The Art of Restoring the Neck and Jawline
When we think about facial rejuvenation, we often overlook the neck. But the neck is the foundation of the jawline, and if the neck sags or loses volume, the entire lower face loses its definition. The key is to inject strategically, using a combination of deep and superficial techniques to rebuild structure and stimulate collagen. Let me walk you through a comprehensive approach that I have refined over years of practice.
Building the Foundation: The Neck
I start with the neck, using hyperdilute Radiesse in a 4:1 dilution. This gives me a total of 7.5 cc per treatment: 1.5 cc of Radiesse mixed with 6 cc of saline with 2% lidocaine. I use five injection points—two lateral, one medial, and two more on the opposite side—each receiving 1.5 cc. The key is to identify the sternocleidomastoid muscle (SCM) as a landmark. My first insertion point is at the SCM, using a 22-gauge, 50-millimeter cannula with the Easy Guide system. The second point is about 1.5 to 2 centimeters below the first, and the third is more medial, targeting the submental area and central neck.
When I insert the cannula, I always stretch the skin to create a glide plane just superficial to the platysma muscle. The red dot on the cannula faces upward. I advance the cannula all the way to the hub, then perform a small retrograde injection. I then redirect the cannula to create multiple passes, each time depositing a thin layer of product. This is a collagen-stimulating procedure, so I often combine it with radiofrequency or HIFU (high-intensity focused ultrasound) for additional tightening. The goal is to achieve a natural, subtle lift and improved skin quality.
Sculpting the Jawline
Once the neck is addressed, I move to the jawline. Here, I need to correct the loss of bony architecture, especially in the posterior jaw. I use a 23-gauge, 70-millimeter cannula with Restylane Lift, a high G-prime filler. My entry point is the lower jaw, just anterior to the anti-gonial notch (where the vessels are located). I inject in the superficial subcutaneous plane, working along the underside of the jaw to build up the gonial angle and create a new, more defined jawline. Sometimes I also inject into the angle of the jaw itself. I am careful to avoid enhancing the jowls; instead, I fill below the jawline to make the area even with the jowls, effectively creating a "new normal" for the jawline.
After the superficial layer, I switch to a deeper plane. Using the same entry point, I advance the cannula along the periosteum into the pre-jowl sulcus. I turn the red dot downward and inject retrograde to fill this sulcus. Then I move to the deep lateral chin fat, and if needed, into the chin itself. All of this can be done from a single entry point, which minimizes trauma and speeds up recovery.
Refining the Lower Face
Next, I address the marionette lines and radial cheek lines. I use a 23-gauge, 70-millimeter cannula with Restylane Refyne, a filler with excellent tissue integration for expression areas. I enter the skin behind the vessels (which run along the nasolabial fold area) and work in a very superficial subdermal plane. I do a small subcision on the pseudotendon between the depressor anguli oris muscle and the skin, then inject retrograde to soften the lines. For the radial cheek lines, I inject into the buccal area, again staying superficial to the vessels. This technique, which I learned from Dr. Sandrine, provides an overall improvement in skin quality and structure.
I also use the same entry point to reach the lower lip, if needed. By staying in the submucosa, I can fill the entire lower lip from one side, crossing the midline. This is a safe and efficient way to enhance lip volume while maintaining a natural shape.
The Final Touch: The Lips
For the lips, I switch to a 25-gauge, 40-millimeter cannula with Restylane Kiss. I inject along the vermilion border, using a retrograde technique with the red dot upward. I start at the Cupid's bow and work laterally, "milking" the product along the border. Then I go slightly more inferior to fill the submucosa. I use a tadpole technique: a larger amount at the start, then gradually less. For the lower lip, I stop about 12 to 15 millimeters from the commissure to avoid the facial artery. I then repeat the process on the lower lip, staying submucosal and using the same retrograde motion.
When I compare the two sides, the difference is clear. The lips are fuller, more defined, and harmonious with the newly sculpted jawline. The entire procedure is comfortable for the patient, and the results are immediate and lasting, thanks to the collagen stimulation from Radiesse and the tissue integration of Restylane.
One final note: it is not uncommon for one side of the jaw to require more correction than the other. I typically limit the total filler to about 2.5 to 3 syringes per side per visit, but sometimes more is needed. The key is to build the structure gradually, creating a neo-gonial angle and restoring the youthful architecture of the lower face and neck. With careful technique and the right products, we can achieve a natural, rejuvenated appearance that stands the test of time.