When we talk about facial harmony, we are of course referring to the entire face as a whole, but there are two major structural areas that play a huge role in achieving a harmonious, well balanced and proportioned face, and those are the cheeks and the chin. With deep bone structure and intact and well positioned fat pads, the skin has tension between the cheeks and chin, forming an ideal triangle of youth. The natural aging process disrupts this youthful presentation, and as we get older that “triangle” becomes an inverted one. At Skin Worthy Toronto we take a comprehensive approach, and analyze how all 5 layers of the face contribute to aging, to determine how to treat aging cheeks and chin.
Bone Deep - How to Treat Mid-Facial Aging
Like many of our bones as we age, as we get older, our anterior cheek projection recesses back with the pyriform fossa, resulting in less support for the layers above - including the cheek, nasolabial fold, and nose. In the mid-face specifically, the “ogee” curve flattens and the sublunar region progressively becomes more concave. To combat bone recession in the mid face, one of the best options is the use of a robust HA dermal filler or a bio stimulator like Radiesse or Sculptra at the boney layer to restore that lost structure.
The Need For Extra Padding - Deep Fat Pads of The Cheeks
Likely the greatest determinant of mid-facial aging is the deflation of the deep fat pads. Similar to the bone, they recess back and shrink in size, leaving you with that gaunt, sunken in and tired looking appearance. Since the mid-face provides support for the area above, the loss of these fat pads can also make eye bags appear more pronounced because of the lack of structure below.
When talking about the cheeks, the fat pads that impact mid-facial aging the most are the anterior deep fat pad called the SOOF, the deep medial fat pad and the buccal fat pads.
To restore the loss of fat pads to the mid-face recommended treatment is similar to that of loss of bone structure. Robust and firm dermal fillers can help to replicate the appearance of a youthful fat pad and restore that desired contoured appearance.
Muscle Up - Muscles That Impact Aging Cheeks
While you may be thinking you don’t typically treat cheek muscles for Botox, you are likely aware that facial muscles move together, impacting other areas. As we age muscles lose support and have less tension behind them. This causes them to contract more and create more dynamic expressions. With natural aging of the muscles and fat pads below, ligaments such as the nasojugal groove can become more apparent as we age.
Myomodulation is also an important here. Simply put, it refers to the change in the activity of a facial muscle when a filler is inserted next to it. As filler is often used to restore loss of fat pad and bone structure below, it can certainly impact the movements of the muscles both above and around. This is why understanding of anatomy is essential for the most optimal outcomes. To treat this we use specifically placed Botox to lessen the extreme muscular contractions that can occur in that upper mid-face area.
Growing Fat Pads - Superficial Fat Pads In The Cheeks
It is a combination of shrinking and enlarging fat pads that contribute to the decent of the face downwards, and that dreaded inverted triangle. As we age and our mid facial fat pads shift, our jowls and nasolabial folds can become heavier and appear more severe. Fat pad deflation of the superficial lateral temporal fat pads can also lead to lateral cheek atrophy - causing us to look to a more boney, less defined and have diminished projection.
Treating superficial fat pads in the mid face is really dependant on the severity, skin quality and individual patient’s anatomy. Evoke, a hands-free, radio-frequency, facial remodelling device can be used to shrink the nasolabial fat pad, leaving the face to look more lifted and contoured. In addition more invasive radio-frequency devices, also from InMode, such as Accutite and Morpheus8 can be part of your evolution plan to soften the appearance of unwanted folds. Instalift Silhouette threads that are laced with poly-L-lactic acid, the same product found in Sculptra can help to subtly lift the lower face and continue to build collagen for up to 24 months.
Finally, dermal filler can be used to soften some transitions between superficial fat pads.
Skin Matters - How Skin Quality Impacts Cheek Aging
Skin thins with age - and when we lose collagen and elastin on our skin in the mid-face, this thinning skin exaggerates the appearance of lines and wrinkles on the cheek when one smiles. Combined with the loss of structure below, this less supported skin also tends to worsen the appearance of crows feet that can appear etched into the cheeks and accordion lines below.
Resurfacing and re-hydrating are two of our favourite ways to address aging skin in the mid face. Our goal is to restore hydration, improve laxity and creepiness, and improve skin quality all while stimulating collagen and elastin production.
Combatting The Aging Chin - How The Chin Ages and How We Can Treat It
When it comes to facial harmony in the lower face, along with the jawline, the chin is one of the most important areas of consideration. As it we age our chin significantly changes both in shape and projection. A strong and defined chin in youth often recesses back and appears less projected and flattened with age.
The mandible predictably recedes on either side of the mentum, causing anterior grooves to form and contributes to the formation of the pre-jowl sulcus (indentations on either side of the chin).
To restore lost projection and definition, HA based dermal filler is used to give you a structured, balanced and stronger profile.
Fat Padding - Of The Chin
While the chin isn’t an area we often think of when we talk about fat pads, changes and aging to both the deep and superficial pads can increase the prominence of the pre-jowl sulcus and may even contribute to chin ptosis. Hypertrophy of the superficial fat pad of the jowl, can also increase the appearance of a more squared and heavier lower face.
A variety of treatments from dermal filler to soften the pre-jowl area or the mental crease to Morpheus8 and Evoke to shrink the pads themselves, and Instalift Threads to provide a subtle lift and softening of strong or deep jowl.
Muscle Memory - How The Muscles in the Chin Impact Aging
The two main muscles that impact the chin are the mentalist and the DAO - both work together in opposing movements. The mentalis aids in lifting of the lip , and dao aids in towards rotation of corner of lips to create a sad face. With the loss of structure below them, we see a stronger holding state of both of these muscles , resulting in a curling upwards of the chin and downturn of the corners of the lips. Other visible change to the chin area include a more prominent labiomental crease (a horizontal groove below the lower lip and above the chin prominence) caused by repetitive action of the mentalis muscle, and the appearance of peau d’orange (dimpling of the chin) from visible dermal attachments causing a cellulite appearance. Botox is the best option to address muscular changes of the chin, and are done at different points and depths to achieve desired results.
Our chins are highly expressive and repetitive muscular contractions with multiple muscles in this area can leave deep and permanent wrinkles on the skin. Microtoxing with Botox can help to improve skin quality, along with laser treatments like Halo or re-surfacing options like TRL and Morpheus8.
The cheeks and chin are two major structural tension points on the face that are essential considerations when it comes to facial harmony. While they are in different areas, treatment protocols for both tend to be very similar as they both recess and atrophy. In order to address signs of aging in the most natural way, we must address the deep bone and fat pads first to restore foundational structure before going to upper layers of superficial fat transition zones. Even with facelift that can precisely address the upper layers of face, if the deeper layers don’t have the structure or support, the results will be lack lustre and may leave a patient unsatisfied. To learn more about our options for cheek and chin rejuvenation, book in for your Beauty Evolution consultation by calling or texting 647-350-7546 or clicking here.