In short. The fold at rest and on movement, the position of the jawline, chin support, skin quality and the bite, and why a still photograph is not enough.
Key points
- A fold present when the face is completely still is produced by volume loss or by descent.
- A fold that appears or deepens markedly when the face moves is produced by the muscle.
- Everything else refines that first distinction.
The fold has three possible producers and they are treated differently, so the examination is designed to find which dominates rather than to measure the fold. Almost all of it is done in a few minutes.
The fold at rest and in movement
The face is looked at still, then speaking and smiling. A fold present at rest is created by volume loss or by descent; a fold that deepens sharply in movement is created by muscle pull. This is the most useful comparison in the examination, and what a photograph cannot provide.
Where the tissue above the fold has ended up
Where the cheek and jaw tissue has moved downward, so that what sat over the cheekbone is now beside the mouth, the fold is a descent problem and a lift addresses it. Where the tissue above has not moved and the fold sits against a hollow, volume is the cause.
Chin projection, seen from the side
The profile is examined, because a receding chin makes the fold read as deeper than the tissue alone would explain. This is a structural cause and it changes the plan. It is the finding most often missed when the assessment is made from the front.
The observation that does most of the work
A fold present when the face is completely still is produced by volume loss or by descent. A fold that appears or deepens markedly when the face moves is produced by the muscle. Everything else refines that first distinction.
Skin quality and the direction of the lines
How thick and how elastic the skin is, and whether the fold runs as a single crease or as finer lines. Skin quality determines how much a topical can change, which is modest, and the direction of the lines helps distinguish descent from muscle.
The bite, the teeth and the jaw joint
How the teeth meet, whether the jaw deviates as it closes, and whether there is pain, clicking or locking in the joint. Where the bite contributes, the assessment includes a dental opinion. Treating the soft tissue while leaving the bite produces a result that drifts back, which is a common reason a reasonable plan appears to fail.
What has been placed before, and when
Previous treatment in this area is recorded with dates, including how much was placed and where. The lower face accumulates material differently from other areas, and the total used over the years changes what is sensible now.
Findings that change the plan
- A fold that has appeared or deepened over weeks rather than years.
- Weakness on one side of the face, numbness, or a change in the bite.
- A jaw that deviates as it closes, or pain and clicking in the joint.
What the three mechanisms are is set out in volume loss, descent or muscle pull. The rungs that follow the assessment are walked through in the ladder, from muscle to surgery, and the reasons volume accumulates in this area are explained in why filler accumulates here.
Frequently asked questions
Why is a photograph not enough to plan treatment here?
Because a photograph cannot show what the fold does when the face moves, and movement is one of the three mechanisms. It also flattens the relationship between the fold and the chin, which is what decides whether the fold reads as deeper than the tissue explains. Pictures are useful as a record over time and not as the basis for a plan.
Why does the examination include the bite?
Because the soft tissue of the lower face follows the teeth and the jaw. Where the jaw deviates as it closes, or where teeth are missing or worn unevenly, the tissue is being guided into a pattern, and treating the fold without addressing that produces a result that drifts back. The bite is part of the assessment rather than a separate concern.
Why is what has been placed before recorded in such detail?
Because the lower face accumulates material over the years, and the total is often more important than any single treatment. Knowing what was placed, when and where changes what is sensible now, and it also explains appearances that would otherwise be puzzling. The record is part of the diagnosis.
Risks & Limitations
- Repeated filler in the lower face accumulates over years, and an over-filled area is harder to correct than an under-filled one.
- Filler does not lift descended tissue, so adding volume while the tissue above continues to descend can leave the area looking heavier.
- A lift improves the fold and does not erase it, because the muscle recreates it with every expression.
- Bruising, swelling and unevenness are common after treatment in this mobile area, and the result is judged weeks later rather than immediately.
When to Seek Care
- A mouth corner that has dropped over hours or days, or weakness on one side of the face — seek urgent care.
- Numbness in the lip, chin or cheek, drooling, or a change in speech.
- A new lump in the lower face or jaw, or jaw pain with clicking or locking.
- A bite that no longer meets as it did, or difficulty closing an eye.
References & Further Reading
- American Society of Plastic Surgeons (ASPS) — procedure and safety guidance
- National Institute for Health and Care Excellence (NICE, UK) — relevant guidance
- Cochrane Library — systematic reviews
- Chinese Medical Association Plastic Surgery Branch — clinical guidance
This page is patient education, not medical advice, and it does not cite individual studies. Discuss your own case with a qualified clinician. To arrange an assessment at Chongqing West District Hospital, see Contact & Consultation.