Facial balancing: treating proportions, not single lines

A staged plan, not a single session

A balancing plan is usually spread over two or three sessions a few weeks apart. Each step has time to settle before the next is decided.

1. Structure first. Support where it has been lost: the cheeks, temples or chin. This is what lifts and frames.
2. The lower face. Definition at the jawline, the corners of the mouth or the lips, if they need it once the structure is in place.
3. Refinement. Small adjustments, anti-wrinkle injections for overactive muscles, and treatments for skin quality.

The order matters. Treating the folds before the support often means using more product for a worse result. A review two to four weeks after each session lets the doctor see the real result and decide whether anything else is needed. Sometimes it is not.

Why more filler is not the goal

The overfilled face is easy to recognise: cheeks that sit too high and wide, a heavy lower face, lips that look separate from the face, a smile that no longer moves naturally. A recent review describes "facial overfilled syndrome" as an increasingly common complication of excessive or poorly placed filler ^[4]. The authors point to three causes: product placed in the wrong layer or area, changes in how the face moves, and the cumulative build-up from repeated treatments.

That last point matters. Hyaluronic acid can last longer than people expect, and topping up on a fixed schedule, without re-examining the face, can add layer on layer. The review's conclusion is a shift from simply restoring volume to precise, layer-specific treatment, with prevention through patient education and knowledge of anatomy ^[4].

When there is too much, hyaluronic acid can be dissolved with an enzyme, partly or completely, and sometimes the plan starts there.

What to expect, realistically, between 40 and 70

A multicentre study of a combined approach treated 100 people aged 35 to 65 with staged filler in several areas, plus anti-wrinkle injections and an eyelash treatment. On a validated satisfaction scale, scores rose from 41.2 to 72.9 out of 100 at four months, and 99% rated themselves improved or much improved ^[3]. People also judged themselves to look younger. The study was funded by a manufacturer, short and without a control group, so it shows what a planned approach can achieve rather than what everyone will see.

Realistically, you can expect:

• a fresher, more rested face that still looks like yours;
• better support at the cheeks and a clearer line at the jaw;
• a more balanced profile, often with modest amounts in the right places.

Filler does not tighten loose skin. If there is a lot of laxity in the lower face and neck, the honest answer may be surgery, or a combination over time.

Risks, and who it is not for

Most effects are mild and pass in days: swelling, tenderness and bruising. The Global Aesthetics Consensus notes that serious adverse events with hyaluronic acid are rare, and that most can be avoided with detailed knowledge of facial anatomy, proper patient selection and appropriate technique ^[5]. The clinician must also be prepared, with the tools to treat a complication on site.

The most serious risk is vascular: filler entering or pressing on an artery. Some areas carry more risk than others. In a systematic review of 44 cases of vision loss after hyaluronic acid, the nose, the frown area and the forehead were most often involved, and no cases came from the chin, jawline or lips ^[6]. Volumes as small as 0.2 ml were enough to cause it. This is why the nose in particular should only be treated by a doctor who knows its anatomy in detail.

Facial balancing is not for everyone. It is not recommended during pregnancy or breastfeeding, with an infection in the area, an uncontrolled autoimmune condition, or after a severe reaction to filler.

It is also not the answer when the concern is out of proportion to what others see. A meta-analysis of 17,107 patients found that 18.6% of those seeking aesthetic or reconstructive surgery met criteria for body dysmorphic disorder ^[7]. For these patients, more treatment tends to increase distress rather than relieve it. If a doctor senses this, the kind response is to pause and talk, not to inject. The same applies to goals no injectable can meet, such as matching a filtered photograph.

How we approach it at Rejuvelook

At our clinic in Fuengirola, facial balancing starts with a medical consultation of your whole face, with a doctor, in English or Spanish. Patients come to us from Marbella, Mijas, Benalmádena and Málaga. We look at proportions, profile and movement, explain what is reasonable to change and in what order, and set out a staged plan with conservative amounts of hyaluronic acid. We review every step once it has settled.

If old filler needs dissolving first, we will say so. If what you need is not filler, or not treatment at all, we will tell you that too.