As the landscape of injectable options expand and grow, injection techniques also continue to evolve. The key to a beautiful, natural-looking facial improvement is choosing a qualified expert injector. A good injector will consider the overall shape of each individual patient’s face and aim to provide balance and harmony using fillers and neurotoxins. A great injector will look at each patient and also discuss their goals, what they used to look like, find out the features that they want to restore and create a treatment plan that meets their objectives.
To get the scoop on the latest injection techniques, we spoke to West Palm Beach dermatologist Kenneth R. Beer, MD, who has conducted numerous clinical trials on the various injectable products out on the market and serves as a mentor and trainer for other expert injectors.
NewBeauty: Why is a heart-shaped face an ideal shape that is appealing? Why do we perceive it as youthful when we see someone with these facial proportions?
Dr. Beer: The heart-shaped face is perceived as youthful because when we’re young, all the fat pads are high in the middle face and upper face. There’s enough fat in our faces to cover the bony structure and the skeletal structure. Everything looks soft and you don’t have the angularity that one sees with age. As we age, we lose fat pads and the ligaments that hold the face up and suspend everything gets stretched.
That’s why old age is associated with drooping and everything starts to collect at the bottom third of the face in more of a pyramid shape. Youthful faces have more of a heart shape where they’re broad at the top and more tapered at the bottom. By making the mid-face and upper face more youthful by injecting fillers that are thick, we can convert a triangle into a heart shape and give the illusion of youth.
NB: What approach do you have to facial aesthetics to help achieve this look?
Dr. Beer: I look at the face as an as a global area, not as a series of lines and wrinkles that need to be filled. I look at the face as a dynamic series of bones, of soft tissue, of skin and the interrelationship between those is what’s important. When I see lines and sun damage, we can address those with different products. But I also look at the shape of the face. When we restore the lips so they look nice and pump, and not huge, they should be proportional, giving the face a more defined jawline, which is hugely important to make sure that the jawline and chin are not receding (so that the face doesn’t disappear before the bottom of the chin). I like to inject the cheeks and the temples to restore the volume that gets lost as we age. And a lot of times I will treat the tear trough as well. Botulinum toxins are essential for relaxing the muscles that pull the face downwards, or create vector lines to make the face more youthful.
NB: Can you describe how the off-label use of filler in the chin and along the jawline are being used to help create a more refined lower face?
Dr. Beer: Fillers used in the lower third of the face can help create a more stable and attractive jawline. Without that definition at the jaw, the bottom of the face just transitions to the neck with no barrier. So, the angularity of that area is lost when you’d like to keep it. The receding chin is then perceived as a weak facial structure, so by putting some filler in there, we can go ahead and give you more definition and it doesn’t take over. It comes down to using the right amount in the right place. Sometimes we do it over series of visits, but it works nicely and in my practice one of the things that sets us apart is the way in which we combine filler with a botulinum toxin to weaken the muscle that pulls the chin and some laser work to make the skin more youthful and bright.
NB: What advice do you have for patients who may not understand how facial proportions work in general and who may just be seeking cheek filler and ignoring their lower face?
Dr. Beer: Invest the time and money to see somebody that understands facial dynamics and facial filling, because if you don’t, you just end up spackling some lines and that’s never a good long-term investment. While you may spend less money initially, it’s going to be expensive and not perfect over the long run, right? I advise injectable patients to find a board-certified dermatologist or plastic surgeon that understands the bony infrastructure and soft tissue packages and has the aesthetic touch to try and restore those instead of just filling lines randomly.