How many times have patients come to you asking for an Angelina Jolie jawline or a Kim Kardashian package? They are desperate to have the important framing features of a jawline. The jaw is an essential part of beauty. The shadow it creates, the way it differentiates the head from the neck, is all part of what makes for feminine or masculine beauty. That is why patients are always seeking it.
But it is really hard. Aesthetic practitioners will struggle with this procedure almost more than any other. The reason is manyfold. It is not simply about injection technique. There are multiple different elements that make a jawline difficult to achieve, or even impossible, in certain patients. As practitioners, the first step is always to understand your patient and what it is that they want. Second, to understand their facial features. Third, to understand your materials and tools, to see if what you have is actually able to create the transformation your patient needs in order to feel happier and more confident.
The Aesthetics of a Good Jawline
Before you even think about injecting a patient, you need to know what you are aiming for. So what are the aesthetics of a good jawline? First, separate between male and female because there is a vast difference.
The male jawline is a much larger structure, broader with stronger angles, more projected, and much more dominant in the face as a whole. The female jawline is much more delicate. It is pointier and narrower in all proportions. It also needs to fit in harmoniously with the flow of the rest of the face. The angle between the cheeks and the jawline must be a feminine angle. If you look at the most projected point of the cheek compared with the most projected point of the jawline in a female, that will form an angle of about 15 degrees. That is male; that is female.
The next thing to consider is how these shapes fit together. The defining points of the chin are narrow and focused in a female and broader in a male. But it is really the planes that flow from this structure that cause what can be called the presentation box of the eyes. Essentially, that heart-shaped face where shadows form a structure that terminates at the chin and spays out to hold the eyes higher up in the face. Someone particularly beautiful like Kate Moss is a good example. She has a very delicate narrow chin at the base but very wide cheeks that project outwards and hold her eyes. This is ultimately what you are aiming for for a feminine jawline.
Why Injecting a Jawline Is So Difficult
Just because you know what a good-looking jawline is does not mean you can now move on to injecting. You need to understand how your injections can either cause more beauty or, unfortunately, the reverse. Starting with male jawlines is actually significantly easier because you are adding volume and angle. This is very easy to do with a dermal filler, for example. You just add more and you get more masculinity. Of course, that is also exactly the reason why females are often more difficult because adding more sometimes adds more femininity but sometimes can add squareness or bulk that makes the female less attractive. So you must select your patients carefully.
What are the types of patients that will come seeking jawline treatments, and how do you manage each one of them differently in day-to-day clinical practice? The biggest problem injectors will have is the patients who essentially want definition because they have excess adipose tissue around their jawline. You cannot see the shape of their skeleton because it is covered by a layer of superficial fat. This is extremely hard to deal with using a dermal filler. There are sometimes where you can make a little difference if they are narrow in a section or have a small chin that you can make bigger, so that it can make the whole jawline look better too. But ultimately, adding definition or detail to a jawline can only be done in slimmer patients or in patients who have naturally very small proportions that you do not mind making bigger.
Where to Place the Needle
If you are going to inject a jawline, where are the common placements? Where should you put the needle in the average female face who needs to be more beautiful or more defined around the chin and jawline area? Although the injection points can look quite similar in different patients, it is really important that you start each procedure with a very clear aesthetic goal. What are you trying to achieve with each injection point? This will help you select the right combination of injection points to get the best result in individual patients.
Typically, when enhancing a female jawline, particularly as you get older, it is about restoring the defining points of the chin. The defining points in a female chin typically are a projection of the rest of the jawline. If you have not lost the lateral aspect of your jawline, the chin is a projection of the lateral part of the mandible. It comes down and forward in a continuous manner. As you get older, there is a rotation upwards and a loss of the curvature of the bottom of the chin. It becomes a little bit squarer and then sometimes competes with the jowl. So your treatment plan should be to restore the angle of the chin and those defining points, so that the low point of the face is very clearly the apex of the chin instead of the jowl or the gonial angle. This makes it easier to decide where you want to inject. If you are typically slightly lowering the chin and projecting it slightly forwards, then your injection point should reflect this.
You can see even in a model how the curvature of a chin tilts upwards. The apex—the greatest projection on the menton—is higher up than it would be in youth. What you would ideally like to do is bring it down and anterior. That means your injection point effectively follows that strategy. You would not inject where it is already full. You inject underneath, onto the periosteum. What you like to imagine is that this mandible is now following a trajectory that continues in the plane that your needle is placed. This means as you inject, you should create a greater curvature inferiorly to allow the definition of the whole jawline to finish where it should, at the defining point of the chin.
Dealing with Jowls
Many of your patients will also be seeking an answer to the question: how can I get rid of my jowls? This is common after weight loss in particular. It is important to understand what is actually going on here. It is not necessarily an increase in the size of the jowl but rather a repositioning of the fat pad. There is a central cheek fat pad that runs down the lateral aspect of your face, which is usually supported by the ligaments at the mandible and the nasolabial fold ligament, and by a more lateral cheek fat pad that blends that fat pad in so that it forms one structure. As you lose volume or weight, or as you get older, this fat pad will rotate forwards and down, creating a heaviness. It is essentially a visual competition that breaks out between the jowl and the chin.
