Dr Tim Pearce
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 in proportion to the cheeks – it is narrower, smaller, and pointier in all proportions.
A key anatomical difference lies in the angle between the cheek and jawline. If you look at a male face, the angle between the lateral part of the cheek and the gonial angle is relatively straight, almost flush. In a female, it should tilt between 10 and 15 degrees. Kate Moss exemplifies this feminine ideal – she has a very delicate, narrow chin at the base, but very wide cheeks that project outwards and hold her eyes.
The defining points of the chin are narrow and focused in a female and broader in a male. But it’s really the planes that flow from this structure that causes what I call the presentation box of the eyes. Essentially that heart shape face where shadows form underneath the cheeks, underneath the jawline form a structure that terminates at the chin. And what does it do? It splays out to hold the eyes higher up in the face.
In youth, the chin is a projection of the rest of the jawline. If you haven’t 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.
Our treatment plan should be to restore the angle of the chin and those defining points so that the low point of the face is now the chin rather than the jowl or gonial angle. This makes it easier to decide where we want to inject. If we are typically slightly lowering the chin and projecting it slightly forwards, then your injection point should reflect this.
Understanding patient presentation is crucial for successful treatment planning. Patients often seek jawline enhancement for varying reasons, though they may request the same procedure. Some present with enlarged masseters causing excessive lateral width, while others struggle with a rounded face and small chin. Many patients are concerned about double chins or have neck and cheek fat that masks their underlying facial features. In some cases, the bony structure simply isn’t strong enough to project beyond the skin and create the desired shadow we’re seeking.
Success begins with a three-step approach. First, we must understand our patient and their desires. Second, we need to thoroughly analyze their facial features. Finally, we must assess whether our available materials and tools can actually create the transformation needed to help our patient feel happier and more confident.
As patients age, significant changes occur in the lower face. The chin undergoes an upward rotation with a noticeable loss of curvature at its base. This results in a squarer appearance that often competes with developing jowls. The jowl is defined by a medial labial fold, created by the resistance of tissue where the fat pad rides over the mandibular retaining ligament and modiolus.
Understanding these changes is crucial because the chin should always be the low point of the face. When jowls develop, they create visual competition with the chin, disrupting natural facial harmony. Treatment plans should focus on restoring the angle of the chin and its defining points, ensuring the low point of the face returns to the chin rather than the jowl or gonial angle.
The complexity of facial fat distribution plays a crucial role in jawline aesthetics. A central cheek fat pad runs down the lateral aspect of the face, supported by mandibular ligaments and the nasal labial fold ligament. This integrates with a more lateral cheek fat pad that helps blend the overall structure.
The ideal treatment candidate often presents with small and atrophied cheeks, showing almost a bony contour. This presentation is commonly seen in middle aged women who have maintained their weight well but are slim – they typically have a very dominant cheek fat pad with almost nothing behind it. If you can replace all of the volume behind with dermal filler and then build the structure up both laterally and underneath the zygoma, you have a reasonable chance of creating support that pulls the jowl slightly backwards.
Botulinum toxin offers two distinct approaches to jawline enhancement. The first involves masseter reduction for facial slimming, particularly effective when true muscular hypertrophy is present. The second, often overlooked application targets the platysma muscle, which runs from the upper chest into the lower face. When treated appropriately, this can create a crisper shadow along the jawline while potentially offering a subtle lifting effect and improvement in jowling.
Fat dissolving injections have evolved over the past 10-15 years as a valuable tool in jawline contouring. These treatments are particularly effective in the midline under the chin, though patients must be prepared for significant initial swelling. While results can be subtle, many patients find them beneficial as part of a comprehensive treatment approach. Multiple sessions are typically required to achieve optimal results.
When approaching jawline enhancement, practitioners must consider multiple elements that make the procedure difficult to achieve or impossible in certain patients. It’s not simply about injection technique – there are multiple different elements that make a jawline difficult to achieve. After supporting the upper structures and strengthening the chin, focus on blending the junctions with the jowl and rest of the face. This can help lift the oral commissure, making patients both look happier and regain some of that youthful contour.
You can then blend in the junctions with the jowl and the rest of the face. The jowl is defined often by a medial labial fold, caused by the ligaments holding onto the surface of the skin with a fat pad riding above. If we’ve supported them above, made the chin stronger and then joined the structures, you will blend in those connecting planes and allow the patient’s lower face to become simpler.
Addressing weight management in aesthetic practice requires both honesty and sensitivity. When discussing this topic with patients, it’s essential to first ask permission before exploring weight-related options. Frame these conversations around treatment optimization rather than criticism.
It’s important to understand that negative emotions during consultations don’t necessarily indicate failure. In fact, these challenging conversations can often become the catalyst for positive change. Sometimes, the most valuable service we can provide is helping patients understand that their desired results may require addressing underlying weight issues before or alongside aesthetic treatments.
By being brave and kind while mentioning the truth, you’ll give your patients the best advice, no matter how challenging the conversation might be. Our role as practitioners is to guide patients toward the most appropriate solutions, even when those conversations prove challenging.
To improve your filler treatments, download our free guide with frequently used filler volumes in all areas of the face here.
Understanding facial anatomy is crucial for precise filler placement and achieving natural, balanced results. Knowledge of anatomical structures and vascular supply not only helps in avoiding complications but also enhances the overall effectiveness of treatments.
If you are eager to deepen your understanding of anatomy, Dr Tim is excited to announce a new training experience tailored for aesthetic injectors
Watch this space to find out more...
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.
Our exclusive video-led courses are designed to build confidence, knowledge and technique at every stage, working from foundation level to advanced treatments and management of complications.
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