Chin augmentation is an essential facial rejuvenation component, which can be done safely and effectively with fillers if clinicians know important aspects of regional anatomy and understand optimal patient selection, according to a recent review and practice experience published in Dermatologic Surgery.
Dr. WilsonWhile the nonsurgical approach to chin augmentation with dermal fillers has been covered in the plastic surgery and otolaryngology literature, little has been published in peer reviewed journals for dermatologic surgeons and other cosmetic physicians. To help address that, U.S. dermatologic surgeons conducted a review and shared their experiences focusing on anatomy, patient evaluation, injection technique, concomitant therapies and potential complications for the use of dermal fillers to temporarily correct chin retrusion.
“The chin should be assessed as a critical component of aesthetic harmony in all patients seeking facial rejuvenation,” says the paper’s lead author Monique J. Wilson, M.D., who is fellowship trained in cosmetic dermatology and practices in Sunnyvale, Calif. “Equipping yourself with the skills necessary to evaluate the chin, determine the best method of augmentation and combine concomitant therapies will help your patients achieve their aesthetic goals.”
Anatomic Considerations
There is no single aspect of a patient's anatomy that will determine whether chin augmentation is appropriate, according to Dr. Wilson.
“Our clinical experience [and] aesthetic literature have taught us that the relative proportions of the entire face need to be considered in any patient to achieve the optimal aesthetic result,” Dr. Wilson says. “As chin retrusion is often unnoticed by patients and untreated by aesthetic providers, we recommend careful routine evaluation of the horizontal projection and vertical height of the chin in patients seeking facial rejuvenation.”
It’s helpful to assess the chin not only in anteroposterior, oblique and lateral photographs, but also with animation, according to Dr. Wilson.
“It is often instructive to review these photos and videos with patients, as many are not aware of their chin retrusion or how it impacts their appearance,” she says.
For example, the authors report that it’s common for patients seeking rhinoplasty not to realize that chin retrusion can give the impression that a nose is larger than it is.
Best Practices
Clinicians can effectively use hyaluronic acid, autologous fat calcium hydroxylapatite and poly-l-lactic acid to augment chins. But the best filler choice depends on, among other things, the patient’s anatomy.
The authors cite research on chin augmentation in Asian patients, which found high-viscosity hyaluronic acid or calcium hydroxylapatite fillers were best. Authors of this paper suggest those same filler types effectively improve the anterior, transverse and vertical chin dimensions.
“The properties of fillers inform our use. Those with greater ‘lift’ are typically used deeper, in a more depot-like fashion to increase chin size, while other fillers are more appropriate for superficial injection and blending,” she says.
The paper’s authors use a combination of depot and threading techniques.
And similar to implants in the cheek, chin implants are often combined with fillers to achieve best results.
“Over time, age-related bone resorption may result in an obvious or unnatural appearing chin implant. This effect can be minimized through the use of fillers to blend and soften the chin,” Dr. Wilson says.
Potential complications of filler use in the chin are similar to those that might occur with use elsewhere in the face, according to Dr. Wilson.
“Of particular concern are contour irregularities that may result from superficial injection and vascular compromise.
Often, patients require concomitant therapies to achieve their desired results, she says.
“Perhaps the most common technique is injection of fillers to treat volume loss along the mandible or in the lips, mental crease, marionette [lines] and oral commissures,” Dr. Wilson says. “Most patients with chin retrusion also benefit from neuromodulator injection to the mentalis, as it is often hyperdynamic in this population. Other surgical, injection and device-based therapies to address skin laxity, submental fat accumulation and platysmal bands can also be combined with chin augmentation for superior results.”
