Facial balance - Cheeks & Contours

Would you be more "beautiful" if your face was more balanced?

Learn more about how a plastic surgeon looks at the face, and what your options are to improve facial balance using Tox products (like botox / dysport), Fillers or Threads. We talk about some of benefits as well as risks.

Quality matters, so treat yourself to the best at Pulsar Health in West Palm Beach, FL, by calling to book an appointment.

The different faces that a few features and varying distances between them can make is mind-blowing - the human face is remarkable! Billions of us exist here, each with our own unique beauty as the foundation of our expressions and communications. Our magnetism.

Pulsar Health wants you to feel confident, to let your beauty shine out. It's not about looking like the latest influencer or celeb, although you can borrow some of their style elements that you like - it's about being who you choose to be and can be. 

Classically, beauty is associated with symmetry and "regular" features, but it is a personal aesthetic. Everyone, and we mean EVERYONE, is asymmetrical. One side of your face is wider whilst the other side is higher. It's just a matter of how much. Then time works its way through our faces, stretching out the cartilage of the nose and ears, whilst the middle of the cheek area forms jowls as it falls relative to the stability of the sides of the head. You can read the section on "Lifting Your Face" for more information on that!

Plastic surgeons look at facial balance by dividing the face into horizontal facial thirds, and vertical facial fifths:

• The simplest way to look at the facial thirds is to define the middle third from the upper eyelids to the bottom of the nose. This is the "Glabella" third, with the upper third going up to the hairline, called the "Trichion", and the bottom third from the base of the nose to the bottom of the chin called the "Menton". 
• The vertical fifths of the face are also defined by your nose and eyes. Here the nose lies in the midline fifth, with the width of this being the width between the inner corners of the eyes ("intercanthal distance"). The fifths outside the middle fifth are formed by the width of the eyes, and the outer fifths are from the outer corner of the eyes to the outer edge of the ears. 
• What is considered "balanced" in the Western world is each vertical fifth being the same width - the intercanthal distance - and each horizontal third being the same height. The lower third is also divided into a third above the mouth and two-thirds below the mouth. 
• The actual facial shape is also an element of facial balance, with the bottom third getting wider with age, or a squarer shape for a more traditional masculine look. 

Yes, we don't all fit into this "ideal" cookie cutter balance, and hello evolution and varieties of beauties.... The face also changes with time, tending to "lengthen", get "bottom heavy" and "cave in" from front-to-back. Facial balance is about getting more harmony to your facial features, or "fixing your face" to a look you prefer.

Tools to "fix your face" (yes Pulsar Health has that website domain!) include neuromodulators like botox and dysport - called "Tox" for short, "Fillers" and "Threads", as well as the "never-out-of-style" Surgery. Enhancing beauty or erasing bothersome imbalances are possible, although our aim is not perfection, which doesn't really exist in nature. The goal is pleasing results.

Tox, short for botulinum toxin from which Botox, Dysport, Xeomin, Juveau, and Daxxify are all derived, functions as a "neuromodulator", which means that it blocks the release of a neurotransmitter called Acetylcholine (ACh) at the nerve muscle junction. This reduces stimulation of the muscle, causing it to relax. Lines that are formed from repeated muscle contracture - otherwise known as wrinkles / frown elevens / crow's feet, or in medical speak "rhytids" - then get a chance to relax and the body can gradually heal them in. 

Tox used correctly can improve facial asymmetry of the eyebrows, or gently lift the outer portion of the eyebrows. It can also create a "lip lift" effect and ease up lines around the mouth. Some people get bands at their chin / neck junction, called platysmal bands after the platysma muscle that sits just deep to the skin here, and these can be softened with tox to improve the facial profile. Frowning happens at the elevens between the eyebrows, but also sometimes on the sides of the mouth, so that can be eased with some Tox too.

However, Tox can go "wrong".... Complications of Tox not being administered correctly include falling down of one or both of the upper eyelids, called ptosis, where the tox affected the levator palpebrae superioris muscle that is used in open the upper eyelid. This can happen if the tox was placed too low near the upper eyebrow. It does wear off, but the fallen eyelid can be helped slightly by eye drops (alpha-adrenergics). Don't confuse this condition though with "unmasking" excess upper eyelid skin, where subconsciously the eyebrows are used to keep the eyes open, so when they are relaxed with Tox, the eyelid skin falls. For this, the best treatment is to remove the excess upper eyelid skin using a quick little surgical procedure called a "blepharoplasty", which can be done in about an hour awake, but takes a few days for recovery.

