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Menton Chin Filler Anatomia
Menton Chin Filler Anatomia
T
he chin and its defining characteristics have a and chin’s aesthetics and anatomy are closely related.
significant impact on the harmony and aesthetic The chin has a bony projection of the mandible, the
of the face, especially in profile view (Naini, mandibular symphyseal region, which is covered by
2011) (Figure 1). The character of the lower face the soft tissue overlying the chin (the chin pad) (Naini,
largely relies on the chin’s shape, contour and position 2011; Lee, 2013). The chin is defined by the labiomental
(Naini, 2011), and its prominence can be a key factor in crease superiorly, the oral commissures laterally, and
the perception of facial attractiveness (Naini et al, 2012). the submental-cervical crease inferiorly (Lee, 2013).
A deficient chin may lead to the lower face merging with The layers of the chin are the skin, superficial fat
the neck, which is not aesthetically pleasing. compartment, mentalis muscle, deep fat compartment
In addition to its role in facial aesthetics, the chin and bone (Braz et al, 2015).
is one of the facial characteristics that people often The root apices of the lower anterior teeth are superior
associate with an individual’s personality (Naini, 2011). It to this region of the mandible (Figure 2), and the mental
is not uncommon to hear people remark that someone foramen can be found around the apices of the lower
has a ‘weak’ or a ‘strong’ chin. Some authors have even second premolar teeth (Oliveira Junior et al, 2009)—take
suggested that a prominent chin in men may be seen as caution when injecting deep in this region.
strength of personality (Naini, 2011). The bony chin affects the position of the soft tissues,
In this article, the author will describe relevant lower and dysmorphology of the chin results in distortion of
facial anatomy landmarks, advise aesthetic practitioners the labiomental fold (Lee, 2013). A deep labiomental
in the analysis of the chin, and recommend evidence- fold is usually observed in those with reduced lower
based treatment options for chin augmentation. vertical face height and a retrusive chin (Lee, 2013).
Conversely, a flat labiomental fold is seen in people with
Chin augmentation increased vertical lower face height and a horizontally
Having a significantly prominent or retrusive (backward deficient chin (Lee, 2013). These individuals also suffer
displacement) chin is a common reason for patients from difficulty in lip closure and mentalis muscle strain
seeking treatment, from surgical procedures, such as (Lee, 2013).
© 2016 MA Healthcare Ltd
Musculature
SOUPHIYEH SAMIZADEH Regional musculature (Prendergast, 2013) includes the:
Dental Surgeon and Clinical Director, Revivify London. ►► Mentalis
e: info@revivify.london ►► Quadratis labii inferioris
►► Triangularis
►► Superior portions of the platysma.
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CLINICAL ▼
Skeletal evaluation
Andrew Bezear
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▼ CLINICAL
Treatment planning
Andrew Bezear
Gender
In men, the soft tissue over the chin is significantly thicker
than in women (Guyuron, 2008). Morphologically, men
usually have wider, square faces and often have more
projected chins. Female chins are smaller in comparison
and are more round (Naini, 2011; Lee, 2013).
Age
As the projection of the chin changes with age, treatment
of young adults under the age of 18 years is not advisable.
Loss of volume and fat redistribution in the lower third
of the face (chin and mandibular areas) lead to sagging of
the neck, marionette lines, pre-mental hollows, pre-jowl
sulcus, an orange peel appearance, and ptosis of the chin
pad (Hamilton, 2009; Carruthers and Carruthers, 2012).
With ageing, there is also a loss of lateral and inferior
volume of the chin, which results in relative protrusion
of the central chin. Hollowing of the lateral parts (lateral
mental atrophy) results in ptosis (Coleman, 2004; Figure 3. With the patient in the natural head position, true
Coleman and Grover, 2006). In addition, mandibular bone horizontal and vertical lines are drawn to assess the chin’s position
resorption due to ageing and/or loss of dentition, results
in chin pad ptosis (Coleman and Grover, 2006). groups by variations in the orbital region and nose height
and width. In addition, aesthetic ideals vary in different
Ethnicity regions and cultures (e.g. a square face is considered to
Facial morphology varies in different races. For example, be unattractive in the East Asian population) (Khadka et
Farkas et al (2005) distinguished various races or ethnic al, 2011).
