The context of the popularity of injectable treatments is outlined with the American Society of Plastic Surgeons (ASPS) 2018 stats describing the 3% rise in the number of injectable dermal fillers being performed. The author gives a detailed description of the anatomical ageing of the lower facial region, discussing the influence of the senescent changes of the neck. There is a strong emphasis on using hyaluronic acid for rejuvenating the lower face, and this rationale is well supported and referenced with current literature.
Other types of dermal fillers are indicated for use in this region, supported by a strong body of evidence, which are not alluded to within this paper. This is based upon the author’s preference. The many considerations underpinning a sound patient consultation and assessment are discussed, particularly in relation to assessing the patient’s bone structure and dental issues, such as irregular alignment and tooth loss. Aspiration is advocated but no rationale or supporting evidence is noted. Specific product characteristics, such as viscosity and G’ Prime are explored with their relevance to use in this area. A ‘validated scale’ is used to assess the lower face (Carruthers et al., 2010), yet, it should be noted that this is one example of a validated scale that is available.
The author chooses a pre-periosteal bolus technique of product placement at the pre-jowl area, with consideration to additional correction at the mandibular angle, and the lateral zygomatic arch if there is evidence of profound boney and soft tissue descent. The author provides useful patient images with topographic markings for placement to support the suggested corrective techniques to guide the reader clearly.