Creating a defined female jawline with fillers without masculinising
When treating female patients with dermal filler in the jawline, a common problem is the injection of too much filler, or poorly placed product along the gonial angle. This results in an overly masculine appearance, with a squared or angular jawline, like a man.
In this blog, Dr Tim Pearce will discuss the gonial angle, how to inject it, and why the result can vary from good to bad depending on how you do it. His top tips for injecting the jawline will help you to feel confident in creating a well-balanced and defined result that keeps your female patients happy.
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What is the gonial angle and how does it relate to female beauty and facial femininity?
Dr Tim explains that the foundational elements of the face are best exemplified by computer models which generate a simplified version of a human head, yet we can all recognise them immediately because they pick up on the most important aspects in terms of the aesthetics of the face. This usually includes the gonial angle, chin, cheek and temple angles, and brow ridges. This simplified model of a face allows the aesthetic clinician to identify structures that are missing or need enhancing in a real patient, alongside those which require blending or softening. This is a key factor in understanding why we inject the gonial angle to create important definition.
The gonial angle is the junction between the neck and the jawline; by keeping them separate, it provides the framing element of the jawline. Thus, from an aesthetic perspective, if you consider the face as a presentation box or frame for the eyes, the jawline and the cheek create two triangles which lead up towards the eyes that are framed by the eyebrows, the cheeks also support the eyes. The gonial angle is the bottom layer of the framing mechanism.
Why do we inject the gonial angle with dermal filler?
The objective for injecting the gonial angle with dermal filler is to create definition – the change of angle and the shadow underneath the jawline that creates a more beautiful face.
However, if you project this area too far in women, you can unbalance the face and create a more masculine appearance. Sadly, this is happening more and more, observes Dr Tim, particularly when aesthetic injectors perform the procedure solely from one viewpoint. It is only when the patient turns to face the front that the practitioner realises they have either lowered the angle of the jaw so much that the heart shape is softened, or they have projected it out laterally so much that the competition with the cheek becomes lost and they appear more masculine.
Therefore, the aesthetic reasons for injecting the gonial angle are when:
- wanting to create a sharper angle or definition from the side where it may be lost, particularly in older female patients where it becomes more rounded,
- or wanting to project it more widely, particularly in male patients to masculinise and create more strength.
Inferior projection which projects the jawline down and lateral, widening the female heart shape (which is masculinising) is sometimes needed so that you can see the definition. As aesthetic clinicians, we are often trying to get it just right, says Dr Tim, and create definition and shadow without creating a masculine face in a female.
Where should you inject the jawline with dermal filler in a female?
Dr Tim provides his injection tips, noting that, with his female patients he feels for the shape of the existing bone, looking for the change of angle. He feels the posterior surface, the inferior surface, and the lateral surface. Typically, he injects on the lateral aspect, to create lateral projection and achieve definition.
If you want to create an increased heart-shaped face, and the patients happens to have a relatively low gonial angle, you can inject a little bit above it, perhaps one to two centimetres higher up on the mandible. This creates the sensation that the change of angle is happening higher up; combining this with a chin treatment will often create a more heart-shaped, youthful face in a female, and is not something typically wanted in a male face.
What are the risks of injecting into the jawline?
Although a vascular occlusion is possible when injecting the gonial angle because blood vessels are everywhere in the face, including the facial artery, Dr Tim does not believe that the gonial angle is a particularly high-risk area.
When treating older female patients, particularly post-menopausal women, there is a risk of bone crumbling when you inject. The bone tends to thin out with age in the gonial angle area, as proven by bone scans and studies analysing skeletal bones. You may feel that when you are injecting, the needle sinks straight into the periosteum, which Dr Tim admits is rather unsettling. It is unknown whether there is a potential for complication, although, despite having never seen one, Dr Tim does not feel comfortable proceeding to deliver the product if this happens. He encourages aesthetic clinicians to try and rest where you think the periosteum should be and avoid pushing into it when injecting the filler.
The parotid gland is also close to this area, and it is possible to cause an injury to the salivary gland when injecting, more commonly occurring with cannula use which can tear the surface of the parotid; anatomy knowledge, as always is critical. Read more on salivary gland injury: cause and diagnosis.
More crucially, your awareness of the carotid vessels underneath the gonial area should inform your injection location. Dr Tim believes that the anatomy is on our side with this, in that the distance to reach them if probably too far, but it is wise to know they are nearby and to avoid injecting without knowing that you are resting on the periosteum. Even so, he recommends that aesthetic clinicians should aspirate when injecting this area, just in case the anatomy is unusual. It can be difficult to find the right spot, but Dr Tim recommends changing angle and approaching slowly, citing that often practitioners are pointed too inferiorly with their needle.
If you are using a cannula, this problem is reduced because the entry angle is different, being parallel to the tissue, making it safer. However, the downside is that the treatment may be too superficial and result in a discrepancy between the movement of the jaw and the placement of the filler product because it is not deep enough to emulate bone. Read best needle injection depth for dermal fillers for a more detailed explanation on the factors that impact on how deep to inject, including movement within a facial area.
Remember says Dr Tim, when treating the jawline and the gonial angle, always think about the face in three dimensions – move around your patient to observe as you place product, avoid standing on one side alone when treating, that way you can mitigate the risk of causing the upsetting aesthetic complication of masculinising a female patient.
If you have any questions or comments about jawline treatments for men and women, including treating the gonial angle, you can find Dr Tim Pearce on Instagram.
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Aesthetics Mastery Show
How To Create A Great Jaw Filler Result & Avoid Masculinising Female Patients
In this episode, Dr Tim discusses a common issue in jaw filler injections for female patients where the injection of too much or badly placed filler in the gonial angle can result in an overly masculine appearance. The video includes top tips for injecting this area so that you can feel confident creating a well balanced and defined result in female patients happy. Watch the full Aesthetics Mastery Show here.
The show has had great interaction from practitioners and patients.
Alberto Rodriguez said:
“My jaw angles used to be so narrow that even at very low body fat percentage I had no definition what so ever. After injecting these places with exclusively Voluma my jaw now looks like Brad Pit’s jaw and I couldn’t be happier and I get complements all the time 🙂 I’m very much looking forward to have Volux injected in my next session”
Practitioner Suho said:
“you’re absolutely my favourite when it comes to expanding my knowledge as a young dermatologist myself”
Patient Roshni commented:
“Would it be patronizing to send prospective aesthetic providers your videos for the procedures I want? I just want to make sure they know these things because whenever I bring up concerns, they’re usually just brushed off or invalidated”
“Find someone who doesn’t brush you off, I know so many careful and considerate nurses/clinicians who would not do that.”
Read more questions and answers or join in the debate on our YouTube channel.
Filler Complications eLearning Courses
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Both give CPD and certificates on completion.
In addition, browse our FREE downloadable resources on complications.
Dr Tim Pearce eLearning
Dr Tim Pearce MBChB BSc (Hons) MRCGP founded his eLearning concept in 2016 in order to provide readily accessible BOTOX® and dermal filler online courses for fellow Medical Aesthetics practitioners. His objective was to raise standards within the industry – a principle which remains just as relevant today.
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