According to people who study the geometry of beauty, an inverted triangle — with the outer corners of the eyes and the chin forming the corners — is what we perceive as being youthful and attractive. Unfortunately, with age, that triangle can become more of a square.
“The lower face is a prominent area on the face that makes us notice signs of ageing,” says EV Expert Dr Ioannis Liakas, Medical Director at Vie Aesthetics. “As we age, we lose fat, the collagen in our skin starts to deplete, and muscle and bone mass reduce, resulting in volume loss and excess skin.
"The combination of volume loss, loss of hydration and elasticity, together with excess skin and the fact that the facial structure weakens, causes the skin to give in to the forces of gravity and start to appear loose or saggy and form lines. It can also make you appear hollow in the cheeks and make the chin and jaw appear wider.”
The result is that, from the nose down, we see a range of signs that can be ageing — from lines around the nose and mouth, to a softened jawline and jowls. However, if these things bother you, there are now a host of aesthetic treatments that can be employed…
Nasolabial folds"As we age, the fat pads in the face descend,” explains EV Expert Dr Osman Bashir Tahir (aka Dr OBT), Founder of Halcyon Aesthetics in London’s Marylebone.
“In addition to that, the incisors can recede and you get a loss of bone density. One of the results of this is that a groove can form at the base of the nose, between the nose and the outer corners of the mouth.
"I like to treat the area with a deep injection, on the bone, of a dense filler that has more stiffness to it and breaks down more slowly, such as Restylane Lift. That means you mimic the bone, rather than superficially filling the line, so it lifts the area without causing puffiness.”
Marionette linesThe same changes in facial structure can also lead to the formation of marionette lines, which track downwards from the outer corners of the mouth. “In this area I use a less viscous filler to soften the lines,” says Dr Tahir.
But he also points out that it’s very rare to treat these areas in isolation, and so a lot of the work that he does on the chin and jaw might also form a part of his approach. “It’s a combination of putting in deeper support as well as superficially softening the lines,” he says.
Dr Liakas is also a fan of using filler to correct nasolabial folds and marionette lines, and similarly restores volume where it has been lost, rather than just injecting the lines. However he often opts for the Ellansé Liquid Facelift. This uses a non-HA filler that “not only volumises, restores and hydrates the skin, but also triggers the body’s natural response to stimulate natural collagen production.”
Jawline“To tighten and firm the jawline I use HIFU, a form of ultrasound, and Vivace RF Microneedling, which combines microneedling with radio frequency,” says Dr Tahir. “The needles force the skin to repair and rejuvenate so you get more elastin, and I like energy-based devices as they boost collagen.
"Together they give better results than each individually, and I usually recommend a minimum of three sessions. As a bonus, the Vivace RF not only tightens the skin but also shrinks enlarged pores and helps fine lines and wrinkles across the face and neck.”
Submental (under chin) areaThere are various ways to tackle localised pockets of fat, such as those seen in a double chin. Depending on the patient, Dr Liakas may suggest Aqualyx fat-dissolving injections, where a course of injections work to liquefy stubborn fat in the treated area, which is then removed via the body’s lymphatic system.
He also likes FaceTite, a facial contouring treatment: "This uses radio frequency, delivered at the deepest levels to tighten loose and sagging skin and stimulate collagen production, but also uses a process called ‘lipopexy’ to eliminate excess fat in the treated area. This can be followed by the Morpheus8 treatment which involves the use of fractional microneedling combined with radio frequency for tighter, firmer and smoother skin."
Dr OBT has another solution. "I am a fan of using Ultracel Q+ which is a very innovative way of delivering ultrasound in a linear fashion so that it breaks down fat. The advantage is that the ultrasound also tightens the skin so you get a double benefit.”
Chin‘The loss of bone and soft tissue that comes with age means the chin can start to recede,” says Dr Tahir. “I think there are very few people who, beyond a certain age wouldn’t benefit from some chin augmentation — using a filler to recreate the volume that has been lost in this area.
"This can also help with the jowl area, as many people have a dip between their chin and their jowl. These are areas where there are naturally ligaments [that can loosen over time], and so it’s possible to support these parts of the face with a stiffer or thicker gel, which smooths and lifts the area.”
"If the chin is dimply, or if you have a slight downward turn in the corners of the mouth, it’s possible to use botulinum toxin in a muscle called the depressor anguli oris (or DAO) – you only need a small amount and it just means it doesn’t pull as much so you don’t get that downturned mouth effect, and it smooths the chin as well.“
JowlsAs well as using filler to help tighten up the jowls, Dr Tahir is also a fan of something he calls the Nefertiti Lift. “This involves injecting botulinum toxin into the platysmal bands that cause vertical lines on the neck. I find that when you inject them with a toxin, not only does it make the bands less visible, but it also helps to stop them pulling down the jowls so you get a correction here as well.”
For Dr Liakas, thread lifts are a great treatment in this area. “Both Silhouette Soft and Elionce PDO Threads, as well as the newly introduced Relife threads can help to lift sagging skin, and thanks to the polylactic acid (Silhouette Soft) and polydioxanone (PDO) that makes up the threads themselves, both treatments help to stimulate natural collagen production which means results will continue to develop over time,’ he explains.
“The combination of filler and especially Ellansé with threads is giving us optimal results, addressing all the root causes of jowls, and erasing the heaviness in the appearance of the lower face. As I explain to our patients: we change the ‘W’ shape of the lower face into a ‘V’.”
Osman Bashir Tahir, Aesthetic Plastic Surgery and Aesthetics
Dr Osman Bashir Tahir is a practising consultant Plastic, Reconstructive and Aesthetic surgeon. He is registered as a Specialist Plastic Surgeon with the...Book with Osman Bashir Tahir
Ioannis Liakas, Medical Director
Dr Ioannis Liakas is a shining gem in the aesthetics world. Prior to becoming an industry leading practitioner, he worked for the NHS for more than 20...Book with Ioannis Liakas