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Safer Filler Techniques for Profile Balancing

Identifying appropriate and safer filler techniques for profile balancing can transform your aesthetic patients’ facial proportions and features.

Profile balancing is rapidly becoming a popular request in aesthetic medicine. It involves employing several approaches, customised to help bring harmony to a patient’s side profile.

Here, Clinical Trainer and aesthetics specialist, Paula O’Sullivan, RGN, shares her best practices for profile balancing.

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Why patients may request profile balancing

“Often, patients seeking a non-surgical rhinoplasty or lip augmentation may overlook the fact that their side profile reveals a small chin. A well-proportioned nose or enhanced lips can accentuate a small chin, disrupting the overall balance of the lower face”, Paula clarifies.

“Profile balancing addresses this by adjusting a retracted chin to the appropriate ratio relative to the nose and lips, harmonising the side profile.

Assessing a patient for these treatments

She comments that in her own aesthetics practice, “There is an indication for each assessment tool and the findings will guide my treatment planning.

During the consultation, Paula recommends “assessing the patient's full face by studying the facial thirds, facial fifths, and Ricketts’ line.”

For example, “you should consider the patient’s bizygomatic width and their bigonial width.” Paula suggests that aesthetics practitioners approach it with “the understanding that female patients tend to have a narrower bigonial width than men. Typically, men will have an equal distance and, therefore, a more square-shaped face.” Similarly, when administering chin filler, a square chin is seen to be more masculine, whereas a pointed chin is more feminine.

When considering the Frankfort plane, Paula suggests “Your patient’s face must be in a neutral resting position using the Frankfort plane. This means the top of the tragus should be in line with the anterior projection of the orbital rim. The nasion should be in line with the most anterior projection of the chin, i.e. the pogonion. In this instance, chin filler would be a good option to consider.

She suggests an example as “Dermal fillers can be strategically applied to the chin to achieve a more defined and contoured appearance. Many patients choose to combine this treatment with jawline filler. These procedures complement each other, resulting in a more structured and refined facial appearance”, she notes.

These assessment tools “This ensures your baseline assessment is the same for each patient. It often highlights areas that require dermal filler enhancement to achieve their goals. At this point you can continue with the consultation with your patients on which aesthetics treatment would achieve the desired best results,” Paula clarifies.

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How to mark up a patient for profile balancing filler treatments

“When aiming to achieve an improved profile balance, landmarks for injections are essential,” Paula stresses. “With every landmark, I’m considering anatomy and what I would like to achieve.

“When targeting the chin, for example, I ask myself if I need to lengthen or anteriorly project the chin in cases of retrognathia. Depending on the treatment required I would landmark to guide my treatment according to the patient’s anatomy”, she cites.

Injecting filler using a cannula vs a needle

“When choosing the appropriate tool for administering dermal filler, I think about the underlying anatomy. In particular, the facial vasculature in the area I’m injecting and depositing filler.”

Paula states that “with anatomy, product choice and volume in mind, my tool choice mostly sways me towards cannula for safer administration. However, it varies for each patient depending on what layer I’m injecting and what result I’m trying to achieve.

Paula comments that she would “use a needle with caution and inject small volumes using low pressure and extrusion force.”

“I typically use a needle when a bolus is required, which is often the case for structural support. Whilst injecting, whether using a cannula or needle, I’m constantly assessing for skin perfusion and any concerning signs of vascular compromise”, she highlights.

The best filler techniques for safer profile balancing

Paula talks us through how she approaches profile balancing and the filler injection techniques she applies.

“The filler used for profile balancing will likely be a firm product and possibly in large volumes”, Paula explains.

“Commonly when injecting the lower face, such as chin filler, to achieve an improved profile balance, I add filler down onto the periosteum in layer five using a needle and deliver a small supra periosteal bolus. This creates support and structure before I target the superficial fat using a cannula. Here, I deposit filler in retrograde linear threads to offer a more contoured and defined result,” Paula continues.

She notes, “Once I’ve added the desired amount of filler - and volume is patient-dependent - I gently massage the area whilst checking the capillary refill time.”

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Profile harmonising pitfalls injectors should be wary of

There are a few pitfalls new medical aesthetics practitioners should be cautious of when approaching profile balancing. Paula advises, “Be mindful when injecting the lower face and avoid adding filler to an already heavy area, eg. the jowls.”

Furthermore, she states “The rheology of the filler you use in this area will be of a high G prime. This can worsen the areas of existing heaviness.”

She adds “Depending on the significance of the problem, don’t underestimate or over-promise results to your patient and ensure their expectations are met.”

Paula warns, “Usually, multiple mls of dermal filler are required to address profile imbalance. It’s important to communicate this to your patient rather than promising a result with 1 ml. Failing to do so can lead to patient dissatisfaction.”

Enhance your skills with specialist-led medical aesthetics training

At Harley Academy, we specialise in providing the highest quality training in aesthetic medicine. Our Level Diploma in Botox & Dermal Fillers is available to doctors, dentists, nurses and clinical pharmacists. A Master’s level qualification, our Level 7 Diploma is Ofqual-regulated and JCCP-approved. It’s the perfect start to your aesthetics career and will set you up with key anatomical knowledge, injecting skills and techniques.

If a more tailored approach is what you’re looking for, then our Cheek, Mid-Face & Lower Face Filler Masterclass may suit your needs best.

In this day-long Masterclass, you’ll broaden your filler techniques and treatment skills through specialist-led hands-on training. Furthermore, you’ll treat your own patient under their supervision. Through this you’ll learn to confidently assess a patient’s face, and combine treatments while adding harmony and balance to the face.

Book a call with one of our Course Advisors to find out more about what courses are available to you. They’ll help you find the right track with your aesthetics career goals in mind!

All information correct at the time of publication