Profile harmonisation — also called profile balancing or face-balancing filler — is the assessment and correction of the side profile as a whole. So that the nose, lips, chin and jawline are in proportion with each other, rather than the treatment of whichever feature the patient has fixated on. It rests on two long-established measurements: the Ricketts E-line, drawn from nose tip to chin, behind which the lips should sit by a few millimetres, and the facial thirds, which should be roughly equal. Measured this way, most ‘big noses’ are average noses in front of a recessed chin, and most ‘weak jaws’ are fine jaws under a short chin. Structural hyaluronic acid filler placed on bone at the chin, jaw and — only where indicated. The nose brings the profile onto the line, usually in a single session. Results are immediate, final at two weeks, last 12–18 months and are reversible. At Medisha Clinic it is performed by Dr Nish Shah MD, who has performed over 6,000 non-surgical rhinoplasties, using The Medisha Method.

At Medisha Clinic the Profile Balancing Package — nose, chin and jaw treated together in one session. Is £750 for 2ml, £1,000 for 3ml, £1,250 for 4ml and £1,500 for 5ml, with a complimentary 4-week review and any refinement included. If the measurements show only one structure is out of line, you will be offered that area alone: chin or jaw filler from £350 (1ml), non-surgical rhinoplasty £450, lip filler £350. Consultation with Dr Nish is £50, fully redeemable against treatment. It includes a standardised profile photograph and E-line analysis. The clinic is at 58 South Molton Street, Mayfair, London W1K 5SL, three minutes from Bond Street station.

The E-line (aesthetic line) was described by the orthodontist Robert Ricketts in 1957 and remains the standard reference for the lower profile. It is a straight line drawn on a outer view from the tip of the nose to the most prominent point of the chin. In a balanced profile the upper lip sits about 4mm behind the line and the lower lip about 2mm behind it. If the lips sit well behind the line, either the nose is projecting too far or, far more commonly, the chin is not projecting far enough, and it is the chin that makes the nose look large. If the lips sit on or in front of the line, the chin is usually recessed relative to the mouth. Dr Nish measures your E-line on a standardised photograph at consultation. The deviation in millimetres becomes the treatment plan, which is why profile harmonisation at Medisha starts with a ruler rather than a syringe.

Yes, and it is the single most useful thing a profile specialist can tell someone considering rhinoplasty. In profile the eye judges the nose against the chin. A chin that sits behind the lower lip makes an average nose project further than it should. No amount of nose treatment corrects that, because the nose was never the problem. Bringing the chin forward by a few millimetres with structural filler on bone brings the lower face to meet the nose, and the nose immediately reads as smaller and better proportioned with nothing done to it. Dr Nish — having performed over 6,000 non-surgical rhinoplasties — assesses this at every nose consultation. In many patients chin filler alone is the answer, and in most the best result is chin and nose together as the Profile Balancing Package.

The package is the treatment. Harmonisation is the method. Profile harmonisation is the assessment — measuring the E-line and facial thirds and identifying which structure is out of proportion. The Profile Balancing Package is what most patients then need: nose, chin and jaw corrected together in one session, from £750. Some patients are found to need only one area, and are offered that area alone at its single price. The package exists because the three structures are one line in profile and the best result, and usually the least total filler — comes from adjusting them against each other in one sitting.

Chin (the most common and most impactful — forward or vertical projection to bring the chin to the E-line). Nose (a bump straightened, a tip lifted or a bridge built, only where the nose itself is out of line). Jawline (definition at the angle and along the border so the lower third reads as strong). Lips (proportioned to the corrected profile, and frequently found not to need treatment once the chin is advanced), and in selected patients the forehead or brow, where a flat or sloping upper third tilts the whole profile. This of these are treated is decided by the measurements, not by the list.

Twelve to eighteen months, at the longer end because the chin, jaw and nasal bridge are low-movement areas where structural HA on bone is broken down slowly. Second treatments often last longer than the first because some structural scaffold persists. Longevity varies with the product, your metabolism and lifestyle factors such as intense exercise and sun exposure. When the effect fades a smaller top-up restores it, and because only reversible HA is used the filler can be dissolved at any point.

Most patients describe pressure rather than pain. Topical anaesthetic is applied for 20 minutes, a nerve block is available for the nose, and every filler contains lidocaine. The jaw angle is the only point some patients find slightly sharp. Downtime is short: the new profile is visible immediately, most patients return to work the next day, mild swelling and tenderness settle within 3–5 days and bruising within 7–10. The result is considered final at two weeks. For two weeks keep glasses off the bridge if the nose was treated, and avoid pressure, massage or sleeping face-down on the chin, jaw or nose. For 48 hours avoid vigorous exercise, alcohol and heat.

In most cases, yes. Surgical rhinoplasty is permanent, expensive and carries a 10–15% revision rate. Before committing to it you should know whether your nose is actually the problem. A profile assessment at Medisha measures the E-line and tells you how much of what you see is the nose and how much is the chin. If the chin is the issue, structural filler corrects the profile for a fraction of the cost with no surgery. If the nose is genuinely large, Dr Nish will tell you so and refer you, and reversible nose filler can still show you a straightened profile on your own face before the operation. After surgical rhinoplasty, profile filler at the chin and jaw frequently completes the result the surgery started.

Yes. It is the profile half of every facial programme. Profile harmonisation with cheek filler is the full structural harmonisation of the face and the basis of masculinisation and feminisation. Profile filler with a PDO thread lift addresses proportion and descent in sequence for patients over 45. Profile filler with Profhilo or Sunekos Performa restores the structure and then the quality of the skin over it. Anti-wrinkle injections for the forehead and frown can be added on the day. Filler and threads are usually spaced 2–4 weeks apart; Dr Nish designs the sequence at consultation.

The risks are those of chin, jaw and nose filler. Expected, temporary effects: swelling and tenderness for 3–5 days, bruising for up to ten days, firmness for a few weeks as structural filler integrates. Uncommon risks: asymmetry (assessed and adjusted at the 4-week review). Over-projection or a heavy chin (avoided by measuring to the E-line rather than to a volume). Migration (a soft-product problem, avoided by structural HA on bone). Infection (rare. Sterile technique, and dental infections are screened for), and a blocked blood vessel. The serious risk, most relevant in the nose, minimised by deep placement, checking for blood vessels, small deposits, reversible HA and hyaluronidase prepared in the room. Warning signs are skin blanching or mottling, disproportionate pain or any change in vision; Dr Nish provides his direct number for the first 48 hours.

Because profile harmonisation is an assessment before it is a treatment, and few practitioners in London have assessed more profiles than Dr Nish Shah MD. He is a medically trained doctor who has performed over 6,000 non-surgical rhinoplasties, which means he has learned, thousands of times over, how often the nose was not the problem. Brand Ambassador and Key Opinion Leader for dermal fillers with a global manufacturer, and Senior International Clinical Trainer at Derma Medical, where he teaches profile assessment and structural filler to other doctors. Every profile is measured on the E-line and facial thirds before anything is placed, corrected with structural HA on bone in one session using The Medisha Method, reversible, with hyaluronidase on site and a 4-week review included. His most common advice to a nose patient is to leave the nose alone. Profile Balancing Package from £750; £50 consultation redeemable. 58 South Molton Street, Mayfair, London W1K 5SL, three minutes from Bond Street. Also Marylebone.