Advances in Cosmetic Surgery 8 (2025) 61–67
ADVANCES IN COSMETIC SURGERY
Chin Augmentation
Arianna Strome, MDa, Alexa B. Steuer, MD, MPHb, Susruthi Rajanala, MDb,
Jeffrey S. Dover, MD, FRCPCb,c,d,*
a
The Ronald O. Perelman Department of Dermatology at NYU Langone Health, 240 East 38th Street 11th and 12th Floors, New York, NY
10016, USA; bDepartment of Dermatology, SkinCare Physicians, 1244 Boylston Street, Chestnut Hill, MA 02467, USA; cDepartment of
Dermatology, Yale University School of Medicine, New Haven, CT, USA; dDepartment of Dermatology, Brown Medical School, Providence,
RI, USA
KEYWORDS
Chin augmentation Dermal fillers Hyaluronic acid fillers
KEY POINTS
The appearance of the chin plays a key role in overall facial balance.
Traditional procedures, such as chin implants, osseous genioplasties, and autologous grafting, may augment the
appearance of the chin; however, they are invasive and associated with risks and down-time.
Hyaluronic acid fillers are a safe and well-studied treatment to optimize chin dimensions and alignment.
While injection techniques vary, most injectors target the pogonion, menton, and prejowl sulci for an overall positive
augmented effect.
INTRODUCTION Anatomic Considerations
The chin is one of the key features for overall facial The bony anatomy of the chin is defined by the underly-
appearance and symmetry [1]. Appearance of the chin, ing mandibular structure [4]. This provides the backbone
and its relationship to and proportionality with sur- for the anatomic planes of the chin, including projection,
rounding facial structures and to the neck are para- height, and width. The pogonion is the most anterior-
mount to overall aesthetic balance [2]. Patients may projecting portion of the chin [3,5]. The height of the
present with concerns, for example, of a large nose, sag- chin is defined by the menton, the most inferiorly
ging neck, or jowls, failing to recognize the deficiency is projecting skeletal portion of the chin [3,5]. The
lack of proportionality and alignment of the chin [1,3]. midpoint between the pogonion and the menton is
Herein, we will review the considerations and current the gnathion [3]. The paragonion protrudes on the
practices for chin augmentation. We include a brief lateral sides of the pogonion and defines chin width
overview of surgical techniques such as alloplastic im- [5]. These surface landmarks that define the chin
plants, autologous grafts, and osseous genioplasty and compartment demarcate it from the jowl and submental
have focused on less invasive approaches, namely compartments [3]. The muscles of the chin include the
dermal fillers, for a more in-depth discussion of proce- depressor anguli oris, depressor labii inferioris, and the
dural technique. centrally paired mentalis. The mental arteries serve as
*Corresponding author. SkinCare Physicians, 1244 Boylston Street, Suite 103, Chestnut Hill, MA 02467. E-mail address:
jdover@skincarephysicians.net
https://doi.org/10.1016/j.yacs.2025.01.006 www.advancesincosmeticsurgery.com
2542-4327/25/ © 2025 Elsevier Inc. All rights are reserved, including those for text and data mining, AI training, and similar
technologies. 61
62 Strome et al
Silicone implants, which are frequently used, can be
ABBREVIATIONS associated with bone resorption, as well as dental
3D 3-dimensional
erosion depending on its placement [6]. This may be
obviated through fixation to the bone with a screw to
ACRS Allergan Chin Retrusion Scale
prevent motion at the interface of the bone and
HA hyaluronic acid
implant. Over time, there is a low risk of malposition-
ing and displacement of the implant. Overall, however,
when executed and secured properly, there is a very low
complication rate for solid silicone implants.
Osseous genioplasty
Osseous genioplasty is a surgical technique that can
address complex deformities of the chin, with the abil-
ity to augment all planes including projection, height,
and width [11]. It affords a permanent solution to
microgenia [11]. This procedure involves an osteotomy
with intraoperative chin advancement and fixation with
metal hardware in order to reapproximate the chin
[11]. When compared with the alloplastic implant, an
osseous genioplasty is a more invasive, complex tech-
nique with longer recovery time [1,6]. In addition to
the invasiveness of this approach, the complexity of
the procedure lends itself to being less commonly per-
formed [1,6,11].