So what can you do to reduce it? The first thing is this can only really be done with injectables in quite mild cases. You are never going to solve a jowl entirely with dermal filler if it is substantial, relatively large, and well defined. But there are many tricks you can use to make it look significantly better. What would you do?
The first thing is this is always easier when the chin is already weak. Making it stronger will both improve the overall ratios of the face but also allow the chin to dominate against the jowl. It is usually more common that patients with a jowl actually have a smaller chin because they notice it much sooner than patients who have a stronger chin. So a weak chin and a strong jowl means you can strengthen the chin, which will give you the first and easiest win in the battle against the jowl, defining the face.
The second opportunity which you may have is to support the jowl more laterally and superiorly. The ideal situation is that the patient has small and atrophic cheeks with almost a bony contour. You will see this often in 55-year-old women who have maintained their weight well but are slim. They have a very dominant cheek fat pad and almost nothing behind it. So if you replace all of the volume behind with a dermal filler and then build the structure up both laterally and underneath the zygoma, you have a reasonable chance of creating a little bit of support that pulls the jowl ever so slightly backwards. You can then blend in the junctions with the jowl and the rest of the face.
The jowl is often defined by a marionette fold. This is the fold caused by the ligaments holding onto the surface of the skin with a fat pad riding over them. The mandibular retaining ligament and the modiolus resist the fat, causing a crease to form just anterior to those structures. If you have supported them above and then strengthen the weak point that defines those two structures, you will blend in those connecting planes and allow the patient’s lower face to become simpler. You can lift the oral commissure, which is clearly visible in many before and afters, and make the patients both look happier, but you can also help the patient regain that more youthful heart shape that is always pursued in youth.
Using Toxin for the Female Face
Let us now consider how toxin can be useful when treating a female face in particular. How do you make a female more beautiful? As a general rule, you make cheeks more dominant and the jawline narrower. This is what you can do with masseter-reducing injections. Injecting botulinum toxin will atrophy the muscle. It causes it to shrink over about a six-week period. In a young female who is relatively square with weaker cheeks and a stronger gonial angle, you can shrink the muscle and therefore redefine that lower part of the face to make the cheeks more dominant over the gonial angle. Just be careful you do not try and do this on someone who just needs to lose a little bit of that superficial fat. This is a very common mistake with jowls: you atrophy a muscle in someone whose face is actually not being defined by the muscle but instead by the fat on the surface. What would happen if you did this? You waste a patient’s money, they will be disappointed because they will still look the same in six weeks’ time, and you may even cause a side effect without any benefits.
When treating the masseter, there is a second use of botulinum toxin which is the platysma muscle. This muscle runs all the way from your upper chest all the way up into your lower face, and it hides the boundary between your jawline and your neck. If you relax this muscle, sometimes you will get a crisper shadow as you can see more of the angle of the jaw because it is no longer hidden by the muscle pulling slightly away from the jawline. It can interestingly also create a subtle lift, allowing the cheeks according to one paper to subtly lift, and also potentially improving some of the jowl because the jowl itself is also tugged on by this same muscle.
The Holistic Truth
Finally, if there is one treatment that is going to make you want to become a more holistic practitioner, it might be the jawline. Because the vast majority of patients pursuing this need to improve diet and weight in terms of achieving ultimate beauty. This is impossible to do if you do not currently offer those services, without it feeling a little bit uncomfortable when you start to give what some might call unsolicited advice. Of course, all of the advice is solicited if you do a good consultation. Frame everything you do as a clinician trying to optimize the outcome for your patient. If the right thing is to lose a little bit of superficial fat with a small amount of weight loss—which often shows very quickly on your face—then that is probably what you should recommend ahead of procedures. Most patients will be grateful, although they may still pursue the quick fix options. Your job is to make sure that you have given them all the available advice, the best advice that they need. Even if you do not provide it, it is still better than injecting someone who is not going to get a good result. So be candid with your patients, do it with love, and they should receive it well and not hold it against you, even if all they want is the quick fix.
So what would you do if a patient clearly not suitable for jawline injections because of being overweight wanted you to put filler into their jaw? There is something that you only learn the hard way in life: in the long run, the truth is your only friend. You cannot avoid it. The only thing you can do is phrase it in a way that does not cause offense or harm to them psychologically. The way to do this is to ask a lot of permission. Is it okay if we talk about other options? Is it okay if we talk about weight loss options as well as injectables? Most patients will be open to hearing other things, and occasionally you might offend someone. But just because someone gets upset because you have mentioned their weight does not mean that you have done them harm. Patients who have had awkward consultations have then become the trigger to change. So just because you get negative emotion in the consultation does not mean that you have made a mistake. It is also important to remember that you will still get negative emotion if you try to put filler into a jawline that is not going to improve because the real problem is excess fat. It is important to be brave and kind and mention the truth and give your patients the best advice no matter how scary it might be, because you simply cannot escape the reality of what the real problem is.