Concave profile: assessing the midface and the chin

In profile, the face draws a line. In some patients that line is concave: the midface, made up of the maxilla, the cheekbone area and the base of the nose, sits back relative to the forehead and chin, and the profile looks "scooped out" in the middle. It is a pattern that changes how the whole face reads and that the frontal mirror barely shows.

A concave profile is often the concern of patients who say "my face is flat", "my nose looks sunken" or "my chin sticks out". This page guides the assessment of the midface and chin and how to project without overdoing it. For the opposite, see convex profile. For the balanced pattern, see straight profile.

What defines a concave profile?

Professionals use lines and angles to describe the profile. The facial convexity angle relates the nasion, the subnasale point and the pogonion. When the value is reduced or negative, the profile tends to be concave. Other references, such as the subnasale-pogonion line and the Steiner and Ricketts lines, help assess the lip and chin against the reference. See reference lines of the aesthetic profile and facial profile analysis: checklist.

The causes vary:

• Maxillary hypoplasia (a small or recessed maxilla), of skeletal origin.
• Skeletal Class III, in which the mandible sits relatively forward of the maxilla. See Angle Class III.
• Resorption with age, which reduces the projection of the maxilla and premaxilla and turns a straight profile into a concave one. See facial bone loss.
• A small nose or one with a low base, which accentuates the reading of concavity in the middle.
• Deep fat loss in the midface, which flattens the area.

The midface as the protagonist

In many cases, the focus of the concave profile is the midface. Projecting the cheekbone area, the paranasal zone and, in selected cases, the upper lip can improve how the profile reads. The page midface without projection in profile covers the topic in detail, and maxillary projection and the midface in profile offers the planning rationale.

The care lies in the limit. When the cause is skeletal, soft-tissue projection can compensate part of it, but there is a point at which the volume needed is too large to look natural. At that point, the conversation should include other assessments.

The chin in a concave profile

The chin is usually the point the professional is tempted to "balance". There is a trap here: in a concave profile, the chin is often already projected relative to the maxilla, and projecting it further accentuates the imbalance. The right question is which reference the patient will accept as "good": the line of the chin, of the lip or of the nose.

In general, the decision favors projecting the midface to bring it closer to the chin, rather than projecting the chin to keep up with a recessed midface. But the analysis is case by case. See big chin, recessed chin and ideal chin projection by sex.

What HOF compensates and what it does not

At the discretion of the licensed professional, HOF can compensate part of a concave profile with soft-tissue support: the cheekbone area, the paranasal area and, in selected cases, the lip. This compensation improves how the profile reads, and it is a reversible path in the case of hyaluronic acid, which can be dissolved with hyaluronidase.

What HOF does not do: it does not advance the maxilla, reposition the mandible or correct malocclusion. When there is a functional complaint (bite, chewing) or a marked skeletal deviation, orthodontics and orthognathic surgery are the indicated fields. Conversation between professionals protects the patient. See orthodontics and profile change and orthodontics and facial profile in HOF.

How to avoid an overdone look

The most common fear is a face that looks too "full" after projection. A few practices reduce that risk, without forming a protocol:

1. Advance in stages, reassessing in profile and three-quarter view.
2. Use the patient's own reference, instead of a generic ideal.
3. Prefer small, distributed volumes to a single large volume.
4. Reassess the nose and the lip, which change how the whole reads.
5. Stop when the change stops being subtle.

Facial identity is a criterion. A concave profile is part of who that person is, and many patients do not want to change their features, only soften them. See facial identity: how to preserve it and plan to balance the profile.

How to assess step by step

Simulation: an important limit

Honesty is needed here. The Harmy projection uses only the frontal photo. A concave profile is, by definition, a profile reading, and the simulation does not show what happens from the side. Use the app to talk about the frontal projection of the cheekbone and chin, and show the profile with other tools and with clinical photography.

See limits of 2D simulation and profile photo of the face in the clinic.

In summary

A concave profile calls for a profile reading, a decision about which reference to bring closer and honesty about what is skeletal. HOF compensates in soft tissue with support in the midface and caution with the chin, and refers when the case calls for orthodontics or surgery. Results vary from person to person and depend on individual factors. The choice belongs to the licensed professional, according to the rules of their professional council.