Treating the Male Mid and Lower Face, Daniel Julien Interview
On 18th January 2022, Dr Tim Pearce hosted a Live on Instagram and interviewed Canadian aesthetic nurse practitioner, Daniel Julien NP, who has a successful clinic, Danesthetics Medical Design in Ottawa, Canada. Dan also hosts his Danesthetics You Tube channel to over thirty-six thousand subscribers. The pair discussed the clinical and consultation aspects required to confidently treat men with medical aesthetic treatments such as botulinum toxin and dermal fillers, achieving and maintaining masculine looks to avoid feminising men.
In this blog – which covers part two of the interview looking at the mid and lower face in men, focusing on the cheeks, lips, jawline and chin – Dr Tim highlights some of the stand-out points from his interview with Dan Julien and invites you to catch up with the whole interview now hosted on You Tube as part of the Aesthetic Mastery Show.
Dr Tim will be discussing more medical aesthetic training tips as part of his upcoming webinar series, so if you’re looking to increase your CPD-certified learning and want to learn more skills to make you a better clinician, then step one is to register for the free webinars by Dr Tim.
How to maintain masculinity when treating men in the mid and lower face with cosmetic injectables
Following on from part one of Dr Tim’s interview with Daniel Julien which discussed the upper face and treating the male forehead and brow area, the discussion moved on to using dermal filler and botulinum toxin in the male cheeks, lips, jawline, and chin.
Dan is one of only a few nurse prescribers in his region of Canada and is triple certified by the Canadian Board of Aesthetic Medicine, as well as a faculty member and educator for the American Association of Aesthetic Medicine and Surgery (AAAMS).
Can you inject filler into male cheeks?
Dan stated that it is quite rare for male patients to present to him specifically requesting cheek filler, however, when he is evaluating and analysing their full face during a consultation, he will review the apex of the cheek, look at where it should be, and evaluate volume loss. Adding filler, conservatively, to replace volume in the mid cheek, tied in with the apex, can result in men looking more refreshed without them even realising that they required cheek filler.
Dr Tim pressed further and noted that the male cheek is more focused on anterior projection rather than lateral projection and how that would impact on the approach taken to treating men by aesthetic clinicians.
Dan showed the audience a useful tool – a golden mean (ratio) caliper – which he uses to help take measurements on a patient’s face and mark out points to ensure he works to a masculine cheek apex as compared to a more feminine apex., which he explained further.
A feminised cheek apex, for example, can be more lateral, taking a line from the tail of the eyebrow, dropping down, and then another line from the upper ala of the nose to the upper tragus and finding the meeting point. A masculine cheek apex is more medial, taking a line from the lateral portion of the mouth to the lower tragus, then creating a triangle from the lateral portion of the mouth up to the lateral aspect of the pupil, connecting the triangle at the tragus and then bisecting it. By going up one third aspect on the bisection you should find the cheek apex for a man, although it’s important to consider natural anatomy and not just rely solely on lines and measurements, these are simply a helpful guide.
When it comes to filler placement, he stays anterior to this point and does not place product in the lateral cheekbone area on men. If there is volume loss in the lower face, he will consider adding volume for masseter projection, but avoids cheekbone projection for males due to the chances of a more feminine result.
Can you treat male lips without making a feminine lip?
Dan noted that the only treatment he considers for men in the lip area is to make the lips look more ‘square’ or wider than those of a female, he achieves this by keeping the lower lip pillows much flatter and wider than you would if you were augmenting female lips.
His aim when treating male lips is hydration, creating a natural and healthy look to the lip with minimal product, rather than attempting to change the shape, plump, or define the vermillion border or Cupid’s bow, as he would do with female patients.
How do you create that superhero male jawline?
Dr Tim noted that when it comes to dermal filler treatments for men, they both agree that less is more, particularly when treating the cheeks and lips in men, an area where treatment is often more pronounced for women. However, the opposite is true when it comes to treating men in the chin and jawline, the jaw being a strong element of masculinity thanks to superhero chiselled lines.
Dan was keen to show another tool in his clinic that he uses to assess male jawlines, his protractor. He noted that the angle of the male jawline can be dropped quite low, even as much as to a 90° angle, and remain uniquely masculine and strong looking; this gives aesthetic clinicians a good foundation for achieving a great aesthetic result, and treatment of the jawline is often the number one request from his male patients.
If a man has a very acute angled jaw and the practitioner is seeking to drop that downwards, Dan cautioned that considering the amount and type of filler product used is important because large quantities of water attracting hyaluronic acid-based products can be less beneficial and become unattractive over time. Dan now advocates the use of Radiesse® (calcium hydroxylapatite), and he often combines this with a robust HA product to give him the best of both worlds in the area, achieving the sharp definition with mouldable projection without the fear of too much water retention from the hydrophilic HA. He noted that this is a more advanced technique for experienced aesthetic clinicians given that calcium hydroxylapatite is non-reversible.
The difference between a masculine and feminine jawline lies in the fact that with a female, you do not want projection, filler is placed behind and below the gonial angle, hugging the line of the jawbone as you treat along the jawline usually with the aim of reducing a small jowl. With a masculine jawline, Dan focuses on the projection of the zygoma, aiming for the jawline to be at the same projection when measured together. As well as treating the jawline to create projection – the mandible and the gonial angle – he places filler in a fanning technique on top of the masseter muscle to give the illusion of a stronger masseter muscle, a look that is usually associated with a more athletic man.
Tips for maintaining a masculine chin with filler
Dr Tim asked Dan if he treats male chins in isolation or as part of a full-face treatment.
Dan remarked that chins are very interesting and aesthetic clinicians need to feel the chin of their patients to get a better understanding of the structure – sometimes the chin can be very stiff, with little muscle close to the bone, and little movement, all of which will create resistance if you choose to deposit dermal filler. In this case, there are other visual cues too, such that as the patient is speaking, you will notice a lot of dimpling in the chin, which also indicates a very strong, inactive chin. To avoid the filler being flat and uncomfortable for the patient, Dan recommends using some botulinum toxin in the chin prior to the filler treatment to relax the area; this allows him to have more flexibility and he can use less filler that can be massaged and moulded for the best result without the muscle fighting the placement.
Technique wise, he mostly uses a needle due to the precision he can achieve when placing filler to create a narrower or wider chin on an individual; however, he did mention that if a patient has a looser chin area, then great projection can be achieved with a cannula which is his preferred option, due to the presence of the mental artery. Like Dr Tim, Dan will often reach for his ultrasound device to check the anatomy, especially if he plans to use a needle approach in this area. Read more on Dr Tim’s opinion on investing in an ultrasound device for your aesthetic clinic.
To maintain the appearance of a masculine chin, Dan again uses his golden mean caliper measuring tools to assess the width of the mouth, taking a line down from the corners to the chin and dissecting a line in the midpoint; he can then deliver boluses of filler into the pockets either side of the midline and within the outer lines.
You can follow Danesthetics Medical on You Tube for more insight on treating male patients and more hints and tips from across the pond.
Aesthetics Mastery Show
Why Botox makes celebs look perfect but you look plastic
This blog accompanies a recent Aesthetics Mastery Show, where Dr Tim Pearce discussed how celebrities keep their eternally youthful looks without looking fake look after Botox and fillers. Dr Tim outlines the 4 reasons he thinks this inequality exists, and explains how injectors can change their practice to keep their patients looking fresh.
Watch the full Aesthetic Mastery Show episode here:
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