January 9, 2023

Chin Ultrasound Dermal Filler Complications

The chin can be a tricky area of the face to treat, primarily due to prominent arteries; although, it is very easy to augment one area of the chin and subsequently change the aesthetic, harmony, or angle of another area of the jawline.

In this blog, Dr Tim Pearce will explain the anatomy of the chin, injection techniques for augmenting the base of the chin, including how to safely inject so you can augment it properly.

Do you feel anxious about causing complications? Many clinicians feel so overwhelmed with the thought of causing a vascular occlusion that it stops them growing their aesthetics business. Dr Tim is currently hosting a webinar series to help you overcome your fear of complications so that you can uplevel your knowledge, and increase your CPD-certified learning to build a successful aesthetics business. Sign up here >>

Why is the chin important to the face?

Dr Tim likens chins to the ‘cherry on the top of the cake’ – in this case, the bottom of the face – providing important structure and support to showcase the beauty of the eyes and the rest of the face.

Chins are one of the most important elements to overall face shape, particularly in females, giving a heart-shape to the face. Similarly, in males, the chin provides a masculine, strong jawline structure. He notes that they are very different to inject, when treating a man versus a woman, although there are some commonalities in the approach; and small variables can make significant differences when injecting the chin in either sex.

As a person ages, the chin tends to become a softer part of the face. It starts to rotate upwards, and the jowls compete with the chin, resulting in a rounder structure where the chin is less dominant and facial structure and support is somewhat lost as proportions change.

This is where cosmetic treatment and aesthetic injectors can help to restore and maintain the lost proportions to improve the overall beauty of the face by augmenting the chin appropriately.

What are the differences between male and female chins?

The male chin is wider than the female, typically being as wide as the mouth and thus squarer. The female chin often comes down from the corners of the mouth to a single point, whereas a male chin often has two points in line with the corners of the mouth.

Knowing this difference is one of the simplest ways to masculinise or feminise a face.

Why can it be difficult to inject the chin?

Dr Tim dermal fillers trainingDr Tim believes that the chin is one of the most difficult places to inject for aesthetic practitioners. This is not because the individual injections are especially difficult or because of risk, but because you are changing multiple planes and dimensions at once, which can all go horribly wrong.

If you consider various other areas of the face, you can get away with a slightly two-dimensional approach to treatment, but the chin is the meeting point of multiple surfaces of the face, thus as you augment in one direction, and particularly if you are at the early stages of your experience, you can alter another dimension in a less favourable way – Dr Tim calls this the Rubik’s Cube problem. If you correct one thing, it throws something off somewhere else, just like aligning coloured blocks on the famous puzzle.

With the female face, for example, we know that there are planes coming from all directions that converge at one point. Thus, a female patient with a small chin, from a frontal view, could be augmented going down and out at the same time. However, this could make their chin appear too strong from the side, a common mistake according to Dr Tim.

Similarly, the augmentation may look great in profile, but when viewing the frontal angle, the chin may be too long or have a bump at the bottom, misaligning the facial proportions. These mistakes come from the complexity of trying to augment the chin congruently with all the planes of the face and doing so simultaneously.

A simple tip from Dr Tim is to look at your patient from all angles as you make your decisions to treat further, rotating around them to get the three-dimensional view in between your injections. Think about the planes that you are correcting – what is good already about the chin – and the aesthetic area that you are trying to augment. Are you trying to project or elongate the chin or achieve something somewhere in between? Usually, it is the latter.

What are the vascular risks associated with injecting the chin?

When approaching the chin with dermal filler injections, there are two arteries to consider – the submental artery that curves underneath the mentum, eventually curving up to supply the anterior part of the chin, and the mental artery which supplies a similar area a little higher up.

Dr Tim regards the submental artery as the primary risk in this area. It is a large vessel that curves into the chin; thus, you can cause blockages (or vascular occlusions) affecting both the chin and parts of the neck. The arteries tend to be on the lateral side, rather than the middle, but that is not a certainty, and Dr Tim has seen anatomical anomalies. They tend to not be on the bone, being a little more superficial in the fatty area, as is common with most arteries; however, this is also not a given, and aspiration is advised. When augmenting the chin, it is common to use large volumes of dermal filler which makes chins a slightly riskier area for injection than many aesthetic practitioners would suspect.

