Weak chin. Fillers or Botox? (Photos)

Thank you for your question. You submitted several photos and describe very well in detail you have this orange peel appearance on your chin, and ask how  to improve this. You also want to address the projection of the chin, and if Botox® alone can treat both, or Botox® with fillers.
You ask a very good question about helping this area, and I can certainly give you some guidance on how I answer this type of question when it comes up in my practice. A little background: I’m a Board-certified cosmetic surgeon and Fellowship-trained oculofacial plastic and reconstructive surgeon. I have been in practice in Manhattan and Long Island for over 20 years. Enhancing the chin area is a very common concern for patients who come to my practice. I’m going to distinguish for you the causes of the two issues you are most concerned about: the orange peel appearance, and the relative projection of the chin.
The orange peel appearance has to do with the action of the mentalis muscle. The chin is referred to as the mentum, and the muscle over the chin is the mentalis muscle. To address the muscle, the use of a neurotoxin such as Botox®, Dysport®, or Xeomin® can relax that muscle to improve that orange peel appearance, referred to in medicine as peau d’orange. The muscle relaxes so you don’t get that dimpling effect.
When it comes to projection, you have a few choices based on one issue that has to do with bone projection. Without unnecessary details, the projection of the chin is dependent on two factors: the relative position of the jaw, or the mandible relative to the upper jaw. If someone has a very strong underbite, the chin can be further back. Sometimes that issue is more of a dental, oral, maxilla issue which requires a different kind of correction as it’s a functional issue, so just be aware of that. More typically, it has to do with the genetics of projection of bone structure where people have what’s referred to as weak chin. That said, you have a choice between an implant like a chin implant, or an injectable filler. I found that many of my patients, just based on timing alone, tend to opt for the filler first. They want to see how it will look, and they like having the convenience of the placement of a filler. In my practice, we do something called structural volumizing, where the filler such as Juvederm Ultra Plus or Juvederm Voluma is placed directly on the bone using a very elegant method with blunt cannulas. Once you get this placed on the bone, you get a very nice, natural-looking projection. Other patients prefer something more definitive, so rather than getting repeated injections, they’d rather do something more permanent. For them, we perform chin implant surgery. Chin implant surgery is one of the most straightforward procedures you can have done. Although it is surgery, it is a very common surgery in our practice. Through a small opening just under the chin, we’re able to put an anatomic implant that looks very natural, and blends with the whole structure. Once it’s placed, and as long as it doesn’t shift or have any issue with infection, it’s there for the duration - it’s very safe and it works out very well.
You have more than a few options/ What you’re differentiating are the muscle action that causes the orange peel effect which needs a neurotoxin, and the lack of volume that needs some type of augmentation whether it’s a filler or an implant. I recommend you meet with qualified and experienced cosmetic surgeons. I say surgeons because they have the option of whether doing injectable fillers or implants, versus non-surgeons who are more limited to injectables and non-surgical treatments. See what you’re comfortable with, then move forward. I think you’ll find that enhancing the chin is one of the most satisfying procedures a person can have. It really balances the person’s face significantly, and I think you would like the outcome whichever path you choose.
I hope that was helpful, I wish you the best of luck, and thank you for your question.This personalized video answer to your question is posted on RealSelf and on YouTube. To provide you with a personal and expert response, we use the image(s) you submitted on RealSelf in the video, but with respect to your privacy, we only show the body feature in question so you are not personally identifiable. If you prefer not to have your video question visible on YouTube, please contact us.

Thank you for sharing your question and photos. You are an excellent candidate for Botox to the chin to soften the mentalis muscle. Although it is difficult to tell based on your photos, you may be a good candidate for a chin implant. In my practice, I like to use 3-D volumetric photos to communicate realistic surgical outcomes for chin implants. It is important that your chin is the right size to be in proportion to the rest of your facial features. Without seeing a photo of your full face, it is difficult to evaluate. If you are not ready for surgery, dermal fillers can be used to improve the contour of the chin temporarily. I recommend consulting with a board certified plastic surgeon who is also an experienced injector in order to evaluate your best treatment options. Best of luck!

Voluma would be a good filler to use in this area.  It can provide you with some length and you can see how you like it before doing something more permanent like a chin implant.  You will also need botox to relax the "orange peel" look to your chin.