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CLINICAL ▼
An irregular contour of the chin could be due to the loss or absence of bone or soft tissue support
Treatment options and outcomes depending on aesthetic goals (Prendergast, 2012b). For
As excess cannot be treated non-surgically; referral is those individuals who require forward and downward
required for surgical intervention (Naini, 2011). However, projection, enhancing the upper and lower part of the
chin and mandibular deficiency can be improved using menton with dermal fillers will achieve the goal and
non-surgical interventions, such as the injection of balance the face (de Maio and Rzany, 2006). If injecting
dermal fillers (Braz et al, 2015). For these patients, dermal in the pre-jowl sulcus, fillers can be placed in the
fillers act as an implant, enhancing the projection of the subdermal plane to avoid the facial artery and vein that
chin’s length and the face (Braz et al, 2015). are pre-periosteal (Carruthers et al, 2005).
The mentalis originates from the bone (incisive fossa
of the mandible) and inserts into the dermis of the chin. Botulinum toxin
Contraction of the mentalis muscles results in elevation Botulinum toxin temporarily causes muscle paralysis
of the medial part of the lower lip, protrusion of the through inhibition of acetylcholine release at peripheral
lower lip, and creates the orange peel-like dimpling of cholinergic nerve terminals (Bitar et al, 2012). Le Louarn
the skin over the chin (Le Louarn, 2001; Prendergast, (2001) reported that superficial medial injections of
2012a). Constant mentalis muscle contraction can result botulinum toxin type A in the upper part of the muscle
in a flat chin (Le Louarn, 2001). would maintain the lower part contraction, hence
Evaluation of the occlusion, skeletal and dental creating a chin advancement with softening of the skin
relationships must be performed before considering of the upper part of the mentalis area (Le Louarn, 2001).
a patient for chin augmentation (de Maio and Rzany, Chemodenervation of mentalis muscle softens the
2006). To manage expectations, it is important to inform dermal insertions of the muscle (Prendergast, 2012a).
patients that the results with biodegradable fillers are In addition, mentalis muscle hyperactivity results in
temporary and long-term results will not be achieved. the formation of an irregular chin contour. This can be
treated by injecting botulinum toxin A in both men and
Dermal fillers women at 1–2 injection points (Bitar et al, 2012).
An irregular contour of the chin could be due to the loss
or absence of bone or soft tissue support (de Maio and Complications and management
© 2016 MA Healthcare Ltd
Rzany, 2006). To enhance the chin, fillers can be used. Complications can be prevented by employing accurate
The best candidates for fillers are people with normal injection techniques and choosing the correct product.
occlusion, and those who have a good chin projection Inaccurate injections will at best lead to suboptimal
with little or no lateral fullness (de Maio and Rzany, 2006). results and complications. To avoid complications
Depot injections can be placed on the anterior or and spread of botulinum toxin to unwanted muscles,
inferior aspect of the menton, on the periosteum, conservative doses should be used and the injections
Journal of Aesthetic Nursing. Downloaded from magonlinelibrary.com by 217.112.157.007 on April 25, 2016. For personal use only. No other uses without permission. . All rights reserved.
▼ CLINICAL
Distributed in the UK by
0120
www.softfil.com www.healthxchange.com
Journal of Aesthetic Nursing. Downloaded from magonlinelibrary.com by 217.112.157.007 on April 25, 2016. For personal use only. No other uses without permission. . All rights reserved.
CLINICAL ▼
injury (Dayan et al, 2014). To minimise risk of adverse Carruthers J, Carruthers A (2012) Soft Tissue Augmentation:
Procedures in Cosmetic Dermatology Series. 3rd edn. Saunders,
effects, the following measures should be taken (Dayan Philadelphia PA
et al, 2014): Coleman S (2004) Structural Fat Grafting. Quality Medical
Publishing, St Louis MO
►► Aspiration before injection
Coleman SR, Grover R (2006) The anatomy of the aging face:
►► The volume of dermal filler injection should be limited volume loss and changes in 3-dimensional topography. Aesthet
to <0.01ml per pass Surg J 26(1S): S4–9. doi: 10.1016/j.asj.2005.09.012
Dayan SH, Brennan TE, Arkins JP (2014) Filler augmentation. In:
►► Slow pace of injection Myint SA, ed. Nonsurgical Peri-orbital Rejuvenation. Springer,
►► Low pressure of injection New York Publishing NY
►► Use of blunt cannulas where possible. de Maio M, Rzany B (2006) Injectable Fillers in Aesthetic Medicine.
