PracticalDermatology

The chin is in. Growing numbers of cosmetic providers are now treating the chin with injectables. While this is new for some, experienced facial aesthetic specialists have been using filler and neuromodulators in this area for decades. There are pearls and pitfalls, and the prudent practitioner will keep these seven pillars of successful chin enhancement in mind for patient safety and predictable outcomes.

1. Do the right thing.

Injectables aren’t the only way to enhance the chin. Some patients may be better off with chin implants or genioplasty, the results of which will last a lifetime. Some patients don’t want surgery, and for them, fillers work beautifully. Still, it’s important to point out that a patient can undergo a permanent procedure for the same price as temporary fillers. Put another way: Always act in your patient’s best interest.

This patient was treated with three syringes of Voluma.

2. Chin enhancement is not always a one-and-done procedure.

Chin filler injections may require multiple appointments. Make sure to manage your patient’s expectations.

3. A bigger chin isn’t a better chin.

Don’t overtreat the chin. One of the hallmarks of facial augmentation surgery is to match the natural look and feel of the area. Too much filler can make the chin look floppy and doughy. The layering of fillers produces the most natural-looking results in the chin.

Many practitioners overlook the mentolabial fold. Injecting this area can make a big difference in lower facial aesthetics.

Pro tip: Start deep and work your way toward the more superficial layers. Injecting in the deep, middle, and superficial planes can provide good support without causing floppiness.

4. Mind the mentolabial fold.

A patient with a recessive chin and deep mentolabial fold may not be the best candidate for chin filler augmentation. Fillers project the chin in front of the fold so it may look unnatural. Instead, consider addressing the mentolabial fold with filler or suggesting surgical options.

A well-done chin implant can satisfy aesthetics in three dimensions and can last a lifetime.

5. Validate the vertical.

A patient may be a poor filler candidate if their lower lip is significantly posterior to their upper lip (especially if they have a deep mental labial fold). In these cases, the patient will also need vertical lengthening of the chin with fillers.

Left: If the lower lip is significantly posterior to the upper lip, a patient is a better candidate for chin implant or genioplasty. Right: Bigger is not better.

6. Don’t forget about neurotoxins.

Hyperactive mentalis muscles can make the chin appear dimpled, balled up, and unnatural. Relaxing the mentalis muscle with neurotoxins before fillers can enhance your results.

The patient at the top only needs horizontal augmentation and is a good candidate for filler injection. The patient on the bottom has vertical and horizontal deficiency. This patient is better served with sliding genioplasty.

7. Know where the chin stops.

Many patients treated with chin enhancement also benefit from filling the pre-jowl sulcus and/or posterior mandibular augmentation.

This article is based on a presentation from Cosmetic Surgery Forum (CSF) 2021: CosmeticSurgeryForum.com