Anatomic Considerations in Chin Augmentation
the primary blood supply to the chin, exiting via the Autologous grafts
mental foramina on the lateral chin at the second Autologous grafts may also be used in the correction of
bicuspid [3]. The inferior labial artery, labiomental ar- chin deformities. Bone grafts may be obtained for
tery, and submental artery also provide anastomotic arte- augmentation purposes if patients are undergoing an
rial supply [3]. Finally, the inferior alveolar nerve which additional procedure. Fat grafting may be performed
travels through the mandible and exits as the mental as a single intervention or adjunctive to an alloplastic
nerve provides the primary innervation to the chin and implant or osseous genioplasty [6]. Fat grafting offers
lower lip [1,3]. the ability to augment the chin in all 3 planes, however,
patients with significant retrognathia are not good can-
didates. This is because excessive volume correction, for
Options for Chin Augmentation example, a projection change greater than 3 to 5 mm,
Alloplastic implant can lead to chin ptosis [12]. The less invasive nature
Alloplastic surgical chin implantation has been cited as has increased attractiveness to patients; however, the
the most studied technique of chin augmentation [6]. It procedure can fail to produce reliable outcomes due
is well-suited for addressing inadequate chin projection; to variable graft survival [3,11,13]. In addition, a pro-
however, it is a suboptimal option for patients without spective study reported a 17.7% mean fat resorption
adequate chin height or with chin asymmetry [1,7]. The rate at 6 months, regardless of what fat volume was
procedure is safe and offers a permanent surgical option injected [6,13]. Therefore, it is not a permanent solution
for chin augmentation [7,8]. Various materials may be and if used alone, will require patients to undergo
used, available in different sizes and readily customiz- repeated treatments over time.
able to fit patient characteristics. For example, custom-
ized 3-dimensional (3D) printed implants are options Dermal fillers
to address mandibular asymmetries, though they may According to the American Society for Plastic Surgery,
come at a higher financial burden. It is, nonetheless, surgical chin augmentations are down 38% compared
an invasive surgical procedure, carrying risks of surgical with the year 2000 [3]. Although the reasons for this
intervention including hematomas, scar, hypergranula- decline are multifaceted, in part, it is likely attributable
tion for oral incisions, dehiscence, and infection [9,10]. to the increasing popularity of less invasive modalities,
Chin Augmentation 63
such as dermal fillers [3,5,6,14]. Dermal fillers are able to be used to evaluate ideal chin projection. The Gonzalez-
shape the chin in all 3 planes thus treating chin retrac- Ulloa line, for example, is a vertical line that extends
tion, horizontal and height deficiencies, and asymmetry. from the nasion downward, perpendicular to the Frank-
While various dermal fillers are available, hyaluronic furt plane (a line from the inferior orbital rim to the su-
acid (HA) fillers are especially popular, as they offer perior margin of the external auditory meatus) [4]. The
the benefit of being a simple outpatient procedure, and ideal chin projection according to this evaluation
reversibility in the event of complications or patient should meet or fall just short of this line [3,4]. A simpler
dissatisfaction. Furthermore, an added benefit of fillers method describes that for men, the chin pogonion pro-
is the ability to trial augmentation of the chin in a non- jection should be in line with the lower lip vermillion
permanent fashion to preliminarily assess the esthetic ef- border, whereas in women, it should be 1 to 2 mm
fect prior to a permanent implantation. Dermal fillers behind the lower lip vermillion border [2,3]. With re-
also often come at a lower financial burden to patients gard to width, the ideal proportions for women are in
as compared with surgical interventions. While fillers line with the width of the medial canthi, and for men
are designed to last up to 2 years, in our experience are in line with the oral commissures [3]. Regarding
chin filler often lasts much longer [6]. Filler injections chin height, the ideal facial alignment should be
are generally safe and well-tolerated, with adverse effects divided into equal thirds: hairline to nasion, nasion to
mainly limited to pain, redness, bruising, and swelling subnasale, and subnasale to menton [2,3].
which subside within several days of the injections In addition to anatomic considerations, a detailed
[14,15]. Severe reactions are rare and will be elaborated history, including clinical history, past trauma, ortho-
on further below. dontic treatment, or oral surgery is essential. History
of any prior injectable treatments and response to treat-
ments should also be elicited [3,17]. Clinicians should
TREATMENT SELECTION also inquire about any upcoming dental procedures or
Advantages and disadvantages exist for each of the procedures that may have occurred in the preceding
options for chin augmentation. Ultimately, treatment week, as some recommend postponing injections to
selection is influenced by both the practitioner’s evalu- minimum 1 week, and sometimes 2 weeks, from any
ation of the patient, comfort with various procedures, dental procedures.
