The shape of the jawline has become a new area for facial enhancement in the past decade. As a u-shaped curve that makes up the lower third of the face, it is an acute transition line between the face and the neck. The jawline has numerous dimensional features including a desired curved or v-shape from one angle to the other and three easily seen and well-defined bony prominences, the chin and the two jaw angles. The width of the jawline is highly influenced by the size of the masseter muscles in the back end of the jaw. Deficiencies in any of the bony prominences or an irregular inferior border make for an undesired weaker jawline appearance. Large masseters muscles can make the jaw look too wide.
A smooth jawline is often age-related and the development of jowls, which everyone will eventually get, can be reversed by conventional facelifting techniques. A shorter chin and/or high jaw angles are the result of one’s genetics and are only affected to a minor degree by small amounts of bony atrophy with aging. Augmentation of the chin and jaw angles by synthetic implants can make dramatic changes in these bony prominences. Large thick masseter muscles are usually ethnic-related but some cases of hyperactivity do exist. Masseter muscle reduction defies a surgical procedure but chemodenervation can be very effective albeit a much longer term treatment.
Despite these known surgical procedures for jawline enhancement, some patients do not want an invasive treatment. Non-surgical (injection) treatment strategies do exist for all areas of the jawline. While they are not ideally effective for many jawline problems, they can offer some temporary and modest improvement. For some, they may be a test before considering surgery. For others, they may be all that will ever be done. Besides effectiveness, what separates surgical vs injectable treatments is the permanency of the results they create.
Injectable fillers are intended to primarily plump up soft tissues such as lips and nasolabial folds but they can be used for bony augmentation. They can be easily and quickly injected onto the chin and at the jaw angles as an office procedure. Of all the injectable fillers, Radiesse is the best choice for jawline augmentation. It is not just because it is partially composed of hydroxapatite particles, which is the inorganic component of natural bone, but because of its greater persistence over most of the hyaluronic acid fillers. (e.g., Restylane) Its thicker viscous consistency also does a better job of pushing the overlying soft tissue away from the bone for a greater effect per volume of injected material.
For the large masseter muscle, Botox injections have proven to be very effective. While it requires multiple injection sessions every 4 to 6 months, the masseter muscle does remarkably shrink. This is evident even several months after the very first injection. Three injection sessions over the course of a year can visible shrink the muscle and make the width of the jaw more narrow. The only question about Botox injections in the masseter muscle is are the atrophy effects permanent? Some tout that once the muscle has been significantly reduced it will stay that way. No long-term clinical trials have ever been conducted to determine if that Botox effect is true. We know it is not true in the cosmetic treatment of the muscles of facial expression but the masseter muscle is a much larger muscle composed of different types of fibers.
Injectable jawline enhancement can be done by Radiesse filler in the chin and jaw angle and Botox into the masseter muscles. Its disadvantages are that neither is permanent and must eventually be repeated to maintain their effects. But for those opposed to more invasive surgery, non-surgical jawline modification is a viable alternative.
Dr. Barry Eppley
Indianapolis, Indiana