Jawline Sculpting Tips & Tricks with Dr. Robyn Siperstein

InStyle recently wrote an article about Kybella for jawline sculpting. What are the best tools for shaping the jawline and who makes a good candidate?

For top tips on jawline sculpting, I reached out to Robyn Siperstein, MD, cosmetic dermatologist in Boca Raton and Boynton Beach, Florida.

What tools do you use — including Kybella — for jawline sculpting?  How do you know which tool to use and when to use it? 

I use the hyaluronic acid filler Juvederm Voluma to add volume to camouflage jowls and create a straight jawline. Radiesse, Restylane Defyne or RH4 are other common fillers used for this purpose. Those with volume loss look best with filler treatments.

If a patient has a large amount of jowl fat which is too large to camouflage and the patient does not want to undergo liposuction or surgery, then Kybella could be an option.

Neuromodulators like Botox and Dysport can also be used to relax the platysma that pulls down on the jawline (nefertiti lift) and also to relax the mentalis muscle which will lower the chin to create a more linear extended anterior jawline. This can be seen in some with strong tight neck cords and short chins with dimpling/Peau d’orange.

I also consider IPL and laser resurfacing for those with sun-damaged skin over the jawline with slight laxity.

Who makes a good candidate for jawline sculpting? 

Overall: Lack of defined jawline or gonial angle.

Filler: Those with volume depletion behind the jowl, which can happen on the side we sleep, on both sides from losing weight or simply over time from the aging process.

Kybella: Those with pinchable jowl fat.

Neuromodulators: Those with a strong mentalis and platysmal muscles.

IPL & Laser Resurfacing: Those with textured photodamaged skin with mild laxity. Moderate to severe laxity often requires surgery.

What are your tips and tricks for dermatologists in performing jawline sculpting?

Filler: If using a cannula for filler, I do not recommend using the jowl for the port site. While it is convenient to use in order to volumize in front and behind, the movement of the cannula in and out causes swelling in the jowl making the jawline look worse temporarily which can scare the patient. I usually use a port site between the anterior chin and jowl to inject backward to the pre-jowl sulcus and anterior to extend the chin. I use a second port site behind the jowl aiming posterior to create a defined straight line and gonial angle. Another tip is to place the filler slightly higher than the patient’s natural jawline since the filler will expand slightly as it settles with gravity, especially if the patient is a side-sleeper. (You would never want to have filler lower than the natural jawline.)

Kybella: OFF LABEL – To limit pain and severe swelling with those who have limited downtime or are known to swell, I mix in a small amount of kenolog (0.1cc of Kenolog-10/1cc Kybella) and lidocaine.

Neuromodulator: I pull the neck cords out and away from the neck to prevent deeper spread of the neuromodulator when injecting the neck cords and inject the mentalis medially to prevent lateral spread to the DLI.

IPL & Laser Resurfacing: Perform these procedures first as less filler will be needed once the skin is smoother and tighter from resurfacing.

What should every dermatologist tell their patients before they undergo jawline sculpting?

Patient Expectations: It is helpful to show patients what jawline sculpting with filler or mentalis neuromodulator will look like by pulling the skin forward both behind and in front of the jowl and chin. Some patients have tight mandibular ligaments which only allow partial correction of the anterior jawline and can be seen when pinching the skin forward in the prejowl sulcus to give both the patient and doctor realistic expectations.

Change of Face Shape: Adding more volume along the jawline in some patients can create a squared masculine appearance so filler is not for all patients. Those with round or oval face shapes are more prone to this happening. I recommend the patient and physician look in the mirror together to show the goal of the treatment by pulling the skin in the direction of filler placement. In some patients you will be able to see that adding to the posterior jaw does not improve the aesthetic look despite creating a straighter jawline based on the proportions of their cheeks above.

Nerve Damage and Swelling: With Kybella, it is vital to let the patient know they will look worse before they get better as the swelling can be considerable after treatment. In addition, there is up to a 5% chance of injury to the marginal mandibular nerve, which can cause an asymmetric smile that can last a few months.

Downtime: Laser resurfacing requires 10 days of absolute downtime inside and can be painful.   

How quickly do patients see results from jawline sculpting?

Results are immediate with filler, though the results may change slightly as any swelling recedes and water absorption occurs.

It would take 6-8 weeks to see results with Kybella due to the prolonged swelling that accompanies this procedure.

Neuromodulator treatments will take several days to start seeing the results but 2 weeks for full results.

Laser resurfacing results can be seen in 1 week; however the skin can be pink for a month or two and results often get better at 1-3 months.

What complications can arise from jawline sculpting? How can a dermatologist best manage complications from jawline sculpting?

The same filler complications that happen in other places on the face can happen on the jawline such as bruising, lumps, infection, granulomas and vascular occlusion (VO). I use a reversible hyaluronic acid filler, which can be removed quickly with hyaluronidase if there is a serious complication. With Kybella, the marginal mandibular nerve could be affected creating an asymmetric smile. There is nothing to reverse either Radiesse (commonly used as a jawline filler) or Kybella, but with Kybella damaged nerves regenerate over the course of a few months. In addition, when injecting the mentalis with neuromodulator it is important to inject medially as lateral injections could spread to the DLI and cause an asymmetric smile for a few months. If this happens, the other DLI can be lightly treated to even out the smile, though difficulty eating could occur (pockets of food getting stuck). In addition, injections in the platysma need to be done by pulling the muscle anteriorly to ensure the product does not get injected into the deeper structures of the neck and vocal cords. Knowing the anatomy of the area will assist in decreasing complications, however with even the most expert injectors these complications can still occur.

Laser resurfacing with coagulation/heat from CO2 or added to Erbium:YAG can cause permanent hypopigmentation. Patients undergoing resurfacing are also at risk for infection, scarring and temporary hyperpigmentation. To prevent these complications, we require prophylactic antibiotics and antivirals, and have patients send photos daily to catch any potential problems early.

Image credit: patient images used with permission from Dr. Robyn Siperstein. 

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