and the patient’s individual desire. Facial and plastic
surgeons, for example, may be more accustomed to Prep and Patient Positioning
alloplastic chin implants, whereas dermatologists are Prior to injection, any makeup should be removed.
more apt to recommend soft tissue fillers [16]. This, Topical anesthetic cream may be applied, if the patient
combined with a patient’s tolerance for down-time desires, 30 to 40 minutes prior to injection; however, is
and/or willingness to undergo a surgical procedure not a necessity for all patients. A semirecumbent position
requiring general anesthesia, should be considered may be comfortable for patients, as well as provide a pos-
alongside the anatomic considerations and specific terior support for the head throughout the procedure, in
chin deformity when electing the appropriate augmen- order to minimize movement. The areas to be injected
tation technique [16]. should then be carefully cleansed with an antiseptic
solution (such as chlorhexidine or isopropyl alcohol).
PROCEDURAL TECHNIQUE: INJECTABLE Procedural Approach
FILLERS The selection of the filler used should allow for both
Preoperative Planning structural support but also appear natural with muscular
A full evaluation of the chin includes its relation to the contraction [18]. An ideal filler for the chin has a high G
nose, lips, teeth, and neck, as well as all components of prime (G0 ) to improve shape in 3D proportions but also
skin and supporting skeletal, muscular, and soft-tissue flexibility to conform to facial movement [2,16–18]. G
structures [3,16]. Physical examination should include refers to the firmness or elasticity of the filler, and prod-
facial evaluation both at rest and in motion [3,16,17]. ucts with higher G0 tend to recoil to their original shape,
Photographs of at least 3 views should be obtained, which allows for structural integrity in this location [19].
including the profile bilaterally, oblique views bilater- Currently, the Food and Drug Administation (FDA) has
ally, and a frontal view [16,17]. The chin itself should approved 2 dermal fillers for use in the chin—Juvederm
be evaluated in all anatomic dimensions of projection, Voluma XC (Allergan plc, Dublin, Ireland) and Resty-
height, and width. There are several guidelines that can lane Defyne (Galderma, Uppsala, Sweden) [20].
64 Strome et al
There are many different approaches to chin augmen- for chin augmentation found overall high patient satis-
tation with filler, and ultimately, the injector’s prefer- faction among 917 patients included across all studies,
ence and practices will influence product selection, as with a relatively low complication rate [14].
well as injection technique. Centrally, filler injections Vanaman and colleagues described their experience
into the chin are performed in a layer deep to the with high-viscosity HA dermal fillers (Restylane Lyft;
mentalis muscle, usually with a bolus technique using Galderma SA, Lausanne, Switzerland; Juvederm Voluma
a needle, as opposed to a cannula. Several smaller supra- XC, Allergan, Inc, Parsippany-Troy Hills, NJ, USA), in
periosteal depots injected lateral to the midline to addition to calcium hydroxyapatite fillers (Radiesse
both round out the chin, as well as create a smooth tran- (1), Merz North America, Inc, Raleigh, NC, USA) in a re-
sition are also commonly performed [2,3]. The prejowl view of chin augmentation [3]. Their techniques
sulcus can be addressed with subdermal fanning of employed no more than 1 to 2 mL of filler total with
the filler, either with a needle and massage, or with can- supraperiosteal injections performed with a needle in
nula [3,5,17,18,21–23]. Manual molding frequently the midline, several smaller supraperiosteal depots
throughout the procedure for further shaping of the lateral to the midline to round out the chin. Cannula
area being treated is often recommended [17,24]. Care was employed if softening of the prejowl sulcus was
should be taken to avoid the mental foramen, through necessary [3].
which the mental nerve, artery, and vein traverse, which One study aimed to assess the use of a chin and
can be found approximately 1.5 cm superior to the jawline grid as a guide to nonsurgical treatment with
mandibular border in line with the first and second pre- a high G0 , high cohesivity filler. In addition to the
molar [24]. In addition, when injecting in the peri-jowl grid guideline, this study employed cannula technique
region or on the mandibular body, care should be taken among 30 patients, injecting 0.1 to 1.5 mL of filler in
to avoid the facial artery [17,22]. One must be mindful the chin apex, 0.3 to 0.7 mL to the labiodental sulcus,
that the facial artery crosses the inferior border of the and 0.1 to 1.5 mL along the jawline. Ninety-six percent
mandible anterior to the insertion of the masseter, of patients rated their appearance after treatment as
running deep and branching into the superior and infe- “much improved” or “very much improved” [22].
