The Inverted Easel: A Novel Technique for Mento-Labial Harmonization Using Hyaluronic Acid Filler

Facial harmonization of the lower third is essential for achieving proportionate, youthful, and natural aesthetic results. Conventional filler techniques for this region often rely on bolus injections that may overcorrect the mental fat pad, leading to projection irregularities and compromised outcomes. This study introduces the "Inverted Easel" technique, a novel and minimally invasive method for mento-labial elongation using hyaluronic acid (HA) filler. The approach emphasizes anatomical precision through vector-based filler distribution to safely enhance vertical dimensions without volumetric excess. Nineteen patients underwent treatment with a single-entry cannula technique using UP Deep®, a biphasic, high-density HA filler. Retrograde linear threading was performed along four radial vectors originating from a central chin point—two medial and two lateral—creating a scaffold that mimics an inverted easel. No bolus injections were used. Facial assessments were conducted with Quantificare® 3D imaging software, measuring changes in mento-labial distance and lower third facial height at baseline and 30 days post-treatment. Of the 12 patients with complete imaging data, 10 demonstrated measurable improvements, with an average increase of 1.76 mm in mento-labial distance and 1.86 mm in lower third facial height. No serious adverse events were reported. Minor side effects, including transient edema and erythema, resolved within 72 hours. Patient-reported satisfaction was high, with 90% rating the outcome as "very satisfied" according to the Global Aesthetic Improvement Scale (GAIS). The Inverted Easel technique provides a safe, reproducible, and anatomically respectful strategy for lower facial harmonization. Its refined injection design enhances structural support while minimizing risks of overcorrection. These results suggest that the method is well-suited for subtle yet impactful lower face elongation, particularly in patients seeking balanced, natural results.