Non-surgical Chin Augmentation Using Hyaluronic Acid

Introduction Hyaluronic acid (HA) chin augmentation offers a temporary way to improve chin projection and lower-face contour. Its clinical value depends on selecting the right anatomical problem, matching the filler to the intended tissue plane, and recognising complications promptly. The evidence supports meaningful aesthetic improvement in selected patients; it is less definitive about which injection technique delivers the best balance of effectiveness and safety. Diagnose the deficiency before planning augmentation “Weak chin” is a presenting description, not an anatomical diagnosis. Assessment should distinguish isolated chin deficiency from mandibular retrognathia, vertical disproportion and soft-tissue changes. Dental occlusion, lip competence, mentalis strain and the overall facial profile help determine whether isolated augmentation is appropriate. A substantial skeletal or occlusal problem warrants assessment for orthodontic or maxillofacial management. Adding soft-tissue volume does not reposition the mandible or correct the bite.

As a practical planning framework, document projection, vertical height, transverse width and symmetry separately. Review the face from frontal, oblique and lateral views, with consistent head position, and observe lower-lip and chin movement. Agree with the patient which dimension needs changing. This framework translates anatomical assessment into a treatment objective; it is not a validated dosing algorithm.

For example, “increase anterior projection while preserving current width” is more useful than “use two syringes.” It defines an endpoint against which each addition can be judged. Likewise, an apparent profile improvement should be reconsidered if it creates unwanted frontal width. Aesthetic targets should reflect the patient’s features and preferences rather than a single universal ratio.

Fig. 1. Assessing the influence of chin prominence on profile esthetics: Pişiren, A. B., Arman-Özçırpıcı, A., & Tunçer, N. İ. (2018). Assessing the influence of chin prominence on profile esthetics: A survey study. Journal of Cranio-Maxillofacial Surgery, 46(4), 628–634. https://doi.org/10.1016/j.jcms.2018.01.004

Understand the vascular anatomy in three dimensions The mental artery is a terminal branch of the inferior alveolar artery and communicates with branches of the facial arterial system. In a small cadaveric study, Kikuta et al. identified anastomoses with both inferior labial and submental arteries. These findings explain why the chin should be understood as an interconnected vascular territory. The sample was too small to provide a universal map for every patient.

A landmark on the skin cannot establish the precise depth or course of an individual vessel. Similarly, reaching the supraperiosteal plane does not establish that the injection site is avascular. Published complication guidance explicitly cautions against describing any facial injection region as completely safe.

This has two practical implications. First, the intended plane and the instrument’s actual position must remain conceptually separate. Second, a familiar entry point should never replace reassessment when anatomy, previous treatment or tissue resistance is unexpected. These are clinical implications of anatomical variability, not proof that one landmark-based technique is superior

Fig. 2. Schematic illustration of the arterial anatomy and anastomotic network of the chin and submental region, demonstrating the pathways implicated in vascular complications following hyaluronic acid augmentation: ECA (external carotid artery), FA (facial artery), LA (lingual artery), SMA (submental artery), ILA (inferior labial artery), MA (mental artery), and a (anastomoses). The extensive collateral connections between the submental, mental, and inferior labial arteries highlight how accidental intravascular injection or retrograde embolization into any branch can compromise blood flow, leading to widespread tissue ischemia or necrosis across the chin and lower lip.

Match filler properties to the mechanical task

Property or consideration	What it means	Relevance to filler selection
HA concentration	The amount of hyaluronic acid in the formulation.	Concentration alone is insufficient to determine suitability for a particular task.
Storage modulus (G′)	The elastic component of the gel’s response under test conditions.	Helps assess resistance to deformation for structural projection; the highest G′ is not automatically the best choice.
Loss modulus (G″)	Energy dissipated during deformation—the viscous component of the response.	Complements G′ when assessing how a gel behaves under mechanical forces.
Cohesivity	The material’s tendency to remain integrated.	Provides information distinct from elasticity; cohesivity and G′ are not interchangeable.
Swelling behaviour	The gel’s tendency to absorb water and expand.	Should be considered alongside mechanical properties when selecting a product for the intended tissue plane.
Treatment objective	Structural projection and superficial contour blending impose different requirements.	Match the gel’s behaviour to the intended correction and placement depth.
Laboratory conditions	Measurements depend on factors including frequency and temperature.	Values from different test systems should not be treated as a universal product ranking.
Clinical evidence	Product-specific evidence complements laboratory measurements.	Rheology alone cannot predict vascular safety or patient satisfaction.

Needles, cannulas and aspiration: interpret safety claims carefully

In a cohort study involving reports from 370 dermatologists and approximately 1.7 million syringes, Alam et al. found one vascular occlusion per 6,410 syringe injections with needles versus one per 40,882 with cannulas. These were pooled facial filler data, not chin-specific rates, and the comparison was observational. Operator selection, anatomical site and technique may influence the association.

