A defined jawline is often seen on runway models and for most aesthetic patients is a desired appearance. In this interview with Aesthetic Insider™ Steven F. Weiner, MD, a Facial Plastic Surgeon and Head and Neck specialist located in Santa Rosa Beach, FL, discusses his many years of experience in the use of facial filers and radiofrequency devices that has led to his “ReJAWvenation” technique. After making a conscious decision 15 years ago to lay down his scalpel and focus on non-surgical options for facial rejuvenation, Dr. Weiner has realized the exciting possibilities of products and technologies that safely and rapidly deliver aesthetic rejuvenation and anti-aging results to his patients. This has inspired him to develop an aesthetic medical practice that exclusively uses minimal and non-invasive aesthetic treatments to bring long lasting beauty to his patients from all over the world. To learn more about Dr. Steven F. Weiner and his ReJAWvenation technique, visit www.theclinique.com.
Dr. Weiner, how did your aesthetic practice develop?
I’m a Johns Hopkins trained Head and Neck, Facial Plastic Surgeon where I was on-staff for a couple years before going into private practice in Georgia. My practice at that time consisted of all types of head and neck procedures, including facial plastics. However, about 15 years ago I began to notice that patients (and the general public) wanted less downtime so they didn’t have to take too much time from work, and less in terms of recovery, i.e. brusing and bandages. This was around the time when Botox® was FDA approved, and then came the filler Restylane® which also received FDA approved. I decided to open what I called The Aesthetic Clinique on the Florida Panhandle in a small town called Santa Rosa Beach. I took the risk of laying down my scalpel, stopped doing surgery and concentrated all my efforts in doing minimal and non-invasive cosmetic procedures and non-surgical procedures. Since that time I have become quite an expert in filler techniques and lasers and I spend almost all of my time doing injections. I also travel frequently around the world lecturing and doing hands-on training courses and I am one of the biggest trainers for the Galderma company, which is the Restylane family of fillers. My practice in Florida focuses exclusively on non-surgical treatments and we have developed a large following of patients from all over the world.
What changes have you seen in the world of aesthetics over the past 15 years?
The changes have been tremendous. Not only have we seen a massive growth in the number of patients seeking aesthetic procedures, but we have now seen that the number of new non-surgical cases are double and triple the number of surgeries. Fillers, injectables and laser treatments are wildly popular and developments in the field in terms of new toxins and new more refined filler products are available to treat a wide variety of concerns. What I find fascinating is that in many cases I can now do something with a filler in five minutes and without anesthesia, that fifteen years ago would have taken several hours and with the patient being put under general anesthesia. It’s wonderful and I am very excited at what will develop over the next few years.
What is the ReJAWvenation technique you have become known for?
I’ve coined the term ReJAWvenation and I am the ReJAWvenator and our patients get ReJAWvenated. It’s a method of defining and de-aging the jawline but let us first go back a step. As a jawline ages it becomes more irregular and less defined. It doesn’t appear as firm as it was and the eye immediately picks that up as a sign of aging. With ReJAWvenation, there are two parts to the actual rejuvenation. There is the enhancement aspect for new younger patients who really don’t have any signs of aging but want a more distinctive and defined jawline which the eye sees as a sign of youth and beauty. For instance, take a look at runway models in advertisements and other media, they all have very strong jawlines. Athletes and the people deemed to be the most attractive men and women in the world, they all have strong jawlines. I recognized that this was an area that needed addressing and rather than do it surgically with implants, I developed a technique using fillers only. Secondly, there is the aging aspect wherein the patient could have had a stronger, or weaker, chin and jawline and now due to aging are seeing that the skin appears slacker and the jaw is not as firm. Those patients are seeing a result that returns a youthful appearance to their face.
How important is the jawline to your male and female patients?
With the men in my practice, I would say that probably the single most important aspect of their profile is their jawline. Whereas in females the order would be cheeks and lips, with the jawline a close third.
How does the ReJAWvenation technique work?
After studying the aging process of the jaw I have come to the conclusion that the main aspect of the aging process is due to volume loss, loss of skin elasticity, gravity, as well as the boney resorption in the mandible (jaw bone). So what we are doing is actually correcting the bone loss using fillers which in turn improves the jawline making it look firm again. It’s a simple technique where I enter with a cannula, which is larger than a regular needle but the tip is blunt so there is no sharp point at the end. It’s not actually a needle, but a blunt cannula which is extremely safe and comfortable. Our patients consider this as one of the more comfortable procedures they undergo. I inject the gel posteriorly, which means backward towards the ear, and underneath the jawline. I use a variety of different types of fillers depending upon the patient and level of treatment. Some of the fillers are hyaluronic acid fillers such as a Restylane Defyne® and Restylane Lyft®. Both of those are great because they are temporary and reversible so if a patient has any apprehension about the procedure, it can all easily be dissolved with something called hyaluronadase. Other fillers I use in this area are Radiesse® fillers which is a more long term filler lasting anywhere from nine to eighteen months, whereas the HA fillers last around nine to twelve months. For a more permanent procedure I use Bellafill® which creates a collagen response from the body which makes its duration last a lot longer, probably permanent. Once I complete the correction in the posterior, the back aspect of the jaw, I turn the cannula around and correct the area closer to the chin. I like to do the ReJAWvenation technique in two treatments. In the first treatment I inject from one to two syringes per side, again, depending on the patient and course of treatment. At that point I stop and have the patient return approximately four to six weeks later to allow the fillers and jawline to take shape and at that point we can decide if there is need for any further correction.
