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The lower face: shaping and contouring with fillers from the Galderma portfolio*

* Lunch symposium “The lower third of the face – treatment challenges and optimal product selection (hyaluron-filler)” at the 50th Annual Meeting of the German Society of Plastic, Reconstructive and Aesthetic Surgeons (DGPRÄC) and 24th Annual Meeting of the Association of German Aesthetic Plastic Surgeons (VDÄPC) on 28.09.2019 in Hamburg.

Many people would like to positively influence the consequences of natural aging processes and look fresher and more vital through aesthetic facial treatments. A large proportion of patients’ wishes now relate to the lower third of the face – the lower face. It forms the foundation of the face and includes the perioral area, nasolabial and puppet wrinkles, lips, chin and jawline. The wish list includes a defined jawline, shapely lips or, in men, often a more masculine chin area. Dr. Keywan Taghetchian, specialist for aesthetic medicine from Munich, spoke at the DGPRÄC annual conference about the relevant aspects of an aesthetic treatment for the lower third of the face.

Age leaves its mark especially on the lower face. Not only skin and ligaments lose their elasticity, but also bone resorption has an effect: Volume deficits and a shift in facial proportions are the consequences. The cheeks and corners of the mouth sink, deep nasolabial and puppet wrinkles and drooping cheeks develop. The chin also flattens over time and the jawline slackens – the attractiveness of the face dwindles.

In order to counteract these processes, a comprehensive understanding of the aging process and anatomical structures as well as optimal product selection are of central importance, explained Dr. Taghetchian. Only in this way can patient needs be met as fully as possible: “Aesthetic expertise and the consideration of patient wishes must be closely linked to achieve the best possible results”.

Tailor-made treatments: The perfect filler for every area

Galderma supports treating physicians with the world’s largest filler portfolio with proven efficacy [1-5]. Dr. Taghetchian presented measures and aspects of how this broad portfolio can be used to restore volume and reduce age-related wrinkles. “It is important to know the gel properties of the various fillers in order to use the appropriate product,” Dr. Taghetchian emphasized. In principle, the firmer the gel and the larger the particle size, the greater the lifting capacity.

A distinction is made between two technologies for hyaluronan fillers: NASHATM (Non-Animal Stabilized Hyaluronic Acid) and the BTTM (Balance Technology) technology. The gels with fixed hyaluron concentration (20 mg/ml), different particle size and gel strength fulfil different tasks: Lifting, filling (volumizing), supporting and giving structure.

The firmer gel of the NASHA products (Restylane®, Restylane® LyftTM) with a fixed degree of cross-linking offers a high resistance to deformation. Controlled particle sizes and two degrees of calibration result in differentiated gel textures with different lifting capacity, suitable for different injection depths. The natural linkages of the hyaluron chains are stabilized, resulting in gel particle sizes with predictable precision. The fillers are integrated into the tissue at specific points and are therefore ideal for patients with good tissue quality. Balance Technology fillers have softer, more flexible properties and a less pronounced lifting capacity (Restylane® FynesseTM, Restylane® RefyneTM, Restylane® KysseTM, Restylane® DefyneTM, Restylane® VolymeTM). They provide structure, contour and volume, integrate gently into the tissue and are suitable for patients with weaker tissue quality. The group includes four degrees of cross-linking for four different gel strengths against deformation. There are three calibration levels for three injection depths and lifting capacities.

Build volume or emphasize facial features?

Dr. Taghetchian illustrated the use of different injection techniques: For example, he uses the retrograde fan technique, linear technique, superficial retrograde linear technique, sandwich technique, triangular and point technique to treat puppet wrinkles. In this case, the corrective build-up of the cheeks should be lateral rather than medial and it is generally important to pay attention to the course and branches of the facial artery, advised the aesthetics expert. For a treatment of the chin and chin line he suggested a retrograde vertical technique as well as the retrograde tunnel technique.

The physician and patient should discuss the desired effect before the treatment: For example, should a facial feature be accentuated, volume built up or rather a lift achieved? Dermatologists also receive support for this as well as for the individual consultation and care of patients in everyday practice in the Galderma practitioner portal at galderma-aesthetics. Additional information – especially on the comprehensive Restylane® product portfolio – is available at The portal provides information on fillers for restoring a youthful appearance, skin boosters for beautifying the skin and care products.

1 50th Annual Meeting of the German Society of Plastic, Reconstructive and Aesthetic Surgeons (DGPRÄC) and 24th Annual Meeting of the Association of German Aesthetic Plastic Surgeons (VDÄPC)

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1. Rzany B, Cartier H, Kestemont P, Trevidic P, Sattler G, Kerrouche N, Dhuin JC, Ma YM  (2012) Full-face rejuvenation using a range of hyaluronic acid fillers: efficacy, safety, and patient satisfaction over 6 months. Dermatol Surg 38: 1153–1161.

2. Narins R, Coleman WP 3rd, Rohrich R et al (2010) 12-Month controlled study in the United States of the safety and efficacy of a permanent 2.5% polyacrylamide hydrogel soft-tissue filler. Dermatol Surg 36 Suppl 3: 1819–1830.

3. Talarico S, Meski AP, Buratini L et al (2015) High Patient Satisfaction of a Hyaluronic Acid Filler Producing Enduring Full-Facial Volume Restoration: An 18-Month Open Multicenter Study. Dermatol Surg 41 (12): 1361–1369.

4. Poster: A randomised comparative study of the safety and efficacy of lip injections with Emervel Lips & Juvéderm Volbella, Hilton et al: präsentiert auf der IMCAS Paris 2016

5. Ascher B, Bayerl C, Brun P et al (2011) Efficacy and safety of a new hyaluronic acid dermal filler in the treatment of severe nasolabial lines – 6-month interim results of a randomized, evaluator-blinded, intra-individual comparison study. J Cosmet Dermatol 10 (2): 94–98.


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