What to do to strengthen profile? Chin lipo? Fillers to cheeks? (Photos)

Question

34, female. I’ve always had a weak jawline with a slope connecting the chin/neck area. The face is obviously an entire unit and I am uncertain how to best move forward in preserving youth. I want to restore my heart shape and strenghen my profile. My research points me towards liposuction of the chin area (I don’t have skin laxity yet) and fillers to the cheek to recreate bone loss. What would you do to accomplish a better and yourhful profile? Providing some pictures from different ages

Jason Emer, MD · Answer

This is my expertise and a huge portion of my practice. Asymmetry is normal and expected. Buccal fat pad gives slimming not symmetry. Masseter botox will make you slimmer and make the jawline more loose. Fillers help give shaping and contouring. If you want perfect or close to perfect symmetry you need maxillofacial surgery or implants customized. I suggest seeing an expert to go through all options. Most of my younger clients use fillers to give them shaping especially on the cheeks, jawline, and chin which make the face look more slim and tight; and threads such as PDO or Instalift can build collagen and support the facial shaping and skin looseness over time, slowing down the aging process and given the face a more “snatched” look; and morpheus8 or PiXel8 deep microneedling RF can tighten crepe skin especially on the neck and jawline and is great for long term tightening of the full face, neck and chest; its often used to give the face a slimmer more sculpted look because it tightens the skin and gives lift. an early face lift can be performed as well even in younger clients if they want a different facial shape, maxillofacial surgery with bone breaking or shaving can also be done. For facial slimming a combination of treatments are always needed. Options include: 1. Buccal fat pad removal to reduce fat on the lower face 2. Factite or Renuvion/J Plasma to tighten the lower face, jawline, and chin to reduce fat and give the jawline and neck tightening and shaping. 3. Botox to the masseter to reduce the muscular size of the jaw giving the face an illusion of being more slender 4. Fillers to the jawline, chin, cheeks, temples and brow help to shape the face and make it more angled and defined Always use at home derma rolling (see link to Emerageskin x anteageMD roller plus stem cells/hyaluronic acid ampules) and peels like emeragecosmetics enlighten or aerify that can be used to improve skin quality and tighten the skin while improving wrinkles, pigmentation, acne, and Melasma. See an expert who does facial shaping with surgical and non surgical methods to get a comprehensive option. Best, Dr. Emer.

Daniel Barrett, MD · Answer

Dear enpotatis,
it is hard to tell for sure without an examination. If you are considering surgery, I would suggest you consult a board-certified plastic surgeon. Only after a thorough examination, you will get more information and recommendations.
Daniel Barrett, MD
Certified, American Board of Plastic Surgery
Member, American Society of Plastic Surgery
Member, American Society of Aesthetic Plastic Surgery

