For many individuals, asymmetry and a lack of definition in the chin area can be a concern. Chin augmentation, a non-surgical cosmetic procedure, involves injecting a gel-like substance into the chin to increase volume, improve facial symmetry, and restore lost volume.

This treatment addresses issues like a receding chin or a lack of prominence, resulting in a more defined jawline and balanced side profile. While chin augmentation can provide immediate results with minimal downtime, this procedure requires precise technical knowledge and an understanding of facial anatomy.

With over 30 years of experience as one of Australia’s leading Cosmetic Plastic Surgeons, Dr Terrence Scamp at Esteem Academy offers a comprehensive selection of Introductory and Advanced Cosmetic Injectable Courses, Dermal Courses, and Masterclasses. These courses are designed to equip aspiring injectors with the knowledge and practical skills necessary for success in this field.

In this article, we discuss the key aspects of chin augmentation treatments, including the importance of facial anatomy, proven protocols and the evidence-based techniques needed to perform safe, effective chin augmentation treatments.

Understanding Chin Anatomy 

The chin contributes to overall facial symmetry and profile definition. When it comes to chin augmentation, a comprehensive understanding of anatomy is essential to creating customised treatments that balance both safety and aesthetic outcomes.

The chin consists of four distinct tissue layers: the skin, the muscular-adipose layer, fat pads, and the underlying mandibular bone. These layers interact in complex ways to influence both appearance and function. Key anatomical landmarks in the chin include:

  •         Pogonion: The most anteriorly projecting central point of the chin, which determines the chin’s forward projection.
  •         Menton: The inferiormost point of the chin that helps establish its vertical height.
  •         Gnathion: Located between the pogonion and mention, this point marks the midpoint of the chin.
  •         Paragonion: The protruding regions lateral to the pogonion, which help define the chin’s width.

Clear boundaries also help define the chin area, including the mentolabial crease (above the chin), labiomandibular grooves (on the sides), and submental ligaments (below the chin). Knowing these landmarks as well as muscle placement and function ensures the gel-like product is placed correctly.

Differences Between Male And Female Chin Anatomy

It’s important to note that male and female chins differ in both structure and appearance. Male chins typically appear wider and align with the corners of the mouth, while female chins often have a V-shape and align with the edges of the nostrils.

These structural differences should be considered when developing treatment to meet individual patient goals. Incorrect placement or overfilling can result in an outcome that is not in line with the patient’s expectations.

Vascular Structures & Danger Zones

Another critical aspect to understand is the vascular anatomy of the chin, meaning the blood vessels that supply the area. The blood supply to the chin is provided by the mental arteries, which branch from the inferior alveolar arteries of the maxillary artery. The submental artery, a larger branch of the facial artery, runs beneath the mandible and feeds the anterior chin region.

The mental foramen is an area one centimetre lateral (below) of the marionette lines, and it is one that should be avoided during the injection. This is where the mental arteries and nerves exit the chin. Deep injections in this area can disrupt blood flow to the chin and mentalis muscle, leading to complications.

Some patients have an anastomosis (a cross-connection between adjacent channels) between the sublingual and submental arteries, which increases the risk of complications during high-volume filler injections.

To minimise complications, injectors should locate and avoid the mental foramen through palpation, use small volumes of product and avoid deep periosteal injections in risk areas.

The Importance Of Patient Assessment and Treatment Planning

A full patient assessment is a critical first step in any chin augmentation procedure. Before deciding on injection techniques or product, practitioners must complete a thorough evaluation to ensure that the treatment is well-planned and tailored to the patient’s needs.

Facial Proportion Analysis

A systematic facial analysis should be performed, using the Frankfort Horizontal Plane as the primary reference point. This standardised anatomical reference plane positioning allows for the precise measurement of key facial and chin landmarks. One important measure is the perpendicular vertical line from the soft tissue nasion to the pogonion, which should ideally fall within 0 ± 2mm.

Additionally, gender-specific structures must be taken into account during facial analysis. This includes evaluating skeletal architecture, fat distribution, and muscular dynamics, which vary between individuals. It’s essential to examine the face from four perspectives:

  •         Front view (patient’s mirror viewpoint)
  •         Profile view (shows chin projection)
  •         Bird’s eye view (from above)
  •         Worm’s eye view (from below)

Additionally, clinical photography, captured from sagittal and oblique angles, provides valuable tools for patient education, helping to demonstrate potential enhancement outcomes and aiding in treatment planning.

Clinical Deficiency Assessment

Expert practitioners must assess chin deficiencies across three dimensions to ensure the most effective treatment approach:

  •         Horizontal assessment: Research identifies that the ideal chin profile typically sits 1-3mm behind a vertical line drawn from the vermilion border of the lower lip.
  •         Vertical assessment: The height of the chin should match the proportions of the other facial thirds.
  •         Transverse assessment: It’s important to assess the width of the chin and check for any asymmetry.

Practitioners must also rule out mandibular dimorphism conditions, such as micrognathia (vertical and horizontal mandibular hypoplasia) and retrognathia (retracted mandible relative to the maxilla). These conditions are often present with dental occlusion abnormalities.

