The decision between surgical and nonsurgical options for chin augmentation continues to be a debate, but according to Michael Somenek, MD, this can be easily settled with personalized patient consultation.
In February 2021, Galderma Aesthetics announced the FDA approval of Restylane Defyne for mild to moderate chin retrusion in adults.1 Defyne is the second hyaluronic acid (HA) dermal filler approved for the indication, following Juvéderm Voluma XC (AbbVie), which got the green light from the FDA for chin augmentation in June 2020.2
These approvals for nonsurgical chin augmentation bring up the continued debate between surgical versus nonsurgical treatments. A debate, according to facial plastic and reconstructive surgeon Michael Somenek, MD, Somenek and Pittman MD Advanced Plastic Surgery, Washington, DC, that is best settled with a simple conversation with patients during the cosmetic consultation.
The optimal choice is dependent on individual patient expectations, including treatment longevity, said Somenek, who offers implants and fillers for chin augmentation at his practice.
Fillers offer immediate results and instant gratification, as well as little to no downtime; however, patients need touchups to maintain their desired results. “Most of the fillers we use today are hyaluronic acid fillers,” he says. “They are temporary and last somewhere approximately 9 to 12 months. There also is a longer-lasting filler option that uses polymethyl methacrylate, or PMMA, also known by the brand name Bellafill (Suneva Medical), which can provide a longer lasting option and has a semi-permanent effect.”3
For those looking for a one-and-done treatment, Somenek suggests chin implants for appropriate candidates. Surgical chin augmentation is a relatively short outpatient procedure, with minimal recovery and results last a lifetime, he says. “That is great for some people that are opened to having an implant in their chin,” he says.
But, although patients are almost always candidates for fillers, the same cannot be said for chin implant candidates. Surgeons should think twice about using implants in patients who have had previous procedures in or around the chin, those who have excessive scar tissue or an exaggerated asymmetry to the chin.4
“It’s really hard to get a good outcome in those cases,” Somenek says. “You can get a customized chin implant but there are a lot of steps that go into that versus the standard chin implant you order. For people with marked asymmetry who are looking for augmentation and more symmetry, I tend to lean more toward the fillers than an actual implant for them because I can contour that area much more effectively and precisely with filler.”
With implants, come the risks of malposition or infection. The risk of infection tends to be highest during patients’ recoveries, according to the American Board of Cosmetic Surgery.5
“It is rare to get a delayed type of infection in the chin, but that is a possibility with an implant,” he says.
A thorough understanding of facial anatomy is key when using injectables as the possibility of coming in contact with vessels and nerves is so high. “That is going to ensure that you know where you are at in the face and the particular area of the chin,” Somenek explains. “You know where the pertinent anatomic boundaries are and landmarks, such as vessels and nerves and muscles.”
He recommends using a slow injection technique, with small aliquots or small boluses, which decreases the risk of intravascular complication… “And to decrease [intravascular complication risk] further, I prefer to use a cannula. I feel a lot more injectors are leaning toward the blunt tipped cannula technique because the risk of an intravascular injection is markedly less. It’s not impossible, but it’s markedly less.”
Using sterile technique is the highest priority for surgical chin augmentation to decrease postoperative infection risk, he said. During the implantation process, Somenek suggests placing the implant into a tight pocket to decrease the risk it will shift or move postoperatively.
For filler, Voluma and Defyne have become his go-to for chin augmentation because of the recent approvals. However, he does not expect much will change in the world of chin implants.
“Quite honestly, there is such a broad catalog of chin implant selection that it would have to be something very innovative to come out to use for a chin implant. We use solid silicone implants, and those have shown repeatedly to be very safe and effective for chin augmentation,” he said.
Somenek is a trainer and speaker for Galderma and a speaker for Suneva.