November 16, 2023

Dr Tim Pearce aesthetics expert BOTOX fillers

Complications and side effects from treating chins and jawlines with dermal fillers are much discussed, but recently a rare and strange side effect was shared with Dr Tim Pearce, relating to an unusual case of hair loss post chin dermal filler treatment in a male patient.

In this blog, Dr Tim discusses this unusual complication, breaking down everything you need to understand if you treat the chin and jawline, particularly as this complication only really affects male patients due to the impact on beard hair.

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Case study: dermal filler-induced male beard hair loss on the chin

You may remember in another recent blog – temple lift complication: dermal filler-induced hair loss – that Dr Tim shared details on a paper from Marina Landau et al. who showed that it is possible to cause alopecia with dermal filler in the hairline using the temple lifting technique.

In response to that blog, a patient, and an aesthetic clinician messaged Dr Tim to share a new, but similar complication with him. In this case, the patient, a man in his 30s reported receiving 2ml of Juvéderm Ultra 4 placed into his chin for augmentation. Subsequently, a few weeks later, a patch of hair follicles started to fall out. There was not complete hair loss, but a distinct thinning of the hair was noticeable, directly underneath where the dermal filler was placed.

Dr Tim asked the patient to describe what occurred post-treatment, leading up to the side effects that he experienced, and this revealed an interesting sequence of events. Firstly, there was a degree of tenderness, aching and pain after the procedure, which is potentially normal, and many patients will experience something like this post-chin filler treatment. The skin remained red for some time post-procedure, approximately 6 to 10 days. Then, there was a period where there was a sense of irritation around the skin which initiated itching.

At the two-week point, the patient noticed that some of the hairs in his beard were starting to fall out, and there was an area of thinning, something which only someone who was good at maintaining their beard would notice. The hair loss in his after photographs was rather subtle, but there was a patchiness directly over where most of the filler was placed.

chin hair loss dermal fillers

Dr Tim believes that the origin of the hair loss is pressure caused by the dermal filler, which is decreasing blood flow, not to the point of inducing a necrotic wound to the skin, but just enough to decrease the blood flow to the hair follicles, causing some of them to fall out, and potentially die. This event happened four years ago, and the patient still feels he has not fully recovered.

Of course, this is only one case report, so there is a degree of subjectivity. However, Dr Tim believes that for male patients who are presenting for treatment in the chin and jaw areas, and who have a beard, it may be worthwhile informing them during their consultation that this is a possible side effect.

What causes dermal filler-induced beard hair loss on the chin?

Accepting potential complications and side effects is inevitable, but Dr Tim always explores how aesthetic clinicians can mitigate or decrease the chance of this happening to their patients.

male botox filler treatmentsFirstly, let’s explore why this may happen in the chin. You will notice in some patients that the chin is a rather tight structure which does not allow a lot of space for dermal filler placement. This tightness can also lead to confusion when diagnosing a chin vascular occlusion because it may simply be pressure-related. Pressure in the chin can compress the capillaries and cause a small necrotic wound over time, much like a pressure sore, as distinct from a true arterial vascular occlusion which follows the path of an artery.

Dr Tim believes that like the glabella and the nose, the chin has an ability to build pressure underneath the skin in a way that other facial areas do not. This characteristic is one of the reasons why he is not surprised to see a chin treatment presented alongside hair loss. Hair loss is known to occur due to pressure and has been postulated as a theory for male pattern baldness relating to the tightening of the scalp with ageing. Having noted the published paper by Marina Landau et al. we have seen hair loss with dermal filler underneath the scalp, therefore, it makes sense that pressure could also apply to this complication in the chin. Dr Tim believes that it is much less likely to happen around the lateral jawline beard hair due to the presence of more loose tissue.

How could we prevent beard hair loss from dermal filler treatment to the chin

There are steps aesthetic clinicians can take to decrease the chance of this happening.

Enough interstitial space?

The first important factor – in much the same way as when approaching a non-surgical rhinoplasty procedure – is to gauge how much room there is in the skin before you start adding volume. Feel the chin and how easily the skin moves away from the periosteum and assess if it feels like there is potential space to achieve the desired projection without significantly increasing pressure. Ideally, there should be plenty of loose tissue so that you can increase the projection with the dermal filler without increasing the interstitial pressure because that is directly causal to a decrease in blood flow that could result in hair loss.

Prompt action

The next vital factor is a prompt response to early signs of a complication. If you are planning on performing a treatment like this on a male patient with a beard, Dr Tim suggests that you may want to consider monitoring them a bit more closely in the first week post-treatment. This will allow you to quickly track if they have any signs of itching or swelling that persist for longer than a few days, in which case, it may be reasonable to reverse the procedure (with hyaluronidase).

Gradual augmentation

Another, sensible way to mitigate a problem, and reduce worry for both patient and practitioner, is to enact a gradual treatment plan for the patient. This will allow you to build up the chin more slowly, adding small volumes, and increasing over time to achieve the desired, augmented result. This gives you a bit more leeway to respond to each incremental treatment as performed and potentially provides a chance for the blood supply in the area to accommodate slightly before you get a negative sequela.

Get more insights on the subject with Dr Tim:

Dr Tim is always keen to hear about the experiences of his followers. So, if you have any questions, case studies, or discussion points for him, you can find Dr Tim Pearce on Instagram

Aesthetics Mastery Show

New injection complication affecting men – chin hair loss after jaw filler

Dr Tim says:

“I was recently sent a message by a clinician who had suffered an unusual side effect from dermal filler injections in the chin/jaw area. This is a very interesting case that has a lot of info to digest. In this episode I’ve broken everything down so that you can understand the cause of this complication, and how to avoid it.”

Watch the full Aesthetics Mastery Show here.

The video has received a variety of comments and feedback from subscribers and viewers on the YouTube channel, including the following comments:

@auricabisiani2391 said:

“Thank you Dr. Tim! Very good information for us to watch out. “

@anas.moheno71 added:

“Great info Dr. Pearce! Avoid large hyaluronic deposits it’s key”

Read more comments and join in the debate on our YouTube channel.

You can also subscribe to our YouTube channel for really useful regular tips and advice.  YouTube

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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.

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