Top-to-Bottom Facial Analysis for Fillers: A Surgeon’s Map
Natural results come from sequence and restraint: restore support, refine contours, and protect expression. Here’s how I assess the face—from forehead to chin—before reaching for a syringe.
By Dr. Tim Neavin • Updated
How I assess (framework)
- Light & shadow: Where do contours fall off? Restore scaffold first, chase lines last.
- Front, oblique, profile: Balance has to read from all angles.
- Facial thirds & harmony: Forehead–midface–lower face proportions guide where small changes matter most.
- Expression & skin: Keep brows and eyes alive; build on healthy skin (retinoid, SPF, texture plan).
Upper face
Temples: Subtle hollowing can age the upper face and flatten the brow tail. Deep, conservative support restores continuity into the hairline without widening the head.
Forehead & glabella: These are usually the realm of neuromodulators rather than filler. Aim to relax overactivity while preserving natural movement.
Brow support (select cases): Tiny, careful support can soften a skeletal superolateral rim. More is not better here.
Midface & tear trough
Malar/zygomatic support: Small, deep placements along the zygomatic arch and malar high points re-establish lift and soften nasolabial heaviness without “puff.”
Tear trough: Often a support problem, not a “line” problem. I restore midface first; direct trough work is conservative and deep, and not right for everyone.
Perioral & lips
Perioral support: Columns at the philtrum, subtle definition of the vermilion border, and gentle lift at the oral commissures help lines without overfilling.
Lips: Ratios matter (lower ≈ 1.3–1.5× upper), but dental show and corner taper matter more. Many patients need small refinements; if the upper lip is long, a lip lift may suit better than more filler. See our note on features of beautiful lips.
Lower face & jawline
Chin & labiomental angle: Restoring projection or length can balance the whole face and ease marionette heaviness.
Pre-jowl sulcus & jawline: Strategic support smooths the mandibular sweep. In men, avoid over-narrowing; in women, protect lower-face taper.
Sequence, dosing & review
- Order: scaffold (midface/temple) → transition zones → fine lines last.
- Small amounts, deeper planes: Placement beats volume. Build gradually and reassess at 2–4 weeks.
- Pair with neuromodulators & skin work: For a rested look that moves naturally. New to injectables? Read our injectables overview.
Safety first
- Know danger zones: Avoid high-risk planes (e.g., glabella/nasion) and respect periorbital/alar anatomy.
- Technique: Needle/cannula choices depend on area and tissue; slow, low-pressure injections.
- Preparedness: Immediate access to hyaluronidase and protocols for vascular events.
FAQ
Will I look “filled” or puffy?
Not with this sequence. Support first, small volumes, and smooth transitions preserve natural light and shadow.
How long do results last?
Most hyaluronic acid fillers last ~6–18 months depending on area, product, and metabolism; structural zones often last longer than surface tweaks.
Is cannula always safer?
Both cannula and needle have roles. Safety depends on anatomy, plane, technique, and judgment more than the tool alone.
Next step: If you want a fresher look without the “done” vibe, we’ll map a light plan that fits your features—and your calendar.
Board-certified plastic surgeon with extensive experience in breast, face, and body procedures.