rior labial arteries [3,17,22]. In the area of the lateral In another international study, Chen and colleagues
jawline, it can be avoided by injecting in a subdermal employed a stepwise specified injection technique using
plane [22]. a high elasticity HA injectable for chin augmentation. In
this retrospective study among 326 patients, HA filler
Immediate Postprocedural Care was first injected supraperiostially at the paragonion
While injecting and immediately afterward, it is impor- close to the inferior border of the mandible and roughly
tant to observe the color of the skin. Indications of an perpendicular to the nasal alar or medial canthus with a
abnormal reaction might include sudden pain, local 27-gauge needle [5]. This was followed by needle bolus
blanching, or livedo. In any of these instances, injec- at the pogonion. Finally, a 25-gauge, 3-cm cannula,
tions should be stopped for rapid reassessment and and fanning technique were used at the junction of the
intervention. Otherwise, firm pressure, with a folded pogonion, menton, and paragonion to increase volume
gauze and flat palm, may be applied to the injection and smoothen [5]. Similarly, for individuals with a pre-
area to control any mild local, pinpoint bleeding. jowl sulcus, a cannula was used to inject filler for soft-
Cold compresses may be applied for pain relief and to ening. In this study, with a mean injection volume of
minimize bruising [5]. Patients should be made aware 1.85 mL of HA filler, the shape and contour of the
that bruising and swelling may occur, in addition to a chin was significantly improved in all patients with dura-
sensation of soreness in the area, sometimes pro- ble improvement at 6-month follow-up by the authors.
nounced with mastication when injecting on or near Beer and colleagues aimed to assess the effectiveness
the jawline. This will typically resolve within several and safety of VYC 20-L (Juvederm Voluma XC; Allergan
days to 1 week. plc, Dublin, Ireland) to address volume deficit and retru-
sion in the chin and prejowl sulci using an evaluator-
blinded delayed treatment-controlled study design
CLINICAL RESULTS IN THE LITERATURE [23]. Assessments were performed at 6 months and
There is a relative paucity of comparative evidence be- 12 months, including both treatment-blinded investi-
tween the various modalities of chin augmentation, gator and participant assessments and self-assessments.
and among the different injectable fillers. A recent sys- 27G one-half -inch needles were used for supraperiosteal
tematic literature review examining studies of HA filler and/or subcutaneous injections into the pogonion,
Chin Augmentation 65
menton, and prejowl sulci, along with 25G 1.5 inch can- determined through computer-facilitated programmed
nulas in the menton and prejowl sulci. Almost all pa- image analysis comparing the mean change from base-
tients (99.3%) were treated at the pogonion, 77.8% at line between treatment and controls in the glabella-
the menton, and 87.5% at the prejowl sulci, with an subnasale-pogonion angle. Secondary effectiveness was
average treatment volume of 2.6 mL for initial treatment, esthetic improvement as rated by investigators and sub-
and 1.4 mL for follow-up treatment. Injection volumes jects using the Global Aesthetic Improvement Scale
were similar among treatment and nontreatment partic- (GAIS) as well as 3 Facial Appearance, Quality of Life,
ipants. Participants were deemed responders if they had and Adverse Events (FACE-Q) scales. Among 90 subjects
at least a 1-point improvement in their Allergan Chin in the treatment group and 29 subjects in the control
Retrusion Scale (ACRS) score, which was observed in group, treatment characteristics were similar with nearly
56.3% of the treatment group at 6 months (P5.0019). all receiving initial treatment at the pogonion, mentum,
The evaluating investigators rated 91.2% of participants and prejowl sulci and 76% receiving treatment at the
as “improved” or “much improved” in the treatment sublabial crease. Treatment volumes were also similar
group at 6 months with durable results at 12 months. in both groups with 2.28 mL in the treatment group on
Approximately 87% of participants in the treatment average at initial treatment, and 1 mL at 1-month
group rated themselves as “improved” or “much touch-up on average. The mean change in the glabella-
improved” at 6 months [23]. subnasale-pogonion angle was 2.12 in the treatment
Marcus and colleagues employed similar methods to group compared with 0.38 in the control group at
assess Restylane Defyne (Galderma, Uppsala, Sweden) month 3, and this gradually declined over time in both
for augmentation and correction of chin retrusion groups but remained 1.28 at 12 months for the treat-
[18]. In this randomized, evaluator-blinded, parallel ment group. Over 90% of subjects had improved/
group, nontreatment-controlled study across 11 centers, much improved GAIS scores and responses on FACE-Q
107 patients with mild to moderate chin retrusion were Satisfaction and Psychological Well-Being Scales [21].
