Mandibular Plane Over 50 For Fillers

Mandibular Plane Over 50: Optimizing Filler Treatments for a Defined Jawline

As we age, the lower face undergoes significant changes that can lead to a less defined jawline and an overall aged appearance. Volume loss, skin laxity, and bone remodeling contribute to these changes, making the mandibular plane, the lower border of the mandible (jawbone), a crucial area to address with cosmetic treatments. In individuals over 50, restoring definition and contour to the mandibular plane using dermal fillers requires a nuanced understanding of the aging process and precise injection techniques. This article explores the anatomical considerations, age-related changes, assessment techniques, filler selection, injection strategies, and potential complications associated with mandibular plane augmentation in patients over 50.

Introduction

The youthful lower face is characterized by a well-defined jawline and a smooth transition from the chin to the neck. However, with aging, the mandibular plane loses its sharp definition due to several factors. The loss of subcutaneous fat, combined with the descent of the cheek fat pads, contributes to the formation of jowls, which obscure the jawline. Additionally, bone resorption in the mandible can alter the shape and projection of the jaw, further diminishing its definition.

Dermal fillers have become a popular non-surgical option for restoring volume and contour to the mandibular plane. By strategically injecting fillers along the jawline, clinicians can enhance its definition, reduce the appearance of jowls, and create a more youthful and balanced facial appearance. However, in patients over 50, the aging process presents unique challenges that require careful consideration and a tailored treatment approach.

Anatomical Considerations

A thorough understanding of the anatomy of the lower face is essential for safe and effective mandibular plane augmentation. The key anatomical structures include:

1. Mandible: The mandible, or jawbone, provides the structural framework for the lower face. It consists of the body, which forms the chin and jawline, and the rami, which extend upwards to articulate with the skull.
2. Muscles: Several muscles influence the shape and contour of the lower face, including the masseter, temporalis, and platysma. The masseter muscle, located on the side of the jaw, is responsible for chewing and can contribute to the width of the lower face. The platysma muscle, a thin sheet of muscle that extends from the neck to the jawline, can cause banding and contribute to skin laxity.
3. Fat Pads: The lower face contains several superficial and deep fat pads that contribute to its overall shape and volume. The submental fat pad is located under the chin and can contribute to the appearance of a double chin. The jowl fat pads, located along the jawline, become more prominent with age and can obscure the mandibular plane.
4. Nerves and Vessels: The lower face is richly innervated and vascularized, with several nerves and blood vessels running close to the surface. The marginal mandibular nerve, a branch of the facial nerve, innervates the muscles of the lower lip and chin. Injury to this nerve can result in temporary or permanent weakness of the lower lip. The facial artery and vein run along the jawline and supply blood to the lower face.

Age-Related Changes in the Lower Face

As we age, the lower face undergoes several changes that affect its appearance:

1. Volume Loss: The loss of subcutaneous fat and bone resorption in the mandible contribute to a decrease in volume in the lower face. This volume loss can lead to the formation of jowls, a less defined jawline, and a flattened cheek appearance.
2. Skin Laxity: The production of collagen and elastin decreases with age, resulting in skin laxity and the formation of wrinkles and folds. The platysma muscle can also contribute to skin laxity by pulling down on the jawline.
3. Bone Remodeling: The mandible undergoes bone remodeling with age, leading to a decrease in its height and projection. This bone loss can alter the shape of the jaw and contribute to a less defined jawline.
4. Muscle Changes: The masseter muscle can become enlarged with age due to increased clenching or grinding of the teeth. This muscle hypertrophy can contribute to a wider lower face and a more square-shaped jawline.

Assessment Techniques for Mandibular Plane Augmentation

A thorough assessment is crucial for determining the appropriate treatment plan for mandibular plane augmentation in patients over 50. The assessment should include:

1. Medical History: Review the patient's medical history to identify any contraindications to filler treatment, such as allergies, bleeding disorders, or autoimmune diseases.
2. Facial Analysis: Perform a detailed facial analysis to assess the patient's facial proportions, symmetry, and skin quality. Evaluate the degree of volume loss, skin laxity, and jowl formation.
3. Palpation: Palpate the mandible and surrounding tissues to assess the bone structure, muscle tone, and fat distribution.
4. Photographic Documentation: Take standardized photographs of the patient's face from multiple angles to document the pre-treatment condition and to track progress after treatment.
5. Patient Consultation: Discuss the patient's goals, expectations, and concerns regarding the treatment. Explain the risks and benefits of filler treatment and provide realistic expectations for the outcome.

Filler Selection for Mandibular Plane Augmentation

The choice of filler for mandibular plane augmentation depends on several factors, including the patient's skin type, the degree of volume loss, and the desired outcome. Hyaluronic acid (HA) fillers are the most commonly used fillers for this purpose due to their safety, reversibility, and ability to provide natural-looking results.

1. High-Density HA Fillers: High-density HA fillers, such as those with a high concentration of HA and a large particle size, are ideal for creating structural support and defining the jawline. These fillers can provide a significant lift and projection to the mandibular plane.
2. Medium-Density HA Fillers: Medium-density HA fillers are suitable for filling in moderate volume loss and smoothing out irregularities along the jawline. These fillers can provide a more subtle enhancement and a natural-looking result.
3. Calcium Hydroxylapatite (CaHA) Fillers: CaHA fillers, such as Radiesse, are another option for mandibular plane augmentation. These fillers stimulate collagen production and can provide long-lasting results. However, CaHA fillers are not reversible and may not be suitable for all patients.