Springer, Berlin
Farkas LG, Katic MJ, Forrest CR (2005) International
Conclusion anthropometric study of facial morphology in various ethnic
groups/races. J Craniofac Surg 16(4): 615–46
The chin is an anatomical area defined by the
Guyuron B (2008) MOC-PS(SM) CME article: genioplasty.
labiomental crease, the oral commissures and the Plast Reconstr Surg 121(4 Suppl): 1–7. doi: 10.1097/01.
submental-cervical crease. It is often disregarded when prs.0000305931.98111.c3
it comes to the aesthetic modification of the face; Hamilton TK (2009) Skin augmentation and correction: the new
generation of dermal fillers—a dermatologist’s experience. Clin
however, it plays an important role in overall facial Dermatol 27(3): S13–S22. doi: 10.1016/j.clindermatol.2008.12.001
attractiveness and the character of the lower face. The Khadka A, Hsu Y, Hu J et al (2011) Clinical observations of
correction of square jaw in East Asian individuals. Oral Surg Oral
size, shape, and contour of the chin is significant for Med Oral Pathol Oral Radiol Endod 111(4): 428–34. doi: 10.1016/j.
a well-balanced and harmonious face. Modification of tripleo.2010.05.061
the chin requires understanding of the anatomy, and Lee EI (2013) Aesthetic alteration of the chin. Semin Plast Surg 27(3):
155–60. doi: 10.1055/s-0033-1357113
the balance between skeletal, soft tissues, and dental Le Louarn C (2001) Botulinum toxin A and facial lines: the variable
components of the lower face. Non-surgical alterations concentration. Aest Plast Surg 25(2): 73–84
include chin enhancement using dermal fillers. Severe Naini FB (2011) Facial Aesthetics: Concepts and Clinical Diagnosis. 1st
edn. Wiley-Blackwell, Oxford
skeletal deficiencies/deformities and excess may require Naini FB, Donaldson AN, McDonald F, Cobourne MT (2012)
surgical intervention. Assessing the influence of chin prominence on perceived
attractiveness in the orthognathic patient, clinician and
layperson. Int J Oral Maxillofac Surg 41(7): 839–46. doi: 10.1016/j.
References ijom.2012.01.012
Bitar GJ, Choi DJ, Segura F (2012) Botulinum toxin for facial Oliveira Junior E, Araújo A, Da Silva C et al (2009) Morphological
rejuvenation. In: Erian A, Shiffman MA, eds. Advanced Surgical and morphometric study of the mental foramen on the M-CP-18
Facial Rejuvenation. Springer, Berlin Jiachenjiang point. Int J Morphol 27(1): 231–8
Braz A, Humphrey S, Weinkle S et al (2015) Lower face: Prendergast PM (2012a) Botulinum toxins. In: Prendergast PM,
clinical anatomy and regional approaches with injectable Shiffman MA, eds. Aesthetic Medicine: Art and Techniques.
fillers. Plast Reconstr Surg 136(5S): 235S–57S. doi: 10.1097/ Springer, Berlin
PRS.0000000000001836 Prendergast PM (2012b) Augmentation with injectable fillers. In:
Buckingham ED, Bader B, Smith SP (2010) Autologous fat and Prendergast PM, Shiffman MA, eds. Aesthetic Medicine: Art and
fillers in periocular rejuvenation. Facial Plast Surg Clin North Am Techniques. Springer, Berlin
18(3): 385–98 doi: 10.1016/j.fsc.2010.04.003 Prendergast PM (2013) Anatomy of the face and neck. Cosmetic
Carruthers A, Carruthers J, Dover JS (2005) Soft Tissue Surgery: Art and Techniques. Springer, Berlin
Augmentation: Procedures in Cosmetic Dermatology Series. Siemionow M, Sonmez E (2008) Face as an organ. Ann Plast Surg
Saunders, Philadelphia PA 61(3): 345–52. doi: 10.1097/SAP.0b013e3181844ea3
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