Mats Hagstrom, MD (license on probation) · Answer

If you look at your last picture the relationship of your chin to your bottom lip is exactly the way it should be. Compared to perfect facial aesthetics there is a slight facial skeletal imbalance in the body of your mandible.
Most likely have a dental overbite occlusion that goes with it. The correct advancement of your mandible should be behind your molars. A giant vestment is something most people don’t want to undergo so they look for easier options like augmenting the chin.
Augmenting the chin is fine if the problem is in the chin.
The chin is also called the mentalis region of the mandible.
If you give horizontal advancement to your mentalis region you will deepen the soldiers at the base of your lower lip and develop a more acute labiomental angle. Facial aesthetics are almost purely based on facial skeletal structure. Soft tissue covering of the facial skeleton tends to be very consistent from person to person. What allows us to differentiate and identify individuals as being unique including their appearance is almost purely based on facial skeletal structure.
Soft tissue manipulation can give good results mimicking better bone structure in areas where is needed. It can however not advance your mandible when the problem is in the body of the mandible not in the mentalis.
Liposuction works very well in the chin and neck region for people who are young, pudgy and have tight skin. The reverse is also true.
You don’t look like you have a lot of fat to remove in your chin and neck region. you should also consider that Liposuction is unfortunately perceived as being a simple and safe procedure by the general public and a substantial number of providers.
The truth is delivering consistent quality liposuction results is far more difficult than people believe and this definitely includes a lot of plastic surgeons who think they’re better at liposuction than they actually are.
Having mastered liposuction includes not only doing the procedure well but also at the ability to accurately assess and predict outcomes accurately and consistently.
There should be no wavering and the hands of someone who knows what they’re doing.
A talented provider was efficient experience should be able to assess a patient and know in advance accurately what the results will look like with any certain procedure and then be able to show numerous before and after pictures of similar patients who had similar facial characteristics.
In reality this tends to not be the case.
Providers will show preselected results representing the best results of their career which almost always happen to be patients who were ideal candidates. 
A patient goal during a consultation should include getting a clear understanding of what average results look like in the hands of each provider and how many of these procedures that provider has performed and is currently performing on a regular basis.
To do that I suggest patients start the process by having multiple in person consultations with local board-certified plastic surgeons who seem to have a knack for doing liposuction. you can start the process by simply looking at how many before and after pictures providers have on their website for the procedure you’re interested in. Make sure there were no other secondary procedures like Liposuction “with a facelift”. During the consultation ask each provider to open their portfolio and show you their entire collection of before and after pictures. Providers may be apprehensive to do so but recognize that you are the one hiring the plastic surgeon and you have a full right to vote the provider and get confirming information regarding what average results look like and the number of cases that actually performed. being shown a handful of sample pictures isn’t going to do that.
I tend to go on about these things and the only reason is I’ve seen too many people disfigured from Liposuction to recognize the procedure should be taken very seriously.
Liposuction is a permanent and irreversible operation. If done poorly patient cannot correct the outcome with revision surgery. there are of course times where results can be improved but when done poorly patients are going to be stuck with some thing they wish they did not sign up for.
When the body of the mandible does not project as much as it should the origin of the platysma muscle begins closer to the neck and causes to put this on muscle to drape the neck in a more oblique manner. if you look at individuals who have exceptional jawline definition you’ll notice that they tend to have substantial mandibles.
It’s possible to have a Mandible that’s too big and too small at the same time.
Lacking projection in the body of the mandible causes issues with a premature double chin, premature formation of jowls. if the body of the mandible is efficient and these problems are not seen. if the mentalis is lacking in projection the person will have an obtuse labomental angle. A weak chin is different than a small mandible.
A weak chin appears meek and unauthoritative. An overly projecting chin appears masculine and Borders on what’s referred to as a witches chin.
Making facial assessments is a complex process and plastic surgeons have very different ways of viewing the same problem. our colleagues in oral surgery are trained to see things from a skeletal perspective and in many ways they are more accurate in their assessments.
Skeletal manipulation is however something people don’t naturally seek out so people look for softer gentler methods.
In the end what’s important is that a clear understanding of what the problem is. In other words you need an accurate assessment or an accurate diagnosis.
Even this will vary from provider to provider and if you consult with multiple providers expect to hear multiple explanations.
In my experience plastic surgeons typically don’t look at the bone structure as the problem because soft tissue manipulation is always what’s in their toolbox for solutions. The exception is working with implants and providers who have experience with craniofacial surgery.
Well done fillers will serve you well but treating your neck is not as easy.
I’m not saying you should or should not have liposuction but recognize that if there’s a little fact to work with the potential change is going to be subtle. I want to also convey the importance of provider selection for liposuction procedures.
For what can be done using fillers alone I suggest taking a look at Dr. David Mabrie’s website. his office is in San Francisco. I’m not suggesting people fly to San Francisco to have fillers but he has an impressive number of before and after pictures on his website. Dr. Mabrie is a facial plastic surgeon whose practice is devoted exclusively to only working with fillers. His work is some of the best I’ve ever seen.
His results can serve as a reference point or gold standard of what can be achieved without surgical intervention.
Good luck,
Mats Hagstrom

What to do to strengthen profile? Chin lipo? Fillers to cheeks? (Photos)

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