It’s important to note that in these cases, dermal fillers may have limited effectiveness, and surgery might be required for more significant correction.

Setting Patient Expectations

Patient satisfaction depends heavily on education and understanding about what chin augmentation can and cannot do. Some of the benefits include:

  •         A non-surgical, temporary solution for mild to moderate chin deformities.
  •         The ability to correct vertical, sagittal, and transverse deficiencies at the same time.
  •         Custom treatment plans based on the patient’s individual goals and priorities.
  •         Three-dimensional chin augmentation with various contours.

However, patients need to understand the limitations of the procedure:

  •         Results are temporary, and maintenance treatments are required to maintain results.
  •         The volume and placement of dermal filler have restrictions and using too much can result in an unnatural appearance.
  •         In severe cases, surgery may be a more appropriate option than dermal fillers.

Clear communication of these expectations, along with before-and-after photos (with consent), helps set realistic goals for the procedure.

Documentation and Consent 

Proper documentation is vital in ensuring that patient care is thorough and consistent. Practitioners should record all assessment findings and treatment plans, including any psychological evaluations. For chin augmentation, it is important to discuss other treatment options, including those from different practitioners, to ensure the patient understands all available choices.

The consent process is equally important and follows strict protocols, which will include, but not limited to:

  • The practitioner performing the procedure must ensure Informed Consent, Financial Consent and Photo Consent is obtained prior to treatment, and a valid prescription is obtained prior to treatment.
  • The patient must understand what to expect/what is involved during and post the treatment
  • Discussions should cover both short- and long-term complications, limitations and potential risks of the procedure.
  • The patient should be informed about the product being used, including the amount administered, as well as the qualifications of both the prescriber and the practitioner performing the treatment.

Selecting the Appropriate Product

Selecting the right product for chin augmentation requires careful judgment. Each product has its own characteristics, making it more suited to specific indications. The patient’s anatomy, the properties of the dermal filler, and the expected results all play a vital role in this decision. Understanding these differences helps practitioners choose the most effective product for each patient’s needs.

  • Facial Structural Definition Needs
  • Thickness of the Treating Area
  • Patient Preference for Longevity
  • Past Experience with Dermal Filler

Common Types of Chin Dermal Filler Products

Common chin dermal fillers include Hyaluronic Acid (HA) Fillers and Calcium Hydroxylapatite (CaHA).

HA fillers typically last between 6 to 24 months and are typically used for their flexibility and reversibility, allowing for refinement in future sessions. They come in varying firmness levels. Firmer gels are used for creating projection and structure, while softer gels support contouring.

On the other hand, CaHA fillers have a longer clinical longevity, typically lasting up to 12 months. These products are often chosen for patients with thicker skin or those looking for pronounced projection, as they offer superior incompressibility and structural support.

Chin Injection Techniques

A variety of injection techniques are used in chin augmentation procedures to address different aesthetic goals and anatomical needs. Over time, most practitioners will develop their own approaches, but there are several standard techniques that are commonly used. These include:

Supraperiosteal Bolus Technique

The supraperiosteal bolus technique is the most commonly used approach for creating chin projection. It involves marking the treatment area with a semi-circle to ensure the ideal width depending on the required outcome. Vertical and horizontal reference lines are then created to evaluate symmetry. The technique involves injecting directly onto the periosteum (the bone surface) at specific points:

  • Pogonion: 0.3-0.4ml at 15-20mm superior to the inferior mandibular border
  • Paragonion: 0.2-0.4ml on each side, close to the inferior border

This technique effectively increases bone volume simulation and adds anterior projection, helping to maintain the chin’s structural support while improving definition.

Linear Threading Method

The linear threading method is used to control chin perimeter contouring and address the prejowl sulcus. In this technique, practitioners use a retrograde linear threading approach along the mandible to soften the pre-jowl sulcus depressions (hollowing of the sides of the chin). Volume is added on the lower side to the chin’s midline, typically between the mandibular ligament and menton on each side.

Cannula vs. Needle Approaches

Both cannula and needle approaches can be used for chin augmentation.

Needles are used to target bone surfaces with greater precision and stability. Practitioners can gently tap the needle to determine the exact location of the bone. However, the risk of vascular occlusion (blockage or narrowing of the blood vessel) is higher with needles (1 in 6,410 syringes) compared to cannulas (1 in 40,882).

Cannulas, typically ranging from 22-25G, are used to minimise potential bruising and trauma. While they require an initial needle entry point, it is usually made laterally to the treatment area in the pre-jowl region, approximately 5mm above the mandibular line.

Depth and Placement Considerations

The depth and placement of the injection can significantly alter the final results.

  • Supraperiosteal injections are used to create a structural chin framework, adding strength and projection.
  • Subcutaneous injections offer smoother transitions and contours, providing a more natural look.

Anterior surface injections help with projection, while apex injections push the chin both out and down. After injection, precise finger movements are often used to evenly distribute the dermal filler. Typically, 1 ml of product is recommended per session for the chin area; however, multiple sessions may be required. The results can last several months.

