Facial Aesthetics 101 – the clinical anatomy of aesthetics

Facial Aesthetics 101Melica Bastani speaks about the importance of understanding the difference between masculine and feminine features before undertaking treatments.

When assessing a patient for facial aesthetics, it is very important to first assess their natural features.

Men and women have very specific perceptions of what makes each gender attractive. So ideally, when it comes to facial aesthetics, you want to stick to that.

Masculine versus feminine

Let’s start with feminine features. Before you enhance facial features, you must first understand the anatomy behind female and male make up.

When we think about the ideal feminine face, we think high cheekbones with a slimming jawline, plump lips, raised eyebrows and a smaller lip to chin ratio.

For masculine faces however, ideal face shapes are the opposite. We often perceive males as more masculine with a square-shaped face because of the angles of the jawline.

Research shows that beauty is not just a simple construct – attractiveness is ingrained into our biology. While some aspects of face perception are innate, other aspects are clearly influenced by the outside environment.

Essentially, you want to keep up to date with what the latest trends are in aesthetics. Usually what we deem as ‘fashionable’ at the time comes from celebrity looks or trends through the generations.

Breakdown of the female face


When injecting lips, make sure you keep that ideal female lip shape in mind. The ideal lip shape is keeping the bottom lip slightly bigger than the top lip.

Make sure to assess this in three dimension – front view and side view of the lips.

With any lip shape, you always want to make sure that you maintain the following features of the lips to give the most natural look that you can achieve: cupids bow, vermillion borders and oral commissures and sometimes even the philtrum but this would need to be judged on a case by case basis. Some people have a more pronounced philtrum than others.

Certain patients will have a more complex lip shape – known as the ‘M shape lips’. For these patients, you can still achieve that beautiful pout, but don’t rush into achieving it in one session. These lips need a gradual build up.

Although hyaluronic acid filler doesn’t promote collagen production, there is research showing the expansion of the dermal extracellular matrix (the scaffold that supports the cells for collagen production) optimises the environment and function of fibroblasts.

Think of fibroblasts as an essential ingredient to provide structural and functional support.


Many women want high cheek bones (or the illusion of them). Not only does it provide extra structural support in the upper face region, but also gives a more youthful look.

When you imagine high cheek bones, picture famous women such as Angelina Jolie and Bella Hadid.

You want to follow the natural contours of a woman’s cheeks whilst still achieving optimum results. You definitely don’t want them looking more alien than human!

The region you are looking at for cheek augmentation is between the tragus and mid ala as shown in Figure 2.

When considering how high you want to enhance the cheekbones, assess what the patient wants versus what is achievable.

Higher cheekbones, like well-known celebrities, require the tragus/ear point to be higher. But for a more subtle look to be slightly lower. Keep this in mind when marking the patient up before injection.


We have already established the importance of maintaining feminine and masculine features between both genders.

Today, women often request a more defined jaw line to give then the appearance of a slimmer neck and reduce the appearance of pre-jowls, as you can see in Figure 3.

For women, it’s often all about the subtle enhancements, similar to what many achieve with makeup. Whereas for a more masculine bone structure and dominant appearance, we need to aim for a squarer jawline focusing on angles and straight lines.

A very important factor to consider is to not augment across the area that is already showing appearances of jowling.

To achieve best results, cannula is preferable and inserted sub dermal to prevent an unnatural or ‘lumpy’ look to the filler.

Understanding anatomy

Understanding the back story to each patient is an important part of the start of their journey. It enables a holistic approach and creates a bespoke treatment plan for your patients.

An essential part of this is knowing your anatomy inside and out. If you have full confidence in your anatomy, good results will always follow.

Unfortunately, well trained healthcare professionals are often contacted by people treated by non-medics or poorly trained professionals. They often fail to acknowledge the serious complications of not fully understanding the anatomy of men and women respectively.

This is not just a concern for the safety of the patient, but also risks leaving patients’ faces disproportionate. As well as failing to educate the patient in male and female anatomy. Thus it leaves the patient feeling unhappy.

Make sure to not only educate yourself by going to the right training providers, but also remember to educate the patient. The more they know about what to expect, the better.

Catch previous Facial Aesthetics 101 columns

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