The most common issue with Tox though is that it often isn't applied as well as it could be. This can result in "peaked" eyebrows or patches of still functioning muscle whilst other muscle has "gone quiet" - so Tox not done right can definitely worsen facial balance. The skill of the provider and the amount of product used makes a big difference here. There is a range of how much to use that depends on your target size (how big is your forehead), muscle strength, metabolism, and how long you want it to last. Using "too much" Tox or "product" can "freeze" your face, but you may also be wasting money on unnecessary product. At Pulsar Health, we try to get you the best value by using the low or middle end of your "range" and, if necessary, doing a "top up" a couple of weeks later as it takes about a week to see the effect of Dysport and two weeks for Botox. 

Fillers are the second main tool for facial balancing. Most fillers are from various forms of Hyaluronic Acid (HA), a glycosaminoglycan (GAG) or sugar molecule that is found naturally in the body between cells. It acts as a cushion that also attracts water. Commercial fillers process the HA to give it different elastic properties and viscosities. Charts of filler Rheology - a branch of physics that looks at the deformation and flow of matter - show varying properties, as some are stiffer than others, better at pushing up tissue, whilst others are softer for nearer the surface, or flow more easily conforming to spaces. Their rate of breakdown also depends on processing. The best filler is selected for the area that is being treated depending on its properties and your budget. 

Fillers can be used to correct cheek asymmetries or make the chin more pointed or symmetrical. They can be used near the jaw bones to make a more defined look, or to replace fat lost to aging such as in the inner cheek or bases of the nose. They can of course balance the lips which are often asymmetrical, and create distinct looks based on the desired aesthetic (see the section on luscious lips for more information).

Besides commercial HA fillers, "bio-fillers" are based on platelet rich plasma (PRP). At Pulsar Health, we activate the PRP using light and then thicken it using controlled bio-incubator heat to produce a uniform thickness of potent bio-filler. We sometimes use HA-PRP combo tubes which has a less cross-linked HA than commercial fillers, such as Restylane or Juvederm. The bio-fillers don't last as long as the commercial fillers and can be a bit more uncomfortable to place as they don't contain lidocaine, but they are better for your tissue regeneration in the long run. 

At Pulsar Health, we also offer Restylane Sculptra (poly-lactic acid) and Fat as longer-term fillers, but not calcium hydroxyapatite (Radiesse). Calcium hydroxyapatite is a form of bony substitute, so we do not use it in soft tissues as it can have negative long-term consequences, even when diluted significantly. Fillers can also cause blockage of blood flow if they enter blood vessels, which is a very rare complication.

Using fillers to rebalance the face can have issues with using inappropriate volumes. Sometimes fillers can attract water especially in the lower eyelid area. They can also be seen or felt if they do not disperse enough. Less expensive fillers are more likely to do this. We only use fillers directly from the manufacturer at Pulsar Health, even though this is more expensive, in order to be sure of the quality of the product. It is important to not overfill the middle third of the face (cheekbones) as this can create a very unnatural "leonine" or lion-like appearance. Overfilling the nasolabial folds on the sides of the mouth, or the lines around the mouth, can create a "simian" or monkey-face type projection of this area. Overfilling the lower part of the face creates a bottom-heavy aging look. 

We like to use fillers as small "tweaks" rather than large volumes at one time, in order to gently bring / keep the face in balance. They can be useful for balancing the chin and nose, versus implants and surgery. They are also wonderful for the lips themselves is applied appropriately. Building lip height rather than forward projection is done using a vertical filling technique rather than simply adding volume. There are many nuances of using fillers, so we recommend going to an experienced provider.

Threads can also be used to rebalance the face by selective lifting or strengthening. 

Lifting threads can adjust the eyebrow position and bring up cheek tissues that are falling down. They are excellent for jawline definition (see section on Snatched jawline), tightening the lower third of the face and adding fullness to the middle third. Care should be taken in placement so that they stay away from the middle fifth of the mid and lower thirds of the face. 

There are many tricks to creating a refined result with Thread lifts and experience plays a huge role here in evaluating the best place to position the Threads as well as how deep and tight to make them for a lovely result. Complications are also more common with Threads, although simple swelling and taking time for any "puckering" to settle down are part of natural healing rather than complications. Infection or migration of the Thread are complications that may require further interventions.

Instead of using lifting threads, Smooth Threads can be used to strengthen areas that have lost elasticity, such as the sides of the mouth / jowls or under the chin. Tightening these areas by strengthening the skin can help bring the face into a more aesthetically satisfying balance.

Finally, surgery can be done to improve facial balance. Dr. Gill is a craniofacial surgeon experienced in doing bony as well as soft tissue work to improve facial appearance and function. One of her biggest rebalancing surgeries was a facial bipartition, where, under anesthesia, she separated the child's face from her skull, took out a middle portion of the face, and brought it all together so that the child could read whereas before her eyes had been too far apart. Please see our separate sections on shapely nose, expressive brows, etc... for more information on your areas of interest.

As always, feel free to reach out to us at Pulsar Health for a consultation to learn more about what options you have for a more pleasing facial balance.