Managing Complications of Chin Augmentation 

As with any clinical procedure, chin augmentation has certain risks and complications. Not only is it important to communicate this to the patient, but understanding how to recognise and manage these issues is crucial for ensuring patient safety and satisfaction. While serious complications are rare, quick intervention can make all the difference in minimising potential adverse effects.

Common Risks Of Chin Augmentation

  •         Bruising: Bruising can occur as a result of the needle causing small blood vessels to rupture, typically resolving within a week or two.
  •         Swelling: Swelling is common after treatment and usually subsides within a few days to a week, with cold compresses helping to reduce it.
  •         Redness: Redness from the injection site typically fades within a few hours to a couple of days.
  •         Tenderness: Tenderness around the treated area is normal and should lessen within a few days.
  •         Lumpiness: Temporary lumps may form but usually resolves on their own or with a gentle massage.
  •         Scarring: While rare, scarring can occur, but it is minimal in most cases, particularly when aftercare instructions are followed.

Vascular Occlusion

Vascular occlusion is the most serious complication associated with chin augmentation, although it occurs in only about 1 in 6,558 treatments (approximately 0.015%). It is a blockage in the blood vessels, which can disrupt blood flow to the affected area, potentially leading to tissue damage if not promptly addressed. Early recognition is key to preventing permanent damage. Practitioners should be vigilant for the following warning signs during the procedure:

  • Immediate blanching or noticeable colour changes at the injection site and surrounding areas. 
  • Delayed, sluggish or absent capillary return
  • Pain that exceeds the normal discomfort of the procedure
  • Pain while swallowing, which may indicate ischemia in the digastric, mylohyoid, or platysma muscles
  • Livedo reticularis (a bluish, reticulated pattern) extending from the mental crease down to the upper cervical area

If vascular occlusion is suspected, the injection should be stopped immediately and the following steps should then be taken:

  • Apply aggressive massage to the affected area
  • Use warm compresses to help improve circulation
  • Administer hyaluronidase (It is important to note that chin vascular occlusions often require multiple hyaluronidase treatments over several hours for optimal results.)

Addressing Asymmetry and Nodules

Natural facial asymmetry is common, and slight post-treatment asymmetry can occur. Minor corrections may be needed, but it’s important to wait at least two weeks before making any adjustments to allow for swelling to subside.

Nodules may appear immediately after the procedure or develop months later. Immediate nodules are often caused by poor placement or filler clumping and may improve with massage. Late-onset nodules can be inflammatory or non-inflammatory, and the treatment will vary depending on the diagnosis.

Firm, painless lumps typically require mechanical dissolution, while tender or inflamed nodules may be signs of infection, requiring antibiotics or steroid treatment for biofilm management.

Managing Patient Dissatisfaction

Addressing patient dissatisfaction starts with effective communication. Listening to patients and allowing them to express their concerns about the results is essential before proposing solutions. In many cases, dissatisfaction stems from miscommunication or unrealistic expectations rather than technical errors.

Dermal Filler Course at Esteem Academy

Esteem Academy offers a comprehensive non-surgical dermal filler course specialising in lower face augmentation. The program combines online theory with a one-day practical, hands-on training session, giving students valuable experience in key treatment areas such as the chin, marionette lines/pre-jowl sulcus, jawline, DAO, and mentalis.

Throughout the course, students will deepen their understanding of:

  •         Facial Anatomy & Ageing: Understanding the key elements of facial anatomy and the processes of ageing to ensure accurate assessment and treatment planning.
  •         Lower Face Augmentation Techniques: Practical training in advanced dermal filler techniques for chin, marionette lines, jawline, DAO, and mentalis.
  •         Needle & Cannula Injection Methods: Mastery of both needle and cannula techniques to suit various treatment areas and patient needs.
  •         Managing Patient Expectations: Developing skills to effectively communicate with patients and manage their expectations for optimal results.
  •         Advanced Injection Techniques: Learning intermediate and advanced injection techniques to achieve smooth, natural, and balanced aesthetic outcomes.
  •         Complications & Risk Management: Training on how to recognise and manage complications, ensuring patient safety throughout the procedure.

Upon successful completion, students will receive a certificate of completion and a statement of attendance.

Developed and endorsed by Dr Terrence Scamp, the academy prides itself on offering small class sizes (maximum two students) to ensure personalised attention and high-quality training. Students will also gain access to the Complete Face APP, a digital resource focused on facial injectables, as well as hands-on training with real client models.

Conclusion

Mastering chin augmentation requires a thorough understanding of facial anatomy, patient expectations, advanced injection techniques and potential complications. By developing a strong clinical foundation through education and training and continuously refining skills, aspiring injectors can deliver safe, effective, and successful results.

If you want to master chin augmentation, Esteem Academy offers a dermal filler course that provides comprehensive training on advanced techniques for lower face augmentation. Led by renowned cosmetic plastic surgeon Dr. Terrence Scamp, the course combines theoretical knowledge with hands-on practical experience. You’ll gain essential skills in facial anatomy, patient assessment, and injection techniques.