Although most practitioners will list the licensed indications for hyaluronic acid fillers without any difficulty, the main challenge for most practitioners lies in deciding on which areas of the face to treat and in what order, and with what volume of filler. This all changes with age, with different skeletal structures, with previous treatment, and with what actually needs sorting out according to patients.
Below are detailed descriptions of all areas of the face that are typically treated with dermal fillers. How to treat them in the correct order and with what volume is also explained. Most importantly, however, how a consultation can lead to a result that looks very natural or even obvious is discussed.
Structural zones versus surface zones
Treatment of areas in which volume of fine lines is to be increased (surface) as opposed to areas in which structure or volume is to be increased (e.g. Collapse of fat). The two are different and require different products and application to different depths within the dermal layers.
Areas of structural correction (Midface, Temples, Lateral Mandible, Chin and Pyriform) need to be treated with firmer products placed in small aliquots deep into tissues. These are often placed supraperiosteally. Surface corrections (Tear Troughs, Nasolabial folds, Perioral lines and lip hydration) are treated with much softer products placed superficially in the skin, in very small quantities, with volume added in fractions of a syringe.
Why the distinction changes your planning
A surface problem has a different root cause than a structural problem. Treating a surface problem with a structural cause may result in a temporary fix that erodes quickly or looks worse. A midface volume loss caused by bone resorption and decreased fat may result in deep nasolabial folds. These folds must be treated after the malar region has been sufficiently filled.
The areas that most commonly justify treatment
In clinical practice the demand for dermal fillers is distributed over a small number of well-defined zones. Often the justification for treatment in individual zones can vary considerably, however.
- Midface and cheeks. The most reliable area for a result patients describe as looking rested rather than altered. Supports the lower lid and lateral face.
- Chin and jawline. Improves profile balance and lower face definition. Often more effective than lip treatment for patients unhappy with their side profile.
- Lips. High satisfaction when conservative, high complaint rate when overfilled. Shape and border definition usually matter more than volume.
- Temples. Underused. Hollowing here ages the upper face and skews the perceived width of the forehead.
- Tear troughs. Technically demanding, with a narrow margin between improvement and persistent swelling or Tyndall effect.
- Nose. Non-surgical rhinoplasty carries the highest vascular risk of any common indication and belongs with experienced injectors only.
- Hands. Restores dorsal volume and reduces tendon and vein prominence. Frequently overlooked when the face has been treated well.
Matching the area to the product and the risk profile
Products are not interchangeable across zones. Consider the product’s rheology, longevity and the vascular anatomy of the zone in question.
| Area | Typical plane | Product character | Primary risk consideration |
| Midface | Supraperiosteal | High G prime, cohesive | Infraorbital vessels, overcorrection drift |
| Chin and jaw | Deep, on bone | Firm, low spread | Mental and facial artery branches |
| Lips | Submucosal | Soft, low G prime | Labial artery, nodule formation |
| Tear trough | Preperiosteal | Low hydrophilic, fine particle | Prolonged edema, Tyndall |
| Temples | Deep or subdermal | Moderate firmness, diluted options | Superficial temporal vessels |
| Nose | Midline, supraperiosteal | Firm, minimal volume | Dorsal nasal artery, necrosis, vision loss |
Consultation decisions that determine the outcome
The assessment does more work than the injection. Many patients with lip enhancement requests have chin retraction and thus would actually benefit from a chin projection rather than lip enhancement. This needs to be discussed with the patient before you even draw up the first product.
What to establish before agreeing on a plan
- Full filler history, including areas treated elsewhere and products the patient cannot name. Residual product changes tissue behavior for years.
- Whether the concern is volume loss, descent, skin quality, or asymmetry. Filler addresses the first two reliably and the third not at all.
- Budget across a course of treatment, not a single visit. A plan that spends everything on one area in session one often cannot be balanced later.
- Red flags for body dysmorphic presentation, repeated dissatisfaction with prior work, or expectations tied to a photograph of someone else’s face.
Increasingly patients are looking at dermal fillers online and then coming into clinic for treatment, having a good understanding of what is possible with professional dermal fillers. Anyone weighing up their options locally is well served by booking an assessment for fillers in Jacksonville FL before committing to a particular area or product. This leads to a better consultation as patients have realistic expectations of what can be achieved with treatment.
Keeping results natural across repeated cycles
Most importantly, to achieve natural results, most cases are treated with restraint, on an ongoing basis, and documentary records of volumes of fillers used in individual areas as well as pre and post treatment photographs of the individual taken on each occasion of treatment are needed to demonstrate that more has not been added over time.
Practical safeguards
Cap yourself in each area of the face and record how much you have used. It is far better to return in 2-4 weeks to fill out rather than top up immediately. Be aware that patients that have had multiple cycles of treatment in the past may benefit from dissolving all filler and starting from scratch. It is far easier to correct small amounts of inadequate fill than to add to a face that has already started to drift. Treating less in any one visit allows for correction in subsequent visits. It is this margin that keeps work invisible.