Do you treat other areas of the face at the same time?
Yes. It is important to treat the entire face. We don’t want to isolate the jaw alone. Often cheek fillers are also used as well as fillers to the preauricular area, which is the area in front of the ear, because this seems to gently pull the skin back from the middle aspect of the face particularly the marionette areas, and it also helps improve the jawline as well.
What is the downtime with ReJAWvenation?
There’s really hardly any downtime with this procedure. Patients are able to go to dinner, go to lunch, etc. I recommend not working out at the gym for the next 24 hours or so but, at most, patients may have a little bit of soreness and sometimes a little bit of bruising but their lives are not interrupted at all.
Please explain how your technique uses both soft and hard fillers
The fillers I use have something called high G-prime. G-Prime is a measurement of the fillers’ ability to lift other tissues. Therefore, we need to use a very thick type of filler in the correction of the jawline, rather than ones that spread out and are kind of pillowy. Those are better placed in other areas of the face or lips. Aging is a process, particularly in the face, that occurs in both hard and soft tissue. The skin becomes a little thinner and crapey, muscles weaken, volume loss occurs and, as mentioned previously, bone begins to resorb. In fact, the decision on what type of filler is based upon some of the soft tissue characteristics and if the soft tissue in the jawline is thin, then we don’t want to structure a product underneath it that will be visible. On those patients, I prefer to use Restylane Defyne, which integrates with the tissues well and does not become as apparent as some of the other products I discussed earlier.
Are current fillers age selective?
The fillers aren’t necessarily designed for certain age groups, but as we continue with research as well as application, some fillers seem to be better suited to a younger and/or an older patient. It is common for me to use two or three different types of fillers in the same patient depending on the level of injection, whether the need is deep or superficial, the area that I am correcting and the need for lifting or the age of the patient.
Has anything happened in recent years that really excited you about this field of medicine?
Well, yes, lots of things and one I found very exciting was when the FDA approved both Restylane Refyne and Defyne. Those products are unique in that they are made with something called expression technology which means they have the ability to stretch and contract so are perfect for areas with animation particularly the perioral area around the mouth, nasolabial, the smile lines, chin area, and marionette area. When a patient moves their mouth for instance, the filler seems to move too making the action look more natural than with previous fillers that did not have that flexibility. A recent study has shown that these fillers reduce the muscle strain in the perioral area. It showed that a 58 year old muscle strain was reduced to one that was comparable to a 35 year old muscle strain after Refyne and Defyne were place.
How long do the fillers last?
When I’m putting these type of fillers around the mouth where there is obviously a lot of movement, they tend to not last quite as long as areas where there’s not a lot of movement. I tell my patients that Refyne and Defyne in the mouth area will last about nine months.
Are you seeing more millennials in your practice for ReJAWvenation?
Yes. Absolutely. My patients are great at referring friends and family to our practice but we have seen an uptick in millennials that find us on Instagram. Instagram shows a lot of before-and-after photos, not just ours, but all the other practices that use Instagram as a method to communicate with new patients. What is interesting is in many of the before-and-after photo results are difficult to see in some areas of the face due to lighting and shadowing. However, in the jawline it is always more obvious and when patients see their ‘selfies’, it is their jawline that they feel they want to improve, especially men. Millenials are now making up a large number of new patients to our practice.
As a result of increased awarenss of ReJAWvenation, have you seen a surge in male patients?
Yes! For men, it’s all about angles and men prefer a more boxy look. Actually there was a study through Fortune 500 Magazine where they went through the Top 500 companies in the US stock exchange and reviewed pictures of their CEOs. They found that 95% of the CEOs had strong jawlines. Strong jawlines are associated with confidence, honesty and with power. In addition, a strong jawline in a male is associated with high testosterone / more fertile and therefore and they are more attractive to females as a mate.
What other aesthetic treatments complement the ReJAWvenation technique?
Great question. I don’t want to pretend that the only treatment for sagging jawlines is filler. In fact, some people need combinations of therapies and one of our more popular therapies is called Genius. Genius is a radio frequency microneedling device that addresses skin tightening issues that aren’t addressed with just filler. Sometimes we use Kybella, a fat melting injection particularly in patients with double chins. There is a newer radio frequency device called FaceTite and more recently AccuTite, which is a little more invasive than the other procedures mentioned but works great in the lower face and upper neck too. ReJAWvenation patients are always really happy to see the improvement to their jawline, and when we are able to complement that with improvement in other areas of the face too they are generally just ecstatic.
Dr. Steven F. Weiner can be reached at 850-622-1214. To learn more about ReJAWvenation and other aesthetic treatments offered by Dr. Weiner, visit www. visit www.theclinique.com.
To listen to Dr. Steven F. Weiner’s ReJAWvenation interview at Aesthetic Insider™ Radio, CLICK HERE!