Masterclass

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Complete Reflection

Tapan Patel (TP):

John, certainly in the non-surgical world, the last few months have seen a lot of interest, particularly in the lower face. One of the companies, Allergan, has brought out a product, Volux, which has got indications for chin and jawline, and what this has meant is that due to the product launches there have been a lot of talks on chin and jawline contouring. We find as a clinic unprecedented demand for these treatments, and it seems to appeal to men and women equally. Do you want to give me an overview of where you see the different options for chin/jawline treatments, starting with the non-surgical and ending with the surgical?

John Blythe (JB):

Yes, very much so. I don’t think there’s ever been a better time in history to request jaw augmentation or jaw contouring. The way that I see it – through the eyes of a surgeon, but a surgeon who’s wanting to step back from aggressive or extensive surgery and looking at minimally invasive techniques – I see there are three fundamental approaches to dealing with the chin and the jawline.

TP:

Okay.

JB:

In the short term, when patients are maybe looking for a result for one to two years, and the severity or the amount of treatment that they require could be classified on a mild to moderate scale, then there have never been better injectables on the market to be able to do this. That would be my mode of treatment for those patients. However, the options between surgical and non-surgical vary and – looking through my eyes and speaking with the patient – fundamentally it comes down to the patient’s bite, and running into the occlusion a little bit later in more detail, the patient’s anthropometric measurements (the size of their jaws in three dimensions). Also, what their short, medium, and long term goals are. I may treat somebody differently who is in their early twenties with the same problem as somebody in their late fifties.

TP:

Sure.

JB:

You mentioned there about both sexes, and there are social pressures now for men to have stronger jawlines, more defined jaw to throat definition.

TP:

Did you notice that as you said that I immediately tightened up my jawline and stuck my chin out?

JB:

Yeah, I think we all try it – you see for photographs, men are clenching their masseters more, and this is kind of the Brad Pitt and co. effect, the influence of Hollywood. If you look at Forbes Magazine for the leading male actors and male models, 9 out of 10 will have what we call an antiface, or a power face. This is really when we’re talking about, in three dimensional both transverse and in projection, a strong lower face.

TP:

One of the things that I think will be really useful – obviously you are in a unique position of being able to offer all three modalities – and I speak for myself certainly, but many of my fellow aesthetic practitioners will admit to doing similar; sometimes we’re guilty of approaching all the patients who in our minds have a weak chin or an underdeveloped jawline, and because our only tool is the injectables, we almost apply the same treatment. What might be really useful is, as we go through this series of videos, your insights into how we might better assess patients, looking at the bite and other factors which might make them more appropriate for invasive procedures.

JB:

Tapan, don’t do yourself down, Rembrandt was very good with oil paints but less so with bricks and mortar. I think that the modern patient needs to be well informed about all the options available. In the yesteryear where injectables weren’t available, then surgery was the main form of treatment. However, we’ve got to step back and look at all the options for these patients. From my point of view, the first option for the short term or medium term would certainly be injectables for mild to moderate cases. However, if the bite is not right and there is a fundamental jaw abnormality then I think it would be important for the aesthetic network – and I talk about the aesthetic web, certainly when I’ve done my talking for Allergan – to try and bring in everybody across the globe in different specialities who are interested in aesthetics. If there is an abnormality with the teeth and with the jaws then you have to call in orthodontists, general dentists, oral maxillofacial surgeons, and so on, we’re all allies. We shouldn’t just focus on doing one thing, but what is the right thing for the right patient at the right time, bearing in mind that these patients who come in at 25 or 30 are going to be our patients for the next 20 to 30 years. There are some great injectable products on the market at the moment but in 2040 it’s going to be a totally different setup.

TP:

Agreed. So what we’ll do is focus our next video on specific chin surgery. From my own point of view, I know very little about the actual operative details of these procedures, so I’m just going to pick your brains on that.

JB:

Okay.