Facial layers and the changing face
Your learning goalDescribe structural contributors to contour without assuming every concern is a volume deficit.
Think in layers
The face includes skin, superficial tissue and fat, muscular and fascial structures, deeper compartments and skeletal support. Their arrangement varies by region. A simplified stack is useful for learning vocabulary, but it does not identify a safe treatment plane in a particular patient.
Separate the contributors
A visible fold or shadow may reflect skin quality, tissue position, support, movement, skeletal shape or several factors together. Describe what is seen before deciding why it is there. Adding volume does not automatically address laxity or every age-related change.
Connect assessment to choices
Observe the face from frontal, oblique and profile views, at rest and in movement. Ask about weight change and prior surgery or devices. Discuss whether the concern is best addressed by filler, another treatment, referral or no intervention. A good plan states both what treatment may improve and what it cannot reasonably achieve.
- A contour is the result of multiple tissue relationships.
- Use more than one view.
- A layer schematic is not a procedural map.
Put the reasoning to work.
A patient requests filler to remove all lower-face laxity.
What should the assessment distinguish?Pause and write your response in the workbook, then compare your reasoning.
Read the case discussion
Explore skin laxity, tissue position, underlying support and the patient’s priorities. Explain limits and alternatives rather than assuming more volume will resolve the concern.