Enhancing the chin for more projection, or addressing a weak chin has been a popular facial plastic surgery as lacking projection in the chin transcends the aging process. A weak chin is primarily caused by the bone structure, when the position of the mandible or the lower jaw bone is further back compared to the upper jaw.
The traditional procedure for this has been chin implant surgery, usually made of silicone. However, with the introduction of longer lasting, more rigid facial fillers, and the evolution of filler placement techniques to add solid facial structure as well as volume, the look of a chin implant can be achieved conveniently and quickly without surgery.
Dr. Prasad prefers to do chin implant surgery via an incision under the chin, which is not visible in the face. A pocket is created between the chin bone, and beneath the muscles of the chin. A customized implant made of silicone is the preferred choice of Dr. Prasad, which is held in place with sutures or titanium screws. Dr. Prasad prefers to do this surgery with local anesthesia under LITE™ sedation so the patient is more comfortable, and heals and recovers more quickly after surgery.
However, many other facial surgeons do prefer to perform chin implant surgery with general anesthesia, which involves longer recovery time for patients. Actual surgery time is 1-3 hours.
Although chin implants can look good for several years, there are important age-related changes that may affect facial implants in the long-term. As aging progresses the loss of facial volume occurs at the foundation where implants are anchored. Even though the cheek or chin implants are properly anchored to the bone to maintain a desired position, there will be continual changes on the natural facial anatomy including the bone, muscle, fat, and surrounding tissue. This progressive change can result in a disproportionate appearance of the facial implant relative to the rest of the face.
Are cheek and chin implants really permanent?
A sad reality of facial aging is the progressive loss of youthful volume as you age the face loses definition it becomes more flat and even sunken in particular the cheek area and the chin areas are frequently recognized as having lost significant volume particularly when you take a look at your profile it’s very popular for many people to get fillers to address their volume loss interestingly there are many people who don’t feel that the fillers are working as well as they want or they get tired of going in frequently to have these filler injections they experience swelling and bruising and eventually develop filler fatigue and become interested in something more permanent in their quest for a permanent solution they become aware of facial implants they perceive that facial implants such as cheek and chin implants are the permanent solution they’re looking for although these implants can appear to look very good for several years there are important age related changes that may not make this option the best choice of having facial implants for the long term as they may appear to be
I’ll discuss how i adapted my approach to facial volume loss from surgical implant placement to longer-lasting non-surgical solutions in my practice I’m Dr Amiya Prasad I’m a Board-certified cosmetic surgeon and Fellowship-trained oculofacial plastic and reconstructive surgeon I’ve been in practice in new york city and long island for over 25 years as a facial cosmetic surgeon
I perform all types of facelift surgery from short incision mini lifts to extensive deep plane facelifts I do perform cheek and chin implant placement surgery both with facelifts and as standalone procedures I also routinely perform non-surgical volume enhancement using injectable fillers in the lips the eye area the cheeks jawline and chin it’s natural to assume that cheek and chin implants are permanent because they aren’t metabolized like hyaluronic acid fillers while cheek and chin implants which are usually made of a soft silicone material are not going to be metabolized
Your underlying facial structure is not permanent the same aging process that causes the loss of facial volume which is primarily diminishing bone volume as well as loss of fat muscle soft tissue and skin thickness continues after facial implants are placed this progressive loss of facial volume occurs at the foundation of where the implants are anchored like the cheek bone and the chin while it’s common practice for the cheek implants to be stabilized or anchored in place using titanium screws or bolsters for stabilization in order to maintain a desired position there will be continual changes of the natural anatomy including the bone muscle fat and surrounding tissues this progressive change can result in a disproportionate appearance of the facial implants relative to the rest of the face as there is progressive fat loss below the skin and the skin becomes thinner it’s also possible to see the actual outline of the implant these issues also apply to chin implants
Although usually not as significant recognizing the presence of natural asymmetry and subtleties of contour the implants often have to be modified during surgery this typically involves shaving the silicone and observing the effects on the facial contour this becomes particularly challenging because of normal intraoperative swelling due to the presence of anesthetic and natural reactive tissue swelling further there are other soft tissue aspects which cannot be adjusted for by carving the implants so postoperatively to optimize the appearance it can still be necessary to employ the use of soft tissue fillers to help optimize the longevity and resilience of hyaluronic acid fillers the makers of hyaluronic acid fillers introduced new fillers such as Juvederm Ultra Plus and Juvederm Voluma although these fillers were a major step in the right direction a common source of frustration is that in spite of the filler’s