Nelson Lee Novick, M.D. is a Clinical Professor of Dermatology at Mount Sinai School of Medicine in New York City, an Attending Physician, and a former OPD Clinic Chief within the department of dermatology of the Medical Center. He is board-certified both in internal medicine and dermatology and is a Fellow of the American... more
In my last blog post, I explained how aesthetic medical science had made a giant leap forward about fifteen years ago when research findings put a new face to facial aging. We learned that so much of the sagging, drooping, jowls, and deep lines and crevices that appear with the passing decades, previously believed to be primarily a skin issue, were in fact related to a relentless loss of supportive volume under the skin, particularly within the deeper fat compartments. Researchers also discovered that as these supportive fat pockets shrink and shrivel with time, they become more subject to the downward pull of gravity, and in their new, lower down locations of the face eventually push and distort the overlying skin into jowly smile lines, loss of definition along the jawline, and generally saggy skin.
Without adequate support, the overlying skin "envelope" is left to form hollows or to buckle over on itself into unwanted folds and jowls nearby. This unhappy situation is often compounded by a simultaneous loss of volume in the underlying muscle and bone. This new understanding of facial aging was a critical, light bulb, "Aha!" moment in aesthetic history because once it was appreciated that loss of volume coupled with the downward vector of gravity were major players in facial aging, we now had the means to quickly fix these problems, nonsurgically, with use of injectable volumizing fillers - to resupply volume where it was lost and to lift and reverse the downward gravitational pull.
The lower two-thirds of the face contains three areas critical to the appearance of a more youthful look: the cheekbones, the back angle of the jawline and the chin. Taken together these three regions constitute the frame of the face. Conventional wisdom would say that if you see hollows and tear troughs under the eyes, the hollows and troughs should be filled. Conventional wisdom might also suggest that if you see deep smile lines and/or deep "sad lines" (marionette lines) drooping down from the sides of the mouth that you should immediately run to fill them up. And conventional wisdom would probably not pay any particular attention to the chin region or the area over the back angle of the jaw. But conventional wisdom would be mistaken in all these cases.
Loss of volume in the cheeks can in large measure be responsible for the development of hollows and tear troughs under the eyes, as well as to contribute significantly to the formation of deep smile lines and sad lines. Diminished volume in the back angles of the jawline and a receding chin can similarly contribute greatly to the development of loss of definition of the jawline and to jowl formation and even to sagging of the upper neck. You can see this for yourself. Squeeze your upper cheek between your thumb and index finger and lift it squarely back over your cheekbone. Notice how not only do the cheeks look more ideally heart-shaped but how the under-eye area and smile lines secondarily improve. Pinch together in a similar fashion the skin at the back angle of the jaw and note how the jowls along the jawline lessen. And to see the benefit to the jawline from chin augmentation, pinch the chin forward.
Unfortunately, many inexperienced injectors even today still immediately race to treat smile lines, sad lines and hollows under the eyes by "chasing" after the individual wrinkles and hollows and directly filling them - an approach that does not address the real underlying volume loss issues and that unfortunately very often leads to patient disappointment and frequently quite unnatural-looking results. The proper use and appropriate placement of natural, injectable, hyaluronic acid-based volumizing and lifting fillers, such as Restylane Lyft and Voluma XC, can quickly and often dramatically correct each of these issues within a matter of minutes and restore the youthful frame to the face.