Key Indications treated with profile balancing
Updated: Jul 23, 2020
It is important to look at your patient in profile and assess the relationship between their nose, lips, chin and jawline. This can be achieved using several methods.
The first would be categorising the skeletal relationship in the antero-posterior plane (AP). A class I skeletal relationship would indicate a harmonious relationship between the maxilla and mandible; a class II relationship would suggest maxilla prognathia or mandibular retrognathia, or possibly a combination of both; and finally, a class III skeletal malocclusion would indicate mandibular prognathia, or maxilla retrognathia, or a combination of both. Using this method, you can determine if product needs to be placed to advance the maxilla (pyriform aperture, nasal spine and columella projection) or the mandible (pogonion projection).
Next, I would assess the vertical dimensions. The patient’s face should be divided into thirds. The upper third is from the hairline to the glabella; middle third from glabella to subnasale and lower third from the subnasale to menton. These should roughly be equal. Here you can determine if the lower third is short and needs lengthening along menton, rather than projection. In addition, you can give the illusion of a shorter middle third, by lifting the tip of the nose.
The importance of the jawline when treating the vertical profile must not be overlooked. A doliocephalic describes an individual that presents with a long, narrow shape and high mandibular plane angle. This can be improved by treating the jawline to reduce the mandibular angle so that the angle of the jawline matches that of the cheekbone. Some practitioners make the mistake of enhancing the jawline without assessing how the angle matches that of the cheekbones. If the jawline is harmonious with the cheekbones, this should be maintained, or else will risk masculinising women, or creating an imbalance which is displeasing to the eye.
I then evaluate the soft tissue profile. I do this by assessing the lip position, in relation to the nose and chin, using Ricketts’ Aesthetic Plane, also known as the ‘E Line’.⠀Here, in profile you can use a straight measuring device to connect the the tip of the nose to the tip of your chin. The lower lip should be touching that line and the upper lip 2mm behind it. If the chin is weak, you will find the lips are far beyond that line. Conversely, the nose and chin may be in perfect balance. However, the lips lack projection and are far behind that line. Finally, the practitioner themselves may have disrespected the patient’s anatomy, overfilling the lips, leading to a profile which is lip dominant and unbalanced. Furthermore, by overfilling the lips, this would shorten the chin and compromise the vertical balance of the face.
Once you correctly identify the skeletal relationship in the AP and vertical planes, and soft tissue relationship, you will be able to determine which part of the face would benefit from being enhanced.