The study supports considering cannulas as a risk-reduction option in suitable settings. It does not establish that a cannula cannot penetrate a vessel or that switching instruments makes a particular chin injection safe. The denominator also matters: risk per syringe is not the same as risk per patient, especially when treatment involves several syringes or repeated visits.

CMAC guidance cautions against relying on aspiration as the sole safety check: a negative aspirate cannot exclude intravascular positioning. Prevention instead combines anatomical knowledge, controlled delivery and continuous assessment. Pain may be masked by local anaesthetic, so the absence of pain cannot substitute for observing perfusion. Discuss satisfaction and longevity without overpromising Patient-reported satisfaction and clinician-rated improvement are complementary. A patient may value a subtle change that does not produce dramatic photographic differences; conversely, a measurable increase in projection may fail to match their expectations. The separate scales used in clinical trials allow these questions to be assessed independently.

For practice audit, record the patient’s goal before treatment and evaluate the same goal at follow-up. Standardised photographs, a consistent retrusion assessment and a suitable patient-reported measure are more informative together than an immediate post-injection photograph alone. This is a proposed audit approach, not an outcome demonstrated by Ou et al.

Longevity discussions should identify the product and distinguish initial treatment, optional touch-up and later retreatment. A reasonable interpretation of the available evidence is that benefit can persist for months and, for studied products, beyond a year. The degree and duration of correction remain individual, and persistence should be reassessed before additional volume is prescribed.

Fig. 3, In this case by IG @doccontessa (CSA Medical Aesthetics), non-surgical hyaluronic acid filler was injected into the lower third of the face to correct a short, retruded chin. Elongating and projecting the chin restored the ideal $1/3$ to $2/3$ lower-facial proportion while naturally tightening the jawline to eliminate the appearance of a double chin.

Complications: distinguish routine reactions from evolving pathology

Bruising, swelling, tenderness and redness can follow filler injection. FDA guidance notes that some adverse effects emerge substantially later, including weeks, months or years after treatment. Worsening symptoms or an unexpected course should therefore trigger reassessment rather than automatic reassurance based on the fact that HA is biodegradable.

The most consequential interpretive error is treating the absence of vascular events in a selected study sample as proof that vascular events cannot occur. Fang et al. reported chin and neck ischaemia following submental artery involvement during HA chin augmentation. Such a case demonstrates possibility, while providing no reliable population incidence. Trials and case reports answer different safety questions.

The clinical assessment should identify whether the problem is primarily perfusion loss, infection, inflammation or a contour issue. A symptom label such as “swelling” does not establish the mechanism. The mechanism determines urgency and treatment. Translate the evidence into a reviewable clinical plan

The strongest practical lesson is to make the reasoning explicit. Document the anatomical diagnosis, intended dimensional change, product and plane rationale, baseline outcome measures and follow-up plan. Describe uncertainty honestly: clinical benefit is supported more clearly than the superiority of any one injection pattern, and rare-harm incidence remains difficult to estimate.

Future studies would be more clinically informative if they compared techniques directly, reported volume by anatomical subunit and plane, used consistent patient-reported outcomes, and captured delayed complications and repeat treatment. These are proposed research priorities arising from the evidence gaps discussed above. They would help doctors move from knowing that treatment can work to understanding which approach works best for a particular patient.

Fig. 4. Chin Filler Treatment Before and After

Reference:

1. Ou Y, Wu M, Liu D, et al. Nonsurgical Chin Augmentation Using Hyaluronic Acid: A Systematic Review of Technique, Satisfaction, and Complications. Aesthetic Plastic Surgery. 2023;47:1560–1567. Published 10 April 2023. Source
   

2. Marcus K, Moradi A, Kaufman-Janette J, et al. A Randomized Trial to Assess Effectiveness and Safety of a Hyaluronic Acid Filler for Chin Augmentation and Correction of Chin Retrusion. Plastic and Reconstructive Surgery. 2022;150:1240e–1248e. Source
   

3. Ogilvie P, Benouaiche L, Philipp-Dormston WG, et al. VYC-25L Hyaluronic Acid Injectable Gel Is Safe and Effective for Long-Term Restoration and Creation of Volume of the Lower Face. Aesthetic Surgery Journal. 2020;40:NP499–NP510. Source
   

4. Lee EI. Aesthetic Alteration of the Chin. Seminars in Plastic Surgery. 2013;27:155–160. Source
   

5. Kikuta S, Iwanaga J, Kusukawa J, Tubbs RS. The mental artery: anatomical study and literature review. Journal of Anatomy. 2020;236:564–569. Source

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