Balancing Act: Considerations for profiloplasty assessment in patients presenting for treatment with dermal fillers

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Background: Dermal fillers are increasingly being used in profile aesthetic correction, but what happens if treatment is commenced without considering the impact on the inter-relationship between the nose, chin and lips in the lateral view? Objectives: Explore the relationship between these three profile features and provide a framework to help standardise the order in which they are assessed when preparing dermal filler treatment plans for profile correction. Methods: Literature review informed the development survey on profile aesthetics and assessment. Survey results were analysed descriptively and presented to a focus group comprising cosmetic physicians and plastic surgeons. This group reviewed validated assessment scales and incorporated these into a 3-step assessment framework, which was pilot-tested on a convenience sample of patients presenting prospectively for minimally invasive aesthetic treatment. Results: There was a 95% survey response rate (38/40 surveys completed). Facial feature proportion was rated the most important factor when determining profile attractiveness (average score 9.11) and the nose was ranked the primary feature contributing to the determination of profile attractiveness. The assessment framework begins with the nose, followed by the chin and then the lips and includes validated assessment scales and standard angles and lines. Results from pilot testing showed that by first balancing the nose, other key profile features could then be harmonised. Conclusions: In patients presenting for cosmetic injections to correct profile aesthetics the assessment framework provides a simple solution to enhance clinician-patient discussion and inform holistic treatment planning. Wider testing and validation are warranted.