In general, the majority of treatment-specific appointments will have a narrower client base than that of a Facial Balancing consultation. Lip appointments, for example, will have clients who have already decided on a specific treatment. The Facial Balancing consultation, on the other hand, will have clients who are generally unsure of what is wrong with their face and are looking for the practitioner to assess and determine the underlying cause of their perceived problems.
Patients who cannot name what bothers them
For the patients that come in for balancing consultations, a common complaint is that they don’t like how they look in a three-quarter view photo of themselves. Many of these patients are also very concerned with how they look in candid photos of themselves, and even in photos that were taken recently, they look older than they do in photos from years prior. In fact, many of these patients comment that they look so much older in recent photos of themselves than they do in the mirror.
Work from the proportion outward. Instead of just going from complaint to complaint in a linear fashion, assess the lower third of the face to the middle third of the face. Check the chin projection in relation to the lower lip. Determine whether apparent nasal size is a nasal problem or a chin deficiency creating relative imbalance. These patients respond well to being shown the relationship between the various features of the face and how they relate to each other to solve a geometry problem.
Screening for body dysmorphic presentation
While a patient that cannot even identify the problem they are having with their face is a good candidate for a facial balancing assessment, a poor candidate for a facial balancing assessment would be someone who has an extremely specific concern with their face that cannot even be observed by the practitioner. This would include but not be limited to patients that are repeatedly unhappy with prior aesthetic treatments, patients that are seeking correction for issues that are within normal medical measurement for that particular feature, and patients that refuse to accept proof of normal anatomy in the form of a photograph.
Asymmetry that predates any treatment
The majority of cases will have some degree of soft tissue asymmetry, most often in the form of uneven fat pad descent. These types of asymmetry can typically be corrected with fillers, whereas a deviated or unequally sized mandible would typically fall outside of the scope of what can be corrected with fillers and/or neuromodulators.
As mentioned earlier, Functional Asymmetries (Muscle Imbalances) are very common and can be misdiagnosed as Structural Imbalances. To provide proper treatment for your patients, it is very important to identify whether their imbalances are caused by Structural Imbalances or by Functional Asymmetries (Muscle Imbalances). These types of imbalances can be easily treated with the proper dosing of Neurotoxins rather than adding fillers.
Profile concerns and the sagittal view
The Profile Consultation, Perhaps the most rewarding type of consultation for the practitioner. Measured and seen within a short period of time, even within a single photo. Assessing the Profile for a good Profile Consultation consists of several factors to be recorded, the chin, the lower jaw angle, the cervicomental angle and the skeletal discrepancies of the facial bones.
A structured profile consultation can be set up to record the following at a minimum.
- Chin position relative to a vertical dropped from the vermilion border
- Nasolabial angle and its contribution to perceived nasal projection
- Gonial angle definition and masseter bulk
- Submental fullness and its origin, whether fat, platysmal laxity, or low hyoid position
- Occlusal relationship, since a Class II pattern changes what is achievable non-surgically
When to refer rather than treat
While there are instances of significant skeletal discrepancy, breathing obstruction, and even untreated malocclusion that would be better served by a Facial Balancing consultation that would refer to an Orthodontist/Surgeon for a suitable treatment, a partial camouflage of certain features would be suitable in these cases only after the patient has been fully informed of the limitations of such treatment and has given their consent for such.
Volume loss versus positional change
A midface with volume loss looks very similar to a midface with descent. The best way to determine if a midface has volume loss or descent is to have the patient lie down (supine position) as the fat will reposition and you can accurately assess for any true deficits. In this position of supine, a midface that has truly descended will look greatly improved with just support and lift as opposed to needing to be filled.
| Presentation | Primary driver | First-line approach | Realistic ceiling |
| Hollow tear trough, early thirties | Skeletal orbital rim recession | Deep supraperiosteal support | Marked improvement |
| Flattened midface, late forties | Fat pad descent plus bone resorption | Structural lateral support before central fill | Moderate to marked |
| Jowling with intact volume | Ligament laxity | Energy device or referral for lift | Modest with injectables alone |
| Perioral lines, heavy smoker history | Dermal quality | Resurfacing and collagen stimulation | Gradual, requires series |
Patients seeking restraint rather than change
New Patients, They Want to Look the Same, but Better. They want to look like they have been resting, but they don’t want to look like they have been treated.
Setting the sequence
Staging treatment of these patients is so much more important than what product or treatment you are giving them. So you can treat the foundation of their face first and reassess in 4 weeks. Many of the other areas of their face that they perceive to need treatment will no longer read as problems. Anyone weighing this kind of staged approach is well served by a clinic that handles facial balancing Jacksonville FL patients regularly, since that volume is what allows the reassessment window to be built into the treatment agreement.
Making the consultation itself diagnostic
It is essential for the patient who has had a consultation for facial balancing to have 3 things, 1) copies of the photographs that were taken during the assessment, 2) a dynamic assessment of their facial features, and 3) a written record of the recommended treatment(s) that were declined by the patient. Patients that have a clear plan of recommended treatment(s) for their facial features that have been explained in detail by the practitioner and that the patient is confident that they are receiving the best possible treatment for their facial features will return for treatment in a timely manner. Furthermore, patients that have had a consultation for facial balancing will be less likely to litigate against the practitioner and their practice.