Sharing, not teaching, my approach to facial aesthetics

Sharing, not teaching, my approach to facial aestheticsDr Benji Dhillon discusses the importance of understanding beauty and anatomy when it comes to facial aesthetics. 

Medical aesthetics as a speciality is exploding. It is increasingly recognised as a discipline that requires knowledge, scientific rigour and an artist’s hand. It should not be simplified into just recommending a ‘skin cream’ or picking up a syringe and ‘injecting some filler’.

We have the capability to change people’s lives, much like dentistry. Unfortunately due to a lack of rigour being applied to training and regulation within medical aesthetics, outcomes are not always positive.

Facial aesthetics requires a deep understanding of anatomy, skin ageing physiology and product knowledge. A lack of knowledge in these areas can lead to serious complications. Vascular compromise which may lead to tissue necrosis is the most severe of complications. But it is the less severe adverse events that often cause the most angst.

Some of the most common complications are aesthetic and often due to a lack of knowledge on how to assess the face, minimal anatomical understanding or poor technique. A poor aesthetic outcome can not only psychologically affect an individual’s wellbeing in the long term, but also lead to serious litigation.

Subjective versus objective

To help avoid such pitfalls I will be sharing, not teaching, my approach to facial aesthetics which revolve around:

  • Facial assessment using my algorithm Teoplan
  • Anatomical understanding
  • Sound technique.

It is vital to recognise that all patients come into our clinics to have their ‘aesthetic’ improved. Practitioners must therefore understand the difference between subjective and objective beauty.

Subjective beauty is how an individual perceives themselves. It is what they observe in the mirror every day. Often social or cultural influences may shape these views. Unfortunately, on occasion, subjective beauty is at loggerheads with objective beauty.

Objective beauty is what is proven and generally accepted, and are based on proportions and ratios. They are engrained in the subconscious to such a degree that a baby will often spend more time looking at an ‘attractive’ face than a ‘non attractive’ one.

During a consultation a good practitioner should respect and respond to a patients ‘subjective’ wishes whilst simultaneously objectively analyse the face based on facial aesthetic ideals. This should lead to sound, evidence-based suggestions on how to elevate the patients aesthetic.

Facial aesthetic ideals can be summarised into gender specific facial shapes. The ideal female facial shape is oval to heart; this means a greater bi-zygomatic to bi-gonial width. The ideal male facial shape demonstrates an almost equal bi-zygomatic to bi-gonial width leading to a square face. Consequently, female beauty predominantly lies within the mid face (cheek) and male beauty in the lower face or chin.

Key features

Every aesthetic practitioner should also be able to confidently identify additional key gender specific beauty features. Examples include:

  • A convex forehead in a female versus a concave male forehead
  • Full anterior cheek volume blending into a full, defined and high cheek bone in a female, and by comparison a slightly deflated anterior cheek with a lower, but still defined, cheek bone in a male
  • The base of the nose should be as wide as the mouth in a female
  • In a male face the mouth should be as wide as the chin.

Understanding beauty ideals is essential to being able to comprehensively assess the face, enabling the development of an optimal treatment plan. In my experience, it is not the best injector who is able to create exquisite results. But rather individuals who innately know how to assess a face and decide where to place filler versus where it should be injected.

The Teoplan facial assessment algorithm which I share on my courses enables anyone to implement the above in an easily reproducible format in clinic.

Every injector must appreciate the layers of the face and consequently the specific compartments that should be targeted to achieve the intended aesthetic outcome. The deep and superficial facial compartments of fat behave differently. The deep fat compartments lie above periosteum and are static. Therefore, a firmer or more robust volumising filler can be used in the deep plane.

The superficial fat compartments, which lie under skin and above muscle, are dynamic and move with facial animation. Softer, more mobile fillers should be used in the superficial plane. This will avoid the accumulation of filler when the patient expresses (animation deformities).

Better aesthetics

The different facial layers also age in various ways. It is critical to appreciate how the bony skeleton of the face changes over time. A key area that most dentists will innately be able to assess will be the lower face, particularly on profile to analyse the class of malocclusion. Deep fat atrophies over time, whereas the different compartments of superficial fat either atrophy or hypertrophy. Musculature will also change, with some muscles of the face becoming slightly more flaccid with time.

An example of this is the zygomaticus group of muscles which can lead to reduced smile excursion. However, some muscles may increase in tonicity such as the depressor anguli oris (DAO), worsening the downturn of the corners of the mouth.

Skin also ages over time and is heavily dependent on a patient’s lifestyle. Smoking, sun exposure and stress are all factors that may prematurely age skin. Poor skin quality is often a contraindication for dermal filler treatment as it is likely to lead to poor aesthetic outcomes.

Taking the time to appreciate the nuances of anatomy, facial assessment and ageing are all critical to our community delivering better aesthetic results. As a collective we have an opportunity to turn this fascinating field of ‘beauty’ into its own speciality – let’s treat it as such.

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