A Complete Guide to In-Office Facial Contouring

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A fuller, Rubenesque face was once a sign of wealth and prosperity, but today a slimmer, more heart-shaped face is considered the aesthetic ideal. Experts say what makes it so appealing is the perception of youth it implies. “We all start off with more of a heart shape, and as the years progress, this flips upside down and we get more heaviness in the lower face, jowls and chin area,” explains Fresno, CA dermatologist Kathleen Behr, MD.

Getting “snatched” can be done a myriad of ways. While contouring had a grip on our makeup routines just a few years ago, the practice of face reshaping has upgraded to minor—sometimes major—tweaks and treatments. Here, experts share the modern tips and procedures that have helped launch a thousand beforeand- after “you’re not ugly, you’re just poor” memes.

Highlight + Contour

The days of placing thick lines of bronzer on the cheek hollows to emphasize cheekbones seem to be long gone, says celebrity makeup artist and founder of Blighlighter Jamie Greenberg. Today, the technique is to strategically place bronzer and blush higher up to draw the eye upward. “One way to slenderize the face is by changing up the way you apply your blush,” she explains. “Apply it to the upper apples of your cheeks instead of directly on the apples of your cheeks for a more lifted and sculpted look.” Next, she says to apply your contour shade slightly above the apples of your cheeks. “Blend upwards to lift the face. Once this is achieved, you can add your highlight to the tops of your cheekbones.”

“Stacked” Energy Facials

Among his celebrity requests, aesthetician Iván Pol counts facial sculpting at the top. His unique method of providing contoured results has made him a go-to stop for A-listers ahead of high-profile events. “I employ various modalities to elevate and define the contours of the face,” he explains. “I use radio frequency to stimulate collagen and elastin while toning facial muscles.” He recommends three to five sessions of his “Beauty Sandwich” layered facials, which also include infrared and blue light, to treat the cheeks, lower face and jawline without needles, chemicals or lasers.

Fat Reducers + Skin Tighteners

To create a sculpted look via nonsurgical treatments, each patient may have a different type of customized plan based on what’s needed to create the sought-after heart shape. “If you have extra fat in the jowls and under the chin, Kybella can be used to eliminate that fat and recontour these areas,” explains Dr. Behr. Kybella, or deoxycholic acid, works best on those with very mild submental fullness; results can be unpredictable and some patients may experience a significant inflammatory reaction. “Mint PDO threads can also be placed to lift the cheeks and jowls while at the same time creating more collagen as they dissolve,” she adds. “Ultherapy is an option, too, and uses ultrasound to heat the fascia, stimulate collagen and give gentle tightening.”

To achieve an inverted triangle for a slimmer jawline, energy devices also come in handy. “CoolSculpting’s CoolMini is a great way to reduce fat under the chin, using cryolipolysis to freeze and eliminate unwanted fat cells,” adds Baton Rouge, LA dermatologist Ann C. Zedlitz, MD. New technology specifically created for the jawline, triLift, treats three layers of tissue— the muscles, the dermis and the epidermis—via Dynamic Muscle Stimulation (DMSt), TriPollar RF and triFX radio-frequency microneedling to provide temporary tightening benefits.

Facial Injections

Strategically placing dermal fillers in the cheeks will restore volume, and in turn, make the lower face less prominent. “This provides optimal light reflection and enhances the appearance of a slimmer more lifted face,” adds Dr. Zedlitz. Your injector needs to have a good aesthetic eye, as not everyone is a candidate for fillers. “Placing fillers in the pre-jowl fold and angle of the mandible will camouflage heavy jowls and slenderize the jawline,” explains Dr. Zedlitz. “Using neurotoxins in the neck, sometimes referred to as a Nefertiti Neck Lift, can also slim the jawline.” However, if placed incorrectly, they can make the face look fuller, which is why it’s important to seek a skilled, board-certified expert injector.

“Teeth grinders tend to have hypertrophy of their masseter muscles, which can result in a more masculine-looking jawline,” adds Dr. Behr. “Botox can weaken those muscles and give the jawline a slimming effect while reducing grinding.”

Dr. Behr performed liposuction under the chin and a radiofrequency skin tightening treatment on this 32-year-old patient to give her lower face a more refined look.

In the last year, facial liposuction procedures increased by 90 percent.

Source: The Aesthetic Society

The Ultimate Combinations

For some patients, nonsurgical modalities will not be able to provide the transformations they are after. For others, a more permanent solution is preferred, which is where surgical facial reshaping comes in. Many times a plastic surgeon will suggest more than one procedure to bring balance to the face.

