The basic aim of the treatment is to adjust the proportions of the nose, chin and lips to create a nicely balanced profile (balance and symmetry being the cornerstones of what we perceive as beauty), using, primarily, dermal fillers.
For the right candidate and in the right hands, this can deliver transformative results without a scalpel in sight, making, among other things, noses look less prominent, minimising double chins and doing away with receding ones.
But as so often with non-surgical procedures, it’s not a colour-by-numbers job, and leading practitioners have their hands full reversing less talented injectors’ bulky, wonky or inappropriate ‘corrections’.
We talked to two specialists – EV Editorial Panel member, surgeon and lecturer Jonquille Chantrey and Cosmetic Surgeon Benji Dhillon – about the possibilities and the pitfalls, and the importance of selecting a doctor whose mathematical approach matches his or her artistic skills.
Taking a lateral viewThe most important thing to remember is that side profile balancing, despite the name, requires an entirely lateral approach that considers the proportions of the whole face from all angles. This can lead to unexpected suggestions by your doctor, who sometimes won’t even touch the feature that bothers a patient most.
A long nose, for example, can be optically shortened and lose its dominance over the face by projecting the chin a little, bringing balance. At the same time, while the focus is on the nose, chin and lips, those are rarely the only features treated.
“Achieving the ideal side view may well require dermal fillers in the jawline, cheeks and forehead,” says Dhillon. “However, while re-shaping the profile, we need to ensure the front-on view looks just as good, and that’s where many patients and doctors go wrong.
"For example, I see far too many female patients wanting a strong, defined jawline and lips to boost their profile, but seen from the front, the lips are disproportionally large and the lower part of the face looks square and bulky, which is not attractive in a female face.”
Chantrey agrees that it is rarely a straightforward procedure. “It’s a really complex area with loads of sub-units of balance to pay heed to in a mathematical fashion, if you want an excellent result. There’s the slope and curvature of forehead, the relationship between the nose and forehead, the curvature of the chin, the angle between nose and upper lip, the distance between the lower lip and the different parts of the chin, to name just a few things we must keep in mind.
"And their ideal proportions vary not just depending on whether you want a masculine or feminine-looking outcome; cultural and ethnic variants are also important to take into account.”
In short, run like the wind if your doctor doesn’t insist on an elaborate assessment of your face before pushing ahead with profile correction.
The right assessmentSo what kind of process should a patient expect their doctor to go through? “Critically, the first step is to assess someone from all angles, ideally using photography,” says Dhillon.
“On profile, I am looking specifically whether certain criteria are met. One measurement we use is called Rickett’s Line - this is a line which helps determine the ideal relationship of the nose, lips and chin. When these sit at certain points in relationship to the line, it leads to a balanced profile. I will then look at the other aspects of the profile, which include cheek volume, jawline definition and the presence of any loose skin under the chin.”
As Chantrey puts it, “we need to do the maths and we need to do it in a comprehensively considerate way.” So don’t be surprised if your doctor whips out a ruler and starts measuring your face like a kitchen cabinet.
When it comes to applying the fillers, “it’s about using the right ones in the right areas to create impactful results with minimal amounts of product,” says Dhillon. “I am teaching more and more injectors around the world how to use cannulas in the cheeks, with the smallest possible amounts of filler to reduce the risk of downtime and bruising.”
For the chin, he’s a fan of Teoxane Ultra Deep: “It’s excellent at restoring a profile with very little filler as it was designed for projection,” he says. It’s also used to correct nose shape, removing bumps and increasing symmetry for a more refined profile.
Chantrey rates Juvederm Volux, which she helped develop and was designed for adding structure to the jawline and chin. Overall, you should see a doctor use a variety of filler densities appropriate to different parts of the face – some that move along with facial animation and others that form dense support, correction and projection.
Non-filler techniques“Increasing the projection of the chin and definition of the jawline can make a double chin look less prominent, which was a game-changer when I first did it about a decade ago,” says Chantrey.
However, Dhillon points out, this is most successful in people whose double chin is largely due to loose skin; if it’s a pocket of fat, often an additional procedure such as CoolSculpting is required.
Both doctors also work with cosmetic dentists and orthodontists in the pursuit of a great profile. “In many cases a weak profile is due to some degree of underlying misalignment with the teeth or bones of the jaw,” says Dhillon.
"For those who look for a longer term, more holistic plan, we can correct the teeth and also use injectables to re-shape the jaw area and profile.”
Slow and steady wins the race“Some patients want a quick and dramatic result, and if they’ve had a thorough assessment and chosen a great practitioner, that’s fine,” says Chantrey. "But a good doctor should always offer the option to do the work in stages at no extra cost, so the patient can monitor the progress every step of the way and decide when enough is enough.”
Dhillon prefers to administer his treatment plans in sessions: “I like to treat structure first (such as significant volume loss due to bone and fat loss) and then leave 2-3 weeks before I apply the finishing touches. It allows me to be very precise and it allows the patient to control their spend, as they might be so happy after the first session that they decide to leave it at that.”
During the process of choosing a doctor who’s good enough to perform profile correction, “look to see whether they’re peer-reviewed, whether they’re leaders in their field,” says Chantrey. "Have they done this procedure for many years? Do you like their aesthetic? Are they truly listening to you and of course, are they exhaustive in their assessment of your face?”
Adds Dhillon: “A good physician also knows what is not possible and will tell you so. I regularly recommend surgery for individuals who are not suitable for non-surgical treatments, for example due to poor skin quality or loose skin. I would not want them to waste their money on something they are likely to get a poor outcome from.”