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The Natural Threshold vs. Full Correction

Posted: 9:54 p.m. Friday, Sept. 22, 2017

By Anita Mandal, M.D.
Question: I have sunken cheeks, deep smile lines and sagging mouth corners. I need fillers badly but when I see so many unnatural looking people with fillers, I get scared. As aged as my face looks, it would bother me more if I looked unnatural. How do you give patients a natural look?
Answer: Next to assuring patient safety, achieving natural results for my patients is a priority in my practice. Rather than focus on complete correction of a specific aging concern, I use the “natural threshold” principal. Unfortunately, patients and plastic surgeons alike tend to focus on correction of the patient’s isolated concern without considering how correction of one area may affect the surrounding facial areas. This “tunnel vision” approach too often results in an unnatural or distorted facial appearance.

When a patient comes to my office seeking improvement of deep nasolabial folds, the first thing I determine is the cause of those deep smiles. Often, volume loss in the upper cheek with sagging of the cheek fat pad can make the smile lines look deeper. In such cases, it is important to properly volumize the cheek and only moderately treat the smile lines to maintain a natural looking appearance to the face.

Patients often request fillers for hollowing cheeks. When temple hollowing also co-exists, filling the cheeks alone can make the eyes and upper face look more aged. Assessing and treating both the temples and the cheeks, in such cases, can be key to restoring a youthful facial balance.

In thin-lipped patients who desire fuller lips, assessing the surrounding tissues is important. When marionette lines, sagging mouth corners and/or deep chin grooves are present, filling the lips alone without addressing these surrounding areas, can give an unnatural and disproportionate appearance to the face.

Too often, fully correcting 1 or 2 of a patient’s particular concerns is quick and simple. Looking at the big picture to see how the other facial features relate to a patient’s isolated concerns requires a higher degree of expertise and more detailed understanding of the intricate facial anatomy. While several filler choices exist, including Bellafill, stem cell fillers, Juvederm and Radiesse, greater technical expertise is required to assess one’s overall facial balance and attain a “natural threshold” result compared to full correction of an isolated area of facial aging. Seeking a qualified Board Certified Facial Plastic Surgeon is the first step.


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