Under-Chin Lipo Recovery

“For starters, the lower face is divided into three portions: the posterior, the middle and the anterior,” explains Arcadia, CA, plastic surgeon Arthur Y. Yu, MD. “The posterior third consists of the masseter muscles. For the middle third, the culprit is usually a herniated buccal fat pad, and for the anterior third, it is usually composed of ‘baby fat’ in younger patients and jowling in older ones.” The treatment to remove that lower face fat is simple he says: liposuction.

Chin liposuction can reduce a double chin and create a sleek jawline. “It typically involves an incision placed behind each of the ears and potentially in the midline to remove the fat,” says Salt Lake City facial plastic surgeon P. Daniel Ward, MD. “However, simply removing the fat is rarely the best solution. In my experience, addressing some of the muscles in the lower face is also important. I do this by elevating the platysma, or the neck muscle, and removing the deep fat to create a nice, tight region underneath the chin.”

This 26-year-old patient felt her face was too wide. Dr. Yu performed liposuction and fat transfer to the chin, and used Botox Cosmetic to slim her jawline.

Buccal Fat Removal

For those with fuller, rounder, “apple cheeks,” adding contour can be achieved by taking out a small, rounded mass of fat located in the middle of the cheeks. “About 20 percent of my patients who have chin, neck and lower-face liposuction will have their buccal fat removed at the same time to slenderize their facial profile,” says New York facial plastic surgeon John Kang, MD, who has seen an uptick of requests for facial slenderizing after Chrissy Teigen put buccal fat removal on the map. However, the procedure does have its drawbacks, and he warns it’s not appropriate for everyone. “When a patient has subtle or minimal fullness, we usually warn that they risk appearing gaunt later in life because many people lose more fat in this deep buccal space as they age. We ask patients to look at their parents to see how much fat was lost with aging.” Micro-liposuction can also be performed in the cheeks for further contouring.

Thread Lifts + Fat Grafting

“The ideal way to make the face more slender is by giving it a lift and using structural fat grafting techniques to restore the patient’s 3-D contour and profile back to the way it was in their younger days,” Dr. Kang says, adding that an immediate effect can be seen after transferring the harvested fat into the face. “Very often, the fat grafting is coupled with a minimally invasive lifting procedure like Ultherapy or a thread lift.” Thread lifts offer a very temporary solution and need continued maintenance, however, a limited-access lift from the temple area, or a full surgical facelift can address the underlying tissue, not just tighten the skin.

Rhinoplasty + Chin Enhancement

Rhinoplasty can not only change the shape, size, appearance and projection of the nose, but it can also have an overall effect on the shape of the face and how it’s perceived by others. The lips, cheeks and other facial features remain intact, but this could change how the nose is seen in relation to other facial features. “This is especially true in those who have a wider nasal bridge,” shares Campbell, CA plastic surgeon R. Laurence Berkowitz, MD, a specialist in rhinoplasty procedures. “When reshaping a wider nose, I prefer to use an ultrasonic power tool called a piezotome, which can be used to meticulously reshape the bone without impacting the surrounding tissue. Amazingly, the rest of the face will appear more refined just by narrowing the width of the nose.”

To create facial balance and harmony, oftentimes a surgeon will recommend enhancing the chin as well. An implant can be used to augment the area or an osteoplasty, which involves moving the bone forward, can also be done. “I personally like to advance a piece of chin bone forward to increase projection,” adds Dr. Berkowitz. “The smooth surface along the chin an implant provides does not mimic our facial anatomy. Our faces are actually divided into two halves, so by advancing the bone it helps retain that natural contour.”

Dr. Berkowitz performed an ultrasonic rhinoplasty to narrow this 18-year-old patient’s nose, which brought balance to her facial features and shape.

Surgical Facelift

For more severe cases that do not respond to nonsurgical treatments, or where lax skin is present, there’s no substitute for a surgical facelift, explains Dr. Ward. “I think the best face slimming treatment is actually a surgical facelift. Repositioning the fullness of the lower face to a more superior position creates a nicer jawline and gives a thinner appearance to the face. During the procedure, I lift the incised portion of the SMAS vertically, which creates fullness of the cheek superiorly while reducing the volume of the lower cheek.”

“For those patients in their 70s who are willing to do everything, I have successfully used a combination of a facelift and necklift, buccal fat removal, jowl and under chin liposuction, and a whole-face fractional CO2 laser treatment to accomplish the look they desire,” says Dr. Yu.


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