Everyone has a different facial contour. One may not like his or hers because of different reasons. It can be considered as too little, too much, or too lax.

When there is too little we talk about augmentation. There are many different facial implants to boost any area, from nose-bridge, to cheeks and chin. These are the area of the plastic surgery and Cosmetic Physicians can provide an alternative solution by injecting fillers into these areas.

An example of how nose-bridge is augmented with Juvederm :

When there is too much we talk about reduction. The nose can be reduced, so are the cheek bones or the chewing bones. Again they are major plastic surgeries and carry significant risks. In the past few years, lots of Oriental people who have square or angular faces have tried having their chewing muscles injected with Botox. This has resulted in dramatic improvement with slimmer and oval faces, and many plastic surgeries have been avoided.

An example of how angular face is reduced with Botox :

When the facial skin is lax and saggy, giving the facial contour a puffy look, one talks about facial skin tightening. This is traditionally achieved by surgical face-lift but this procedure is losing its stand fast because of the many skin tightening treatments available. Apart from more people opting to the less invasive procedures even at the time when they need a face-lift, having these treatments as prevention at younger age probably make less demand for face-lifts 10 or 20 years later.

There are many skin tightening treatments available, including ablative laser, non-ablative laser, and radio-frequency. The newest advance in 2007-2008 would be the Fractional CO2 Laser skin resurfacing, which gives a result close to the gold standard of traditional CO2 laser skin resurfacing, and yet only has a downtime of 4-7 days.

Due to the natural shape of our skull, the temples are normally sunken. Some people have high cheek bones which make the temples look more sunken. In the majority, as we age and the collagen is lost, the subcutaneous supporting tissues will shrink and result in the same sunkenness.

Sunken temples will have two consequences in our cosmetic appearance:

First, sunken temples make the facial contour irregular and add a fierce appearance to the look.

Second, sunken temples fail to support the facial skin below, plus other factors that age the skin at the same time, will exaggerate the sagging appearance. The upper eyelids look heavy and saggy, the tear trough, naso-labial folds, marionette lines will all deepen. The jowls will sag and the neck silhouette is lost.

Large molecule Hyaluronic Acid Dermal Filler has been used with great success but it is more recommended now to use Sculptra for this purpose because the result is more natural and is also more cost efficient.

Total 5 vials of Sculptra done in 4 sessions

Like the sunken temples, some people are born with a flat cheek bone, so that the cheeks look hollow. Sometimes we refer the cheek as an apple because when we are younger we have some fat pad in that area and when a child smiles, it bulks up like an apple.

Actually when we all age, the collagen is lost and the fat pad as well as the subcutis migrates downwards due to gravity, and the cheeks will definitely look more flat and sunken.

Apart from negatively affecting the facial shape, this also makes worse the swollen eye bags, tear troughs, naso-labial folds, and sagging appearance, giving an old and tired look.

Large molecule Hyaluronic Acid Dermal Filler has been used with great success but it is more recommended now to use Sculptra for this purpose because the result is more natural and is also more cost efficient.

However, Sculptra should not be injected above the cheeks into the orbit / eye bags area, otherwise there is a high chance of causing some ugly looking fibrous lumps, and again it is important to go to an experienced cosmetic doctor.

Injected with Dermal Filler

Normally the lower portion of the orbit is filled with fat pad which acts as a cushion and support to the eyeballs.

When there is too much fat tissue, or if it shifts forwards in its position, it will cause a swollen eye bag. On the contrary, when we age, the fatty tissue may degenerate and shrink, same in a person who may be excessively under-weight, then it will give a hollow bony appearance with deep tear troughs and dark eye circles.

To deal with this, we can inject a small amount of to fill it up with great result. However,Sculptra should not be used in this area. Some doctor will also use autologous fat transfer.

Oriental people particularly the Koreans have a boarder and shorter facial contour and therefore when the jaw and chewing muscles is enlarged, the face will appear in a very square or pentagonal shape which is cosmetically not desirable.

The cause of this square shape can be an over-size mandible, particularly at the corner, or due to a large bulky chewing muscle. This large chewing muscle is usually a result of excessive chewing of tough food stuffs like chewing gums or dry squid, or involuntary teeth grinding during sleep.

To make this chewing muscle smaller, it is simple only to inject Botulinum into it,and the muscle bulk will slower get smaller over the next few weeks. The result is a smaller, longer and more oval looking face contour. Hence a lot of aggressive surgery can be avoided.

A case of classic improvement in facial contour with Botulinum:

Oriental people in general have a flatter nose bridge and this is usually regarded as less attractive, and plastic surgeon will insert an implant to augment it making it higher. However, very often this may be overdone with a disproportionally high nose bridge, and appears too sharp too straight, with an obvious fake perception. The overall cosmetic appearance of the nose also depends on the nose flares, nose tip, and the area connecting the nose bridge and the eyebrows, which may not have an implant that can be inserted.

Apart from a flat nose bridge, sometimes the nose can be affected with a bony bump along the nose bridge or that the nose bridge is skewed.

For many years, the Hyaluronic Acid Dermal Filler is the main material that is used to augment the nose bridge. There is also another material called Radiesse but in terms of result and safety profile, Hyaluronic Acid Dermal Filler is still the better choice.

Most doctors still inject the Dermal Filler in multiple injection points using a small size needle. This method of injection has a very high chance of causing bruises, and what is more, has a real risk of injecting the Dermal Filler into a blood vessel, with the dreadful consequence of causing tissue necrosis. Therefore, it is highly recommended to inject with a blunt tip cannula which causes no bruise in almost all cases, is safer, and the final result is also more straight and natural.

Recently augmentation of the nose bridge using PDO Thread Lift is getting more popular. A small puncture is made at the nose tip and the thread is inserted up the nose bridge with a cannula. Multiple threads are needed. The result will gradually come on in 1 to 3 months, and perhaps can be even better than using Dermal Filler, particularly in those cases where too much Dermal Filler will make the upper nose bridge too swollen and too wide.

A case of augmentation using Hyaluronic Acid Dermal Filler :

Looking from the front the chin can be too small and short, and looking from the side, it can be too retracted backwards. This is mainly a result of the facial bone structure we are born with.

When the jaw or the chin is too small, short, and retracted, the ratio of the facial contour is changed with a less attractive appearance. Plastic surgeon can insert a chin implant, but if the deficit is not too much then injecting with Hyaluronic Acid Dermal Filler is enough to create a significant improvement.

Many people request Dermal Filler augmentation because of a flat looking or skewed chin. What they are hoping to achieve is a rounder, more pointed, or merely more symmetrical looking chin.

However, sometimes the injection is done with too much in the centre of the chin, without paying attention to the overall ratio of the jaw, giving the chin a weird curve and over pointedness. It is corrected by filling in the sides of the jaw as in this case:

Full lips usually curve upwards slightly and give a young, vibrant and sexy appeal. When we age the connective tissue in the lips will shrink, then because of the facial skin above in the mid-face also becomes saggy downwards, the upper lip is allowed to roll inwards. The overall effect is a thin, flat and even downward curving upper lip, giving a sad look.

Improvement need to be done as an overall consideration. The temples and the cheeks can be hold up with more support by injecting Sculptra, while the lips can be augmented with Hyaluronic Acid Dermal Filler.