Injection Strategies for Mandibular Plane Augmentation

Precise injection techniques are essential for achieving optimal results and minimizing the risk of complications in mandibular plane augmentation. The following injection strategies can be used:

1. Linear Threading: This technique involves injecting the filler in a linear fashion along the jawline, creating a smooth and defined contour. The filler is injected deep into the subcutaneous tissue, close to the bone.
2. Bolus Injections: This technique involves injecting small amounts of filler in strategic locations along the jawline to create structural support and projection. The filler is injected deep into the subcutaneous tissue or into the periosteum (the membrane covering the bone).
3. Fanning Technique: This technique involves inserting the needle at a single entry point and then fanning out the filler in multiple directions. This technique can be used to fill in larger areas of volume loss and to smooth out irregularities along the jawline.

Step-by-Step Injection Protocol

1. Preparation:

   • Obtain informed consent from the patient, discussing potential risks, benefits, and alternative treatment options.
   • Cleanse the treatment area thoroughly with an antiseptic solution, such as chlorhexidine or isopropyl alcohol.
   • Consider applying a topical anesthetic cream or administering a local anesthetic injection to minimize discomfort during the procedure.

2. Marking:

   • With the patient in a relaxed, upright position, mark the key anatomical landmarks along the mandibular plane.
   • Identify the areas of volume loss, skin laxity, and jowl formation.
   • Outline the desired jawline contour, taking into account the patient's facial proportions and aesthetic goals.

3. Injection:

   • Using a fine-gauge needle or cannula, inject the selected filler into the subcutaneous tissue or periosteum, following the chosen injection technique (linear threading, bolus injections, or fanning technique).
   • Start with small volumes of filler and gradually build up the desired contour.
   • Massage the treated area gently to ensure even distribution of the filler.

4. Post-Injection Care:

   • Apply ice packs to the treated area to minimize swelling and bruising.
   • Advise the patient to avoid strenuous activities, excessive sun exposure, and alcohol consumption for the first 24-48 hours after the procedure.
   • Schedule a follow-up appointment to assess the results and address any concerns.

Managing Patient Expectations

It is important to have an open and honest discussion with the patient about their expectations for the treatment. While fillers can provide a noticeable improvement in the definition and contour of the mandibular plane, they cannot completely reverse the effects of aging. Patients should be aware that multiple treatment sessions may be required to achieve the desired outcome.

Potential Complications

While mandibular plane augmentation with fillers is generally safe, potential complications can occur. These include:

1. Bruising and Swelling: Bruising and swelling are common side effects of filler injections and usually resolve within a few days.
2. Redness and Tenderness: Redness and tenderness at the injection site are also common and usually resolve within a few hours.
3. Infection: Infection is a rare but serious complication of filler injections. Proper sterile technique is essential to prevent infection.
4. Nerve Injury: Nerve injury is a rare but potentially devastating complication of filler injections. Injury to the marginal mandibular nerve can result in temporary or permanent weakness of the lower lip.
5. Vascular Occlusion: Vascular occlusion occurs when filler is injected into a blood vessel, blocking blood flow to the surrounding tissues. This can lead to skin necrosis (tissue death) or, in rare cases, blindness.
6. Granuloma Formation: Granulomas are small, hard nodules that can form around the filler injection site. Granulomas are usually not painful but can be unsightly.

Conclusion

Mandibular plane augmentation with dermal fillers can be an effective way to restore definition and contour to the lower face in patients over 50. However, a thorough understanding of the aging process, anatomical considerations, assessment techniques, filler selection, and injection strategies is essential for achieving optimal results and minimizing the risk of complications. By carefully assessing each patient's individual needs and tailoring the treatment approach accordingly, clinicians can help their patients achieve a more youthful and balanced facial appearance.

FAQ

Q: How long do fillers last in the mandibular plane?

A: The longevity of fillers in the mandibular plane can vary depending on the type of filler used, the individual's metabolism, and lifestyle factors. Generally, HA fillers can last from 6 to 18 months, while CaHA fillers may last longer, up to 2 years.

Q: Is mandibular plane augmentation painful?

A: The level of discomfort experienced during mandibular plane augmentation can vary depending on the individual's pain tolerance and the technique used. Topical or local anesthetics can be used to minimize discomfort during the procedure.

Q: Are there any alternatives to fillers for mandibular plane augmentation?

A: Yes, there are several alternatives to fillers for mandibular plane augmentation, including surgical options such as jaw implants and facelift surgery. Non-surgical options include radiofrequency skin tightening and thread lifts.

Q: How much do fillers cost for mandibular plane augmentation?

A: The cost of fillers for mandibular plane augmentation can vary depending on the type of filler used, the amount of filler required, and the geographic location of the clinic. On average, the cost can range from $800 to $2500 per treatment session.

Q: What are the contraindications for mandibular plane augmentation with fillers?

A: Contraindications for mandibular plane augmentation with fillers include active skin infections, allergies to filler components, bleeding disorders, autoimmune diseases, and pregnancy or breastfeeding.