
HIFU is safe for all skin types and some patients may see an immediate result although optimal results are seen in 6-8weeks and continue to improve 6 months after treatment. Results last for approximately 1 year
Pros of HIFU · FDA approved for tightening and lifting · Suitable for all skin types · No injections · Natural looking results · Instant results
Cons of HIFU · 6-8 weeks for optimal results
An example of a radiofrequency based device is Thermage, which is used to tighten skin along the chin and jawline to create a slimmer and sharper jaw and chin. The radiofrequency waves target the dermis to remodel collagen and stimulate collagen production. This causes skin tightening and lifting of the jowls and better definition of the chin and jawline. Thermage also has the additional benefit of smoothening skin to reduce the appearance of fine wrinkles.
Pros of Thermage · Natural looking results · Gradual improvement · No injections
Cons of Thermage · Risk of burns · More suitable for mild to moderate sagging
One of the causes of a square shaped face is large jaw muscles. The muscles are located at the sides of the jaw and are used for chewing. This muscle is called the masseter muscle and can be enlarged in certain conditions such bruxism (teeth grinding or clenching). Some people may have a habit of chewing food preferentially on one side and may have asymmetry of their jaw muscles too.
For patients with hypertrophy of the masseter muscles which contributes to a square shaped face, Botulinum toxin (Botox) injected into the masseter muscle can help to relax and slim down the jaw muscles to create a more harmonising, V shaped appearance. Botox of the jaw muscles is also used to treat teeth grinding and jaw muscle asymmetry!
The chewing motion of the jaw is not weakened as there are 3 more muscles that are also involved in chewing. 1-3 injection points may be used, depending on the size of the masseter muscle. It takes approximately 4-6 weeks to see the slimming effect and can last approximately 6 months. To see how jaw botox is done in my clinic in Singapore, please see this review A Guide to A Slimmer V Face: Jaw Botox and Chin Filler review.
Studies have also shown that with consistent relaxation of the masseter muscle with jaw botox over 2 years, the jaw bone (also known as the mandible) undergoes remodelling to form a slimmer shape.
Pros · Fast procedure · Almost no downtime · Minimal discomfort
Cons · Needs 4-6 weeks for maximum results
Besides a slimmer and defined jawline, the chin can be shaped to complete the V shaped look. In Asians, a common trait is a short, stubby and receeding chin, which detracts from ideal facial proportions and a V shaped look. In order to contour the chin, hyaluronic acid (HA) fillers are injected into the chin to accentuate the chin for a V shaped look.
Face Threadlift is a non-surgical, minimally invasive treatment that lifts the skin to sharpen the jawline. Using absorbable materials such as PDO and PLA, threads are placed under the skin to sharpen the jawline. These materials have been used in surgical sutures for a long time and are proven to be safe in the body. Depending on the material used for the threads, the results can last 1-2 years.
The threads work by a 2-pronged method
1. Immediate mechanical lift- especially with threads that contain barbs or cones 2. Regenerative effect- the threads stimulate the skin and tissue to produce their own collagen that has been depleted for a sustained result
The additional benefit of threadlifts are the anti-aging effect with the lift and collagen stimulation. The skin is also lifted and this reduces the appearance of jowls and saggy skin.
Pros of a threadlift · Immediate results · Most obvious results · Minimal downtime · Relatively longer lasting results · Progressive restoration of the skin’s own collagen · Material is absorbed by the body over time
Cons of a threadlift · Risk of thread extrusion and migration
