Tips for Filling the Jaw, Chin, and Mid-face

These past two years have ushered in several new fillers, along with new indications for available injectables. Here, Cosmetic Surgery Forum faculty members discuss how they are using Restylane Contour and Juvéderm Voluma for chin augmentation in their practices and share pearls for achieving optimal cosmetic results.

Lift, Cohesivity, Moldability

Approved for cheek augmentation and correction of midface contour deficiencies, Restylane Contour comprises patented Restylane XpresHAn technology, which allows the filler to move dynamically with facial movement. Juvéderm Voluma is now approved for augmentation of the chin region and cheek augmentation to correct age-related mid-face volume deficit.

Hema Sundaram, MD, FAAD, Founder and Director of @twicebornbeauty Dermatology, Cosmetic and Laser Surgery Center, with offices in Rockville, MD, and Fairfax, VA, has vast experience with Restylane Contour for the midface and jawline, as it was approved in Europe before it came to the US. “The key is not to inject lumps of filler, but to distribute it evenly through the tissue using a cannula or microbolus technique,” she says.

When injecting Voluma in the chin, Mark G. Rubin, MD, a dermatologist at the Lasky Clinic in Beverly Hills, first cleans the patient’s skin with Microcyn to decrease the chance of biofilm formation. “I side light the patient with a surgical light to highlight the areas of deflation, which show as shadows in the side light,” he says.

Next, Dr. Rubin outlines the areas to be filled with a uni-ball micro-point pen. He notes that the ink marks can be easily removed with alcohol.

“I then mix 1cc of Voluma with 0.5cc of bacteriostatic saline,” he says. “I mix the Voluma with saline before the injection because it makes the Voluma smoother, creates less swelling after the injection, and yet still gives significant lift to the area of injection.”

He uses a 32-gauge, half-inch needle and injects the Voluma with a linear threading technique from the lateral chin toward the medial aspect of the chin, injecting both antegrade and retrograde. “I try to inject deep in the deep subcutaneous or supraperiosteal plane,” he says. “I then roll a large cotton-tipped applicator over the area repeatedly to smooth out the injection site.”

Dr. Sundaram also likes Juvéderm Voluma for the chin, jawline, and midface. There are, however, some subtle differences between these two soft tissue fillers. “The cohesivity of Contour is a little bit higher than Voluma, but there is not a real difference in how they will settle. Both have a nice balance of lift, cohesivity, and moldability,” she says.

Her advice? “Try all the products and find what works best in your hands. Both Restylane Contour and Juvéderm Voluma produce very good results in those areas.”

Dr. Sundaram is a clinical investigator and consultant for Galderma and a consultant for Allergan. Dr. Rubin has no relevant disclosures.