treated, with 33 nontreatment controls. Follow-ups Overall, while comparative studies are lacking, pub-
were performed at 3 days, 12, 24, 36, and 48 weeks after lished data show safety and efficacy of high G0 filler tar-
treatment. Injections were performed using a 27G one- geting the pogonion, menton, and pre-jowl sulci to
half inch needle with the investigator’s chosen tech- smoothen the chin and improve retrusion. Further
nique. Responders were participants with a greater large-scale and comparative trials are needed to help
than 1-point improvement from baseline on the Gal- further guide technique and product selection.
derma Chin Retrusion Scale and esthetic improvement
was also assessed using the Global Aesthetic Improve-
ment Scale by evaluators and patients alike. The mean POTENTIAL COMPLICATIONS AND
total volume injected was 3.6 mL including initial treat- MANAGEMENT
ment and 4-week touch up. Injections at both the Common complications encountered with dermal
pogonion and the surrounding areas were performed fillers include injection site reactions such as bruising,
using both serial puncture and/or linear retrograde, swelling, pain, and erythema [3,5,14]. Across these
and specifically at the pogonion, supraperiosteal depot studies in the literature, the majority of patients experi-
technique was used, with a mean treatment volume of enced mild to moderate injection site reactions immedi-
1.67 mL. Eighty-one percent of the treatment group ately following the injection, such as some tenderness at
were rated responders at 12 weeks (P<.001), with high the site, and less frequently erythema or swelling
patient satisfaction rates. Ninety-six percent of treat- [5,18,21–23]. A minority of patients experienced asym-
ment participants remained improved at 48 weeks. [18]. metry following filler injections, which can be addressed
A prospective, single-blinded, randomized controlled through filler correction of asymmetry and/or neuro-
study across 10 international sites was performed to toxin injections into the mentalis. This may improve
assess the safety and effectiveness of VYC-25L (Juvederm the esthetic appearance and also the longevity of the filler
Volux; Allergan plc, Dublin, Ireland) in restoring and [5]. Treatment-related adverse events, such as delayed
creating facial volume in subjects with chin retrusion nodules, and more rarely infection, have been cited in
[21]. Treatments were performed using a 27G 13 mm a handful of patients [21,23]. When present, hyaluroni-
needle according to investigator’s evaluation and tech- dase can be used for delayed-onset nodules and as
nique. Subjects were seen at 1, 3, 6, 9, and 12 months shown improvement [21].
for safety and effectiveness visits and 3 and 14 days for Serious complications are rare; however, the most se-
safety visits. Here, the primary effectiveness was vere potential risk of injections is vascular compromise
66 Strome et al
either secondary to intra-arterial injection, injection-
or Contour, and Juvederm Voluma or Volux offer the
related edema, or arterial compression [25]. Although
necessary firmness and structure needed to support
exceedingly rare, it has been reported to occur on several the chin.
occasions [12,26–28]. Risk of vascular compromise can
be mitigated by periosteal injections and careful consid- Chin filler treatments are tolerated well overall, with
eration of the anatomy, particularly near the mental fo- swelling and bruising being the most common
adverse events. While rare, vascular occlusion must
ramen, while the chin is not considered a high risk area
be promptly identified and managed.
traditionally, there can be considerable variation and
While clinical studies evaluating filler overall show ef-
anastomoses in this region and prompt recognition
ficacy and high treatment satisfaction, further large-
and management of occlusion are essential [26]. This scale comparative studies are needed to elucidate
should be addressed with the injection of the area product choice and ideal treatment techniques to
with ample hyaluronidase, and simultaneous massage, enhance esthetic outcome and minimize risks.
warm compresses, and possibly topical nitroglycerin
[5,25]. The patient should be continuously assessed un-
til the color and pain improves in the region, as repeat
cycles of hyaluronidase injections, massage, and topical DISCLOSURE
therapies may be necessary. It may be beneficial to have Dr J.S. Dover is a consultant to Revance, AbbVie and
the patient remain in the office for at least 30 minutes to Galderma and the SkinCare Physicians research depart-
be re-evaluated and confirmed safe by the physician ment has had research funded by AbbVie, Revance,
before they leave [5]. and Galderma.
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