Rare Chin Filler Complication: Pressure-Induced Beard Hair Loss in Male Patients

If you treat chins and jawlines with dermal fillers, particularly in male patients, this article is essential reading. A rare but important complication has recently been identified that could affect your bearded male clients following chin augmentation procedures.

An Unusual Side Effect of Chin Filler Treatment

Recently, details emerged about a patient and clinician case report describing an unusual complication following chin dermal filler treatment. The patient, a man in his 30s, received 2ml of Juvederm Ultra 4 placed into his chin for augmentation. A few weeks following the procedure, something rather unexpected occurred: a patch of his beard hair follicles started to fall out.

The patient didn’t experience complete hair loss, but he noticed a distinct thinning of the hair directly underneath where the dermal filler was placed. For someone who maintained an immaculate beard, this change was immediately apparent. In the after pictures, there is a patchiness directly over where most of the filler was placed, though the effect is rather subtle.

The Timeline of Symptoms

When asked about his experience, the patient described an interesting sequence of events that led up to this complication:

Immediately Post-Procedure:

• A degree of tenderness, aching and pain (potentially normal for many chin filler patients)
• The skin remained red for approximately 6 to 10 days after the procedure

Days 6-10:

• A period of itching and a sense of irritation around the skin

Week 2:

• The patient noticed some of the beard hairs starting to fall out
• A distinct area of thinning became visible

Understanding the Mechanism Behind Beard Hair Loss

The hypothesis for what is happening in this case is that pressure caused by the filler is decreasing blood flow. Importantly, the blood flow isn’t decreased to the point of causing a necrotic wound to the skin, but just enough to decrease the blood flow to the hair follicle, causing some of those hair follicles to fall out and potentially die.

Although this event happened four years ago, the patient still feels he has not fully recovered. While this is only one case report and there may be a degree of subjectivity involved, it’s worth considering informing all patients with beards about this potential complication prior to chin filler treatment.

Why Does This Happen in the Chin?

The chin has unique structural characteristics that make it susceptible to this type of complication:

The Tight Structure of the Chin

In some patients, the chin is a rather tight structure that does not always allow for a lot of space. This was first noticed during a case that appeared to be a chin vascular occlusion but was actually just pressure – pressure in the chin itself had compressed the capillaries and caused a small necrotic wound which recovered well. However, it didn’t look like a true arterial vascular occlusion which follows the path of an artery; it looked more like a pressure sore.

The chin is different for this reason. Similar to the glabella and the nose, the chin has a particular ability to build pressure underneath the skin in a way that other areas don’t. This is one of the reasons why it’s not surprising to see a chin complication presenting alongside hair loss.

The Connection Between Pressure and Hair Loss

Hair loss is something that happens with pressure. It’s one of the theories for baldness generally – that the scalp gets tighter as you get older. Since hair loss has now been observed with dermal filler underneath the scalp (as demonstrated in Marina Landau’s paper on the temple lifting technique), it makes sense that pressure could also apply in the chin.

This complication is much less likely to happen around the lateral jawline where there’s more loose tissue. That’s why we haven’t seen it reported in that area before.

How to Prevent Pressure-Induced Beard Hair Loss

There are several steps clinicians can take to decrease the chance of this complication occurring:

1. Assess Available Space Before Treatment

One of the most important lessons from non-surgical rhinoplasty is how crucial it is to gauge how much room there is in the skin before you start adding volume. With a nose, for example, you pinch and see if the skin moves easily away from the periosteum.

Something similar could be applied with the chin – feel the periosteum and the skin around the chin area. Does it feel like a potential space, or are you going to have to increase pressure significantly to get the projection that you’re after?

What you’re looking for ideally is plenty of loose tissue so that you can increase the projection without increasing the interstitial pressure, because that’s the bit that causes decrease in blood flow that could cause the hair loss.

2. Respond to Early Warning Signs

If you’re going to do a chin filler treatment on a patient with a beard, you may want to consider monitoring them more closely in the first week. If they have any signs of itching or swelling that persists longer than a few days, it may be reasonable to reverse that procedure.

3. Build Volume Gradually Over Time

The step before reversing, which would be even better,  is to do things more gradually. The clinician who sent this case report said that due to his experience, he likes to build chins up slowly over time. This is a very sensible way of approaching chin augmentation if you are worried about this complication.

Small volumes increased over time until you get the result gives you more leeway to respond to what you see on the day. It also potentially gives the blood supply the chance to accommodate slightly before you get a negative sequelae.

The Bigger Picture: Pressure-Independent Vascular Complications

This case is actually exactly the same problem as Marina Landau demonstrated in her case report with the temporal lifting technique. In that paper, she demonstrates that pressure independent of a vascular occlusion can cause hair to fall out.

What this chin filler case report also demonstrates is that this could apply wherever there is hair. The chin is another part of the face where there’s quite a tight connection with the skin and there isn’t a lot of room – that’s why it’s happening in chins as well potentially.

Key Takeaways for Aesthetic Practitioners

The take-home message for practitioners treating male patients with chins and jaw lines:

1. Consult male patients with beards about the possibility of beard hair thinning before chin filler treatment
2. Don’t make too big a deal of this complication – although it’s strange, it is also mild, presenting as light patchy hair loss
3. Assess tissue laxity before treatment by feeling how easily the skin moves away from the periosteum
4. Monitor patients closely in the first week post-treatment, especially if they report itching or persistent swelling
5. Build volume gradually using small volumes over multiple sessions to allow blood supply accommodation
6. Consider reversing with hyaluronidase if early warning signs appear

You can probably reduce the chance of this complication by taking the preventative steps discussed: assessing space before treatment, responding to early signs, and building chins gradually over time.

Ready to master the most common complications so that you can 10x your injecting skills and confidence? 

Register here for my next free webinar >

Aesthetics Mastery Show

New injection complication affecting men! Chin hair loss after Jaw filler

Watch the full Aesthetics Mastery Show here.

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

Anatomy360 - The Ultimate 3D Anatomy Course

Understanding facial anatomy is crucial for precise filler placement and achieving natural, balanced results. Knowledge of anatomical structures and vascular supply not only helps in avoiding complications but also enhances the overall effectiveness of treatments.

Dr Tim Pearce's anatomy course delivers a thorough understanding of facial anatomy through 12 online lessons. Tim says:

“The problem is we’re taught anatomy in 2D textbooks, but real-life anatomy isn’t flat. In order to feel confident with injecting and to get that millimetre by millimetre precision that increases safety, we need more detail. That’s why I’ve created the ultimate Anatomy learning experience specifically for aesthetic injectors. It’s going to help you up-level your anatomy knowledge and boost your injection safety & confidence in a way that no cadaver course could ever.”

Anatomy360 Course