improved viscosity and longevity people who want to have better cheek definition and chin definition end up looking soft and doughy the doctors who place these fillers are also frustrated because when they place the fillers under the skin and intentionally mold the fillers to look like cheekbones and other facial structures unfortunately the look they achieve in the office does not last since conventional placement of hyaluronic acid fillers result in the fillers migrating there was a clear need to place the fillers in a way where migration would be less of a problem in some ways this is comparable to cooking where you have the right ingredients but what you need is the right technique fortunately the right technique in my opinion has been developed by adapting strategies and anatomic knowledge from facial implant surgery when we look at relative proportionality of volume loss associated with facial aging it’s clear that the most significant impact is at the bone level
This is why facial implants are placed on top of the bone structure this of course begs the question why are soft tissue fillers to improve facial structure placed just below the skin level it should be no surprise that these fillers end up being displaced and creating the stereotypical “pillow face” appearance this means that there needs to be a consistent and predictable method to place long-lasting filler at the bone level to take advantage of the strong foundation and the intrinsic shape inherent to the bone structure although many of my colleagues and non-physician injectors believe that they are placing filler at the bone level when they do a demonstration and show how the needle they’re using is hitting the bone they’re not really delivering the filler into the space that optimizes an enhanced structure
In addition these well-meaning injectors doing these demonstrations repeatedly pierce the skin with their needle thereby inducing more bruising and swelling than would be necessary I employ a technique called Structural Volumizing since i’m creating more definition by placing volume on the bone structure
I believe by placing this thicker and longer lasting filler using blunt cannulas instead of needles I’m able to deliver the material i want into the spaces above the bone in a smooth almost frictionless way reducing the risk of bruising swelling and other potential complications I’m essentially performing a non-surgical treatment by applying my surgical knowledge to place the filler at a deeper level my patients are typically very happy about how good they look immediately and rarely have any concerns about bruising and swelling the next day by placing the filler mostly at the bone level
I can be more conservative with the volume if i need to place any filler below the skin level to address any subtle contour issues by using this approach of placement in limited quantities below the skin the filler is less likely to be displaced i usually see my patients again after two weeks to see how they look after everything is settled something worth mentioning is that if there is any issue with the facial implant then surgery is necessary to remove or exchange the implant with structural volumizing even at the bone level hyaluronic acid filler can be quickly dissolved by using the enzyme hyaluronidase when considering cheek and chin augmentation for a more youthful appearance remember our facial dimensions change with age but the facial implants don’t by using thicker hyaluronic acid fillers placed by applying the principles of facial implant surgery we achieve the same results in many situations as a surgical procedure with greater flexibility and precision with lower risk while fillers do not last as long as surgical implants they do last longer than they did previously and are certainly far more convenient for my patients i’ve also observed that many people who would have otherwise objected to undergoing any kind of facial implant surgery are much more interested in having Structural Volumizing because of the convenience safety predictability and reversibility
I hope you found this information helpful thank you for your question
Chin implants are long lasting while its disadvantage with the purpose of chin augmentation are the same as any other implant surgery. The implants can shift, can become infected, or need removal due to the patient’s dissatisfaction of the results.
The introduction of more rigid, longer lasting cosmetic fillers has changed chin augmentation to make it more convenient, faster, and cost-effective for patients. The same look achieved with chin implant surgery can be done in minutes without surgery in many cases, and reduced recovery time.
A thicker hyaluronic acid filler like Juvederm Ultra Plus or Juvederm Voluma is injected with a blunt cannula on top of the bone, and beneath the muscle to hold it in place with Dr. Prasad’s technique called Structural Volumizing. These thicker fillers are designed to add facial structure, and last up to two years.
It is possible that lacking projection in the chin may be caused by a pronounced underbite that pushes the lower jaw back further than it should be. In such cases, cosmetic surgery may not be the best option, but rather oral surgery to set the chin and lower jaw forward. While this can be performed by some plastic or cosmetic surgeons, this is more the specialty of an oral surgeon as this has to do more with function rather than aesthetics.
Dimpling of the chin, commonly called peau d’orange, orange peel skin, or even golf ball skin of the chin is caused by an overactive mentalis muscle. The excessive tightness of the mentalis muscle can also cause deep creases in the chin. Treatment for chin dimpling involves an injectable neurotoxin like Botox®, Dysport®, or Xeomin® to relax the mentalis muscle which reduces mentalis activity and smoothes the skin appearance of the chin, and decreases the depth of muscle-associated creases.