why do it?
Facial enhancement and contouring can make a significant difference to the entire face for both men and women. Certain face shapes are often considered more aesthetically pleasing to the eye.
Men tend to value sharper and more defined facial features, especially along the jaw. Women, in contrast, often seek softer or more delicate facial features. This is known as sexual dimorphism and is a result of sex hormones. Androgen-dependent features in males may signal stronger immune systems whereas estrogen-dependent features in females correlate with health and reproductive fitness and are found attractive.
In women, contouring techniques focus on creating a V, heart or almond-shaped face with round, full forehead, temples and cheeks, a smoothly tapered jawline with a delicate pointy chin and defined nose.
In men, a more defined, masculine appearance with high but relatively flat cheekbones, strongly defined jawline, square angle of the jaw and prominent broad chin is traditionally considered attractive.
Neoteny (retention of youthful features) and facial symmetry are also considered attractive.
to sculpt facial features safely and effectively
Fillers for Facial Sculpting
Injectable dermal fillers are hydrogels that can be implanted to enhance the shape and contour of the nose. They can be classified into temporary, semi-permanent and permanent fillers. Temporary fillers are most popular and can be classified into 2 broad groups:
- mainly volume replacement – most commonly composed of hyaluronic acid, a naturally occurring glycosaminoglycan polysaccharide which draws and binds water to itself and the surrounding skin. Other examples include agarose or collagen
- collagen stimulating – contain materials such as calcium hydroxyapatite, polycaprolactone that cause the body to produce collagen
Fillers have different structural properties such as cross-linking that manifest in their rheological properties such as viscosity, cohesivity, hardness and resistance to deformity. Hard, cohesive and viscous fillers are preferable for facial sculpting as they keep their shape well. Softer, medium viscosity fillers can also be used for certain softer areas such as the temples.
Neurotoxins for Facial Sculpting
Neurotoxins inhibit release of acetylcholine at the neuromuscular junction. Treatment of specific overactive muscles causes localized muscle relaxation. Neurotoxin can be used to relax prominent masseter muscles in square-jawed patients to slim the facial shape.
High-Intensity Focused Ultrasound
High-intensity ultrasound energy is focused precisely on the targeted fat layer, creating a rapid rise in local temperature at the targeted area without harming surrounding skin, tissue or organs. HIFU relies on the fact that, above a threshold of 56 degree C (for > 1 second), irreversible cell death occurs. The heat produces a dual tissue response within the treatment area – permanent destruction of targeted fat cells and contraction of surrounding collagen that helps improve tissue laxity. The body naturally removes the destroyed fat from the treatment area, reducing the size of a fat deposit.
Subdermal laser or radiofrequency
A tiny probe inserted under the skin is used to conduct laser energy or radiofrequency energy that is absorbed by the skin and surrounding tissues, stimulating collagen contraction and production to tighten loose skin, reshaping bulging or loose tissue.
1Aesthetics’s View on Facial Sculpting
dr wan’s perspective
Facial contouring is highly sought after.
Who wouldn’t want to look like a better, more attractive version of themselves?
Facial sculpting can be achieved surgically using implants and drastic cosmetic surgery but patients may not always want such sudden obvious changes with huge costs, recovery time and not to mention risks of surgery. Furthermore, if the result of surgery turns out less than ideal, it would be a huge waste of money and potentially be costly (in terms of time, money and effort) to reverse.
Many patients would prefer to have subtle, gradual changes and improvements to their facial structure to highlight their natural features and camouflage any deficiencies. In Dr Wan’s view, it is important to analyze each patient’s face systematically to make the best use of each person’s natural proportions. While there is a set of so-called ideal or most attractive facial proportions that most people find attractive, this should only be used as a guide. Following a strict cookie cutter template will lead to attractive but ultimately soul-less results. Nobody wants to look like someone else altogether, no matter how attractive. It is so much more important to find and bring out the beauty within your own features while at the same time creating a harmonious balance with the rest of the face, to express the attractive and confident self within.
Generally, the treatment approach would be to first address any areas of obvious asymmetry or deficiency followed by enhancing patient’s specific features more towards the ideal proportions and balance.
As facial sculpting is very personal, Dr Wan always uses 3D imaging to discuss in detail so that the patient understands enhancements to be made and is able to give their own inputs and preferences. For example, the androgynous metrosexual look is becoming more popular especially with the rise of K-pop and some patients may prefer a less traditionally masculine or feminine look. Pre-procedural planning and constant feedback during facial sculpting are very important and Dr Wan usually spends a lot of time and effort here.
In terms of technique:
- Long lasting, viscous and cohesive fillers with high G-prime should be used to strategically add volume and structural support to the face, using blunt cannulas wherever possible. For example, in ladies, common areas of augmentation would be the cheeks, temples and chin. Gentlemen more often require work on the jawline, angle of the jaw and chin. Generally, gentlemen would require more fillers due to larger faces.
- Areas of excess fat or laxity would be reduced with high intensity focused ultrasound or subdermal laser or radiofrequency. Square jaw due to enlarged masseter muscles can be reduced using neurotoxins. Prolonged neurotoxin masseter muscle reduction can lead to bone remodelling over time that may produce a reduction of the underlying bone, leading to a more permanent jaw slimming effect.
It may sound simple in summary but facial sculpting, like the name suggests, is akin to a work of art. Done right, it can give nuanced, natural results that make the facial proportions subtly more attractive. It can be tempting to overdo things but part of getting a good result is having the vision to place just enough at just the right places while being very vigilant against over-filling which could give decidedly unnatural results.
Fat Compartments and the Superficial MusculoAponeurotic System (SMAS)
The youthful face, characterized by diffuse, balanced distribution of superficial and deep fat, has a well-rounded 3D shape delineated by a series of arcs and convexities:
- primary arc of the jawline
- convexities of the temples
- multiple smaller secondary arcs of the lips
3 primary curves in the profile view are the most definitive features of youth:
- the lateral cheek projection (the “ogee” curve), an unbroken convex line from the lower eyelid to the cheek
- the arc of the jawline
- the arc of the forehead
Facial ageing is associated with
- loss of soft tissue fullness in certain areas: forehead, temples, around the eyes and cheeks, etc.
- persistence or accumulation of fat in others: eyebags, nasolabial folds, jowls and double chin, etc.
- fat pockets become more discernible as separate entities
- malar fat compartment gradually slides forward and down to bulge against the nasolabial fold
- the redistribution and demarcation of facial fat compartments gives rise to an unbalanced bottom heaviness
The SMAS is a continuous three-dimensional architecture connecting the periosteum, the facial muscles, and other supporting structures with the skin, consisting of an organized fibrous network of collagen fibres, elastic fibres, fat cells, and muscle fibres. The SMAS is an important support structure in the face and plastic surgeons specifically tighten and reposition the entire SMAS layer during a surgical facelift. As we age, loss of underlying skeletal support together with laxity and loss of elasticity in the SMAS result in weakened support to the fat compartments and overlying skin.
The fat compartments are divided into superficial or deep compartments by the SMAS
- superficial fat compartments between the skin and the plane of the SMAS – these are mobile and tend to sag with age
- deep fat compartments are beneath the facial muscles of expression, between the SMAS plane and the bone – these tend to lose volume with age