FEATURE Chin augmentation: filler versus prosthesis

BY LUCA PIOVANO

ver recent years, aesthetic Baseline Filler Surgery medicine and aesthetic surgery have become closer O and more combined in daily practice. There is also a gradual shift, with aesthetic doctors performing more invasive techniques, whereas plastic surgeons are also, whenever possible, moving to less invasive procedures. Minimally invasive injectable treatments have now become available, including new injectable implants based on polycaprolactone (PCL) a b c and calcium hydroxylapatite (CaHA), Figure 1: a) Baseline, b) Post non-surgical approach with fillers and c) post-surgical result. offering a good safety record combined with durable effects and product viscosity, plasticity and elasticity for for PCL and CaHA is chin contouring. In a few patients with ‘mandibular tissue expanding capacity. In this particular area a minor senilis’ (atrophic age-related jaw and There has been an international augmentation (5-6mm) can change chin), the aimed expansion of the jowl increase in the use of PCL and CaHA in the entire shape of the face. It is tip would sometimes offer a better the aesthetic treatment for soft-tissue important to know that this correction aesthetic outcome. Figure 1 shows the augmentation and facial contouring. is achievable and is stable even with same patient in a two step technique. Both these products are gaining usage changes in body weight. Image b shows the results from a non- for correction of profile deformities, Chin augmentation is ideal in surgical approach with filler, a good and in some cases replacing the patients with a small, hypoplastic improvement, but not stable. Image surgical interventions performed by chin, essentially due to a deficit of the c shows the result following surgery: plastic surgeons. A good indication now mental tubercle and surrounding . stable, sharp and predictable.

Non-surgical chin augmentation Another method of chin augmentation uses an injectable (filler). Most fillers are temporary with results lasting months to years. Common temporary fillers include hyaluronic acid and calcium hydroxyapatite preparations. Permanent fillers, like ‘free’ silicone, have fallen out of favour due to the risk of migration, chronic inflammation and , which can permanently disfigure the chin. Recommended techniques and procedures for correction of the chin It is recommended to inject a multiple bolus of the PCL- or CaHA-based soft tissue filler in the supraperiosteal area by a 27G needle in the areas near the tuberculum mentalis, in each lateral site. The bolus is then massaged in order Figure 2: Pre and post non-surgical approach with fillers. to evenly distribute the product over the

pmfa news | AUGUST/SEPTEMBER 2016 | VOL 3 NO 6 | www.pmfanews.com FEATURE

Prosthesis Filler Procedure Surgical Aesthetic Medicine Approach Planned Progressive Reversibility Yes Yes / No Dislocation Yes Yes Migration No Yes Extrusion Yes Yes Infection Yes Yes Malleable Yes / No Yes Contour Sharp Blurred Evolution Stable Variable

Figure 4: Prosthesis versus fillers.

pocket is made and the implant placed Discussion and conclusion into the pocket. Some chin implants are These two approaches to chin fixed to the mandible, while others are profiloplasty are so different but held in place by the pocket itself. have the same objective to restore Another surgical chin augmentation harmony in contouring the face. The uses the lower prominence of the medical approach is relatively simple, mandible as the ‘implant’. Known as less aggressive and inexpensive, with a sliding genioplasty, the procedure short down time. However, I favour involves cutting a horseshoe-shaped the surgical approach as it is more Figure 3: Pre-post surgical profile correction: chin piece of bone from the lower border of extending implant and reduction . predictable and stable, the new profile the mandible known as an . will be sharp and more firm. For chin augmentation, the piece of Sometimes these procedures may be area. If the results are still not satisfying, bone is advanced forward to increase used in combination to achieve the most then a second bolus (50% less volume the projection of the chin. The bone can desirable results for the patients – first than the initial bolus injection volume), also be recessed backward for a chin surgical implant followed by some filler should be injected again in the same reduction. The new position is held in to smooth the final profile. area. However, the total amount per place with a titanium step plate using site should not exceed 0.5cc of product, titanium screws. The bone segment while usually 0.25cc per site is enough. can also be fixated with 26 or 27 gauge Therefore, it can be reasonably assumed wires and inter-maxillary fixation (IMF) Luca Piovano, that the maximum filler needed is one (wiring the jaw shut) for three to four MD, Plastic Surgeon, syringe (1cc), while half of the syringe weeks. This type of surgery is usually Teaching Professor at University of Camerino, most likely will be enough in the performed by an oral and maxillofacial Italy; majority of cases. surgeon or plastic surgeon. 143, Circ. Gianicolense, More involved 00152 Rome, Italy. Surgical chin augmentation may be required in cases where a small www.lucapiovano.it The most common type of surgical chin chin and a significant overbite co- Declaration of competing interests: augmentation uses a chin implant. exist. While the procedures above may The author would like to declare the following competing interests: There are many types of chin implants, improve the cosmetic appearance of • KOL Sinclair-Pharma and many are described by previous the chin, they will not improve dental • KOL IBSA-Academy • KOL General Topics authors. Chin augmentation with a chin occlusion. Mandibular advancement • KOL AQTIS Medical implant is usually a cosmetic procedure. • KOL Merz Aesthetics surgery can be used to correct the • KOL Bioform Medical An incision is made either under the alignment of the teeth and improve the chin or inside the lower lip sulcus, a projection of the chin.

pmfa news | AUGUST/SEPTEMBER 2016 | VOL 3 NO 6 | www.pmfanews.com