Customizing lower-face esthetics: A five-case series using a diverse range of optimal balance technology and non-animal stabilized hyaluronic acid

INTRODUCTION

Minimally invasive esthetic procedures, particularly hyaluronic acid (HA) filler injections, have surged in popularity, driven by a growing understanding of the ageing process and increasing demand for treatments that correct and rejuvenate facial wrinkles, folds, and contours.^[1] HA—a key glycosaminoglycan in the extracellular matrix plays a central role in maintaining skin hydration, elasticity, and structural integrity, an age-related decline that contributes to volumetric loss, laxity, and the formation of facial folds.^[2] HA fillers provide a durable, yet non-permanent, non-surgical option to address facial volumetric changes associated with aging. HA filler treatments aim to provide volume so that the face appears lifted while looking even and natural.^[1]

Since its 1996 introduction in Europe, Skin boosters Non Animal Stabilized HA (SB-NASHA) and Optimal Balance Technology (OBT) range of fillers have become a foundational HA filler in esthetic dermatology, appreciated for its safety and natural esthetic results.^[3] Initially used to replenish volume in static wrinkles and folds, HA fillers now also enhance facial contours and definition.^[4] Optimal outcomes depend on proper filler selection, requiring matching rheological properties to each anatomical site.^[5]

NASHA and OBT are 2 distinct HA technologies, tailored to specific tissue dynamics. NASHA preserves long HA chains and controlled particle sizing to create firm gels with high elastic modulus (G'), suited for structural support and projection—ideal for areas such as the midface and chin. OBT, by varying degrees of crosslinking, produces softer, highly flexible gels accommodating natural movement, making them ideal for dynamic regions such as lips, perioral zones, and nasolabial folds.^[1]

Jawline and chin contouring significantly influence facial symmetry and esthetic balance. Injectable HA fillers enhance projection, refine the mandibular angle, or correct chin retrusion.^[6,7] Similarly, HA-based formulations are also used for lip augmentation and smoothing perioral rhytids, offering hydration and subtly enhanced shape.^[8] Choosing the appropriate HA formulation, firm for lift or flexible for movement, is crucial.^[1]

This case series presents 5 patients who underwent jawline, chin, and lip contouring using NASHA, moderate G' OBT, and low G' OBT. Product choice was guided by anatomical and functional needs, demonstrating how formulation-specific rheology optimizes esthetic outcomes in minimally invasive facial contouring.

CASE SERIES

This case series includes a total of five patients, comprising five females. Informed consent was obtained from all participating patients [Table 1].

DISCUSSION

These cases highlight the importance of tailored filler selection using NASHA and OBT range of fillers to meet the distinct structural and dynamic requirements of different facial subunits. Jawline, chin, and lip enhancement each require specific rheological profiles—firm, high G' NASHA gels provide durable projection and support, while balanced, flexible OBT gels such as moderate G' OBT and low G' OBT adapt to movement, ensuring natural results in contouring and dynamic perioral and lip regions.^[1,5]

In our series, patients treated for lower-face definition (Cases 1, 2, and 4) demonstrated marked improvement in the Jawline Volume Loss Scale and high patient-reported satisfaction using the Jawline Subject Satisfaction Scale [Figure 1 and Table 2 ]. These findings are consistent with results from prospective clinical trials supporting the use of NASHA and moderate G' OBT for jawline contouring.^[6,9] Case 4, which also involved chin projection correction using NASHA for structural support and moderate G' OBT for contour refinement, underscores how combining filler technologies can restore lower-face harmony [Table 3]. A randomized trial evaluating moderate G' OBT for chin augmentation and correction of chin retrusion demonstrated that the procedure is well-tolerated, effective, and capable of producing significant improvements in chin profile.^[7]

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Figure 1:

Pre and post photo documentation of cases 1, 2 and 4 after treatment showing improvement in the clinical findings (arrows).

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Similarly, patients undergoing lip augmentation (Cases 3 and 5) reported significant improvements in FACE-Q satisfaction domains and Merz Lip Fullness Scale scores, supporting the suitability of low G' OBT for enhancing shape and hydration [Figure 2 and Table 3]. A randomized, evaluator-blinded, multi-center study comparing the effectiveness and safety of low G' OBT versus control in lip fullness augmentation and correction of upper perioral rhytids. The results showed that improvements in lip fullness and wrinkle severity persisted through Week 48 and were accompanied by high esthetic improvement and subject satisfaction scores. Notably, the mean volume of low G' OBT injected was approximately 20% lower than that of the control.^[8]

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Figure 2:

Pre and post photo documentation of cases 3 and 5 after treatment showing improvement in the clinical findings (arrows and circle)

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Across all cases, scale, including the Global Aesthetic Improvement Scale, aligned with subjective patient satisfaction, thereby achieving both structural correction and natural appearance [Figure 3]. All procedures were well tolerated with no reported adverse events, reinforcing the known safety profile of NASHA and OBT fillers when administered with appropriate technique and anatomical knowledge. While this series did not include extended follow-up beyond the early post-treatment period, previous research indicates that NASHA fillers provide durable lower-face support for 12–18 months, whereas OBT fillers (e.g., low G' OBT) maintain lip enhancement for up to 12 months.^[10,11]

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Figure 3:

Global aesthetic improvement scale (GAIS) scores before and after treatment.

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The small number of patients and short follow-up period limit generalizability. Nevertheless, the consistency of improvements across objective scales and patient-reported measures strongly supports the clinical value of this tailored, multi-formulation approach.

CONCLUSION

This case series demonstrates that selecting NASHA and OBT fillers according to the structural and dynamic requirements of each facial region enables natural, balanced, and patient-satisfying outcomes. Firm NASHA gels provide the projection and support required for the bony lower face, while OBT gels, such as moderate G' OBT and low G' OBT, accommodate mobility and natural expression in dynamic areas such as perioral regions and lips. By leveraging the rheological diversity within the NASHA and OBT fillers, practitioners can individualize treatment, optimize facial harmony, and achieve predictable, safe results.