In February 2021, Galderma Aesthetics announced FDA approval of Restylane Defyne for mild to moderate chin receding in adults.1 Defyne is the second hyaluronic acid (HA) dermal filler to be approved for the indication, following Juvéderm Voluma XC (AbbVie), which received FDA approval for chin augmentation in June 2020.2
These approvals for non-surgical chin augmentation highlight the ongoing debate between surgical and non-surgical treatments. A discussion, according to facial plastic and reconstructive surgeon Michael Somenek, MD, Somenek and Pittman MD Advanced Plastic SurgeryWashington, DC, this is best resolved with a simple conversation with patients during the cosmetic consultation.
The optimal choice depends on the patient’s individual expectations, including the longevity of the treatment, said Somenek, who offers chin augmentation implants and fillers in his practice.
Pros and cons
Fillers offer immediate results and instant gratification, as well as little to no downtime. However, patients need touch-ups to maintain the desired results. “Most of the fillers we use today are hyaluronic acid fillers,” he says. “They are temporary and last about 9 to 12 months. There is also a longer-lasting filler option using polymethyl methacrylate or PMMA, also known under the brand name Bellafill (Suneva Medical), which can offer a longer-lasting option and has a semi-permanent effect.3
For those looking for a unique treatment, Somenek recommends chin implants for the right candidates. Chin augmentation surgery is a relatively short outpatient procedure, with minimal recovery and results that last a lifetime, he says. “This is great for some people who are open to having an implant in their chin,” he says.
But while patients are almost always candidates for fillers, the same cannot be said for chin implant candidates. Surgeons should think twice about using implants in patients who have had previous procedures in or around the chin, those who have excessive scar tissue, or excessive chin asymmetry.4
“It’s really hard to get a good result in these cases,” Somenek says. “You can get a custom chin implant, but there are a lot of steps that go into it compared to the standard chin implant you order. For people with severe asymmetry who are looking for augmentation and more symmetry, I tend to lean more towards fillers than an actual implant for them because I can outline that area much more effectively and accurately with filler.”
With implants, come the risks of misplacement or infection. The risk of infection tends to be higher during patients’ recovery, according to the American Board of Cosmetic Surgery.5
“It’s rare for a delayed type of infection to occur in the chin, but that’s a possibility with an implant,” he says.
Best practices
A thorough understanding of the facial anatomy is key when using injectables, as the potential to come in contact with blood vessels and nerves is so high. “This will ensure that you know where you are on the face and the specific area of the chin,” Somenek explains. “You know where the relevant anatomical boundaries and landmarks are, such as blood vessels, nerves and muscles.”
He recommends the use of a slow injection technique, with small amounts or small boluses, which reduces the risk of intravascular complication… “And to reduce [intravascular complication risk] Additionally, I prefer to use a cannula. I feel that many more injectors are leaning towards the blunt tip cannula technique because the risk of an intravascular injection is significantly less. It’s not impossible, but it’s noticeably less.”
Using sterile technique is the highest priority for chin augmentation surgery to reduce the risk of postoperative infection, he said. During the implant procedure, Somenek suggests placing the implant in a tight pocket to reduce the risk of it shifting or moving postoperatively.
For filler, Voluma and Defyne have become his guests for chin augmentation due to recent approvals. However, he doesn’t expect much to change in the world of chin implants.
“Honestly, there is such a broad list of chin implant options that it would have to be something very innovative to use for a chin implant. We use solid silicone implants and these have been proven time and time again to be very safe and effective for chin augmentation,” he said.
This article originally appeared on our sister publication Aesthetic Principle.
Disclosures:
Somenek is a trainer and speaker for Galderma and a speaker for Suneva.
Bibliographical references:
- Galderma receives FDA approval for Restylane Defyne for chin augmentation. News. Galderma. 4 February 2021. Accessed 26 February 2021. https://www.galderma.com/news/galderma-receives-fda-approval-restylaner-defyne-chin-augmentation
- FDA approves Juvederm Voluma XC for chin area enhancement. News. AbbVie. June 15, 2020. Accessed February 26, 2021. https://news.abbvie.com/news/press-releases/fda-approves-juvderm-voluma-xc-for-enhancement-chin-region.htm
- Bellafill. Patient brochure. Suneva Medical. Accessed 26 February 2021. https://www.sunevamedical.com/products/bellafill/
- Harris WC, Raggio BS. Facial chin augmentation. In: StatPearls. StatPearls Publishing; 2021. PMID: 32119393
- Chin implants. American Board of Cosmetic Surgery. Accessed 26 February 2021.