Limited edition arterial blood supply anatomy posters are available to buy for your aesthetic clinic as a helpful tool to understand the paths of the facial vasculature.

It is acceptable to use either needle or cannula when augmenting the chin, says Dr Tim. He likes to use cannulas to reduce the total risk of vascular occlusion when injecting various areas of the face. However, the downside is that cannulas result in more superficial placement and the filler will work better in augmenting the chin if it is placed deeper to give more stability and to emulate bone. Thus, his preference is a needle for chin augmentation.

How to inject on the bone for chin augmentation

Having a good understanding of where your needle is when you are injecting on the bone is at key element of mastering the techniques for chin augmentation, explains Dr Tim. Are you on the anterior surface of the bone, the inferior surface, or aiming for the apex?

The apex is the greatest curvature of that surface. Think about dermal filler sitting on the bone. As you are injecting, it can only push away from that structure, and the overall structure, position, and direction of that surface will dictate the direction of the augmentation with the filler. If the filler is on the apex, it will push the chin out and down, versus on the anterior surface where it will push it out for projection only, or on the inferior surface where you see elongation only.

Dr Tim likes to perform gentle taps with the needle because he believes that with practice you can tell very accurately which surface you are on – are you skidding upwards, downwards, or sat plum in the middle of the bone where it feels much more stable?

All these tips and tricks from Dr Tim will give you more confidence when injecting the chin to achieve the aesthetic result that you want.

For more on chin augmentation, why not read how to avoid causing a vascular occlusion with chin fillers. You can find Dr Tim Pearce on Instagram if you have any further questions or comments about chin anatomy and augmenting the chin with dermal fillers.

Is your worst nightmare causing a VO?

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Aesthetics Mastery Show

Nasolabial fold advice

In this episode, Dr Tim discusses the instances in which you need to use Botox vs Dermal Filler and shares his top tips for producing great results and staying safe when injecting this area. Watch the full Aesthetics Mastery Show here.

The show has already been watched over 10k times and has generated over 30 comments from practitioners, including:

Dandeli0n said:

“I love how you explain about the differences between using a cannula and a needle. Thank you. You touched on filler and Botox for the nasalabial fold. How about using biostimulators to generate own collagen instead? In my understanding, filler to the peri-oral area get metabolised very quickly as it is a higher movement area. Would love your thoughts on this.”

Dr Tim’s Clinical Advisor, Mary replied:

“Bio stimulators can be very powerful however we like to sleep at night. Biostimulators such as calcium hydroxylapatite (radiesse) are a non dissolvable product and should a complication arise such as vessel occlusion you are increasingly  restricted when trying to restore blood flow. Non filler bio stimulation such as microneedling we can get on board with!

In a separate discussion, Amanda Corrao asked:

“Since certain products are going to be best deep and for lift such as in the pyreform aperture and others are better more superficially along the fold as it extends towards the oral commissure..do you recommend your patients use multiple products in one session for best results? And if so do you find hesitancy on the cost of that?”

Tim’s Clinical Advisor, Mary replied:

“If doing a other treatment using different viscosities of filler yes it would be better to have a more dense filler deep and a softer one more superficial. But most prefer just one syringe we find that volift by juvaderm works good at different depths. Also Teosyal dynamic but strong fillers like rha3 and 4 work good too. Just not too superficial.”

Read more questions and answers or join in the debate on our YouTube channel.

Filler Complications eLearning Courses

If you want to increase your confidence by learning how to handle complications, Dr Tim Pearce offers two comprehensive courses that are highly rated by our delegates:

Both give CPD and certificates on completion.

In addition, browse our FREE downloadable resources on complications.

Dr Tim Pearce eLearning

Dr Tim Pearce MBChB BSc (Hons) MRCGP founded his eLearning concept in 2016 in order to provide readily accessible BOTOX® and dermal filler online courses for fellow Medical Aesthetics practitioners. His objective was to raise standards within the industry – a principle which remains just as relevant today.

Our exclusive video-led courses are designed to build confidence, knowledge and technique at every stage, working from foundation level to advanced treatments and management of complications.

Thousands of delegates have benefited from the courses and we’re highly rated on Trustpilot. For more information or to discuss which course is right for you, please get in touch with our friendly team.

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