Is there anything I can do to fix mental crease in chin? (Photo)

Question

I'd really like to get rid of this crease without having to keep getting fillers. I spoke to a Dr. already who told me fillers wouldn't make much of a difference anyways. Would an implant fix this?

Larry S. Nichter, MD, MS, FACS · Answer

Without an exam your question cannot be answered.  You will need to see an Oral/Maxillofacial surgeon to see if othognathic surgery, genioplastyor using an implant is best for your specific case. It should be noted that patients with severely weak jaws or abnormally functioning jaws maybe better treated with other facial surgery (orthognathic surgery), although a chin augmentation may be an option at a later time. These patients should seek the advice of a plastic surgeon to determine which course is right for them. Here is some information to help you make thisdecision: Candidates for Chin Augmentation - Patients whose chin profiles are weak but have normally functioning jaws are candidates for Chin Augmentation. Many of these candidates have used injectable fillersin the past to strengthen the protrusion of their chins, but are looking for a permanent solution. If you are one of these patients, thenyou are a likely candidate for chin augmentation

Jonathan Kulbersh, MD · Answer

Yes, an implant can improve a crease in the chin, which can be customized to your desired results. Hope this helps.

Faisal A. Quereshy, MD, FACS · Answer

Great question!  We have a lot patients that we see specifically for a deep crease / fold (termed labiodental sulcus).  A lot of patients often present with a deeper bite leading to the cause of such a crease.
To treat the area, a couple thoughts come to mind:  1.  a non surgical filer with a subcision/to remove the scar band caused by the mentalist muscle using a simple needle approach, followed by a semipermanent filler option;  2.  A more permanent chin implant which would also fill the crease but care not to place a very large implant to create an unnatural look.

Hope this helps!

Dr. Q

Francis R. Palmer, III, MD (retired) · Answer

Hi, I have performed many facial shaping procedures using dermal fillers, facial implants (cheek, chin), liposuction and/or facelifts for over 30 years.  Your mental crease is normal in depth and appearance however, if you'd like it softened an HA dermal filler can be used.  I prefer Restylane Lyft and would advise against using fat for facial shaping as discussed below. A chin implant creates forward projection, to the chin, in order to correct a chin that is "weak".  As the chin is brought forward, the mental crease deepens which does not seem to be what you're seeking. When the chin is weak, this creates an imbalance making the nose appear larger, the mid face top heavy, the lower face looks short, de-emphasizes the lips and allows early formation of a "double chin".  
 Proper placement of a silastic chin implant adds forward projection to the chin thereby creating harmony and balance to the lower face.  Using the same incision, liposuction can be performed to reduce the fat and further shape the neck.  Excess skin, from below the chin, can also be removed through the same incision.  
 I have found that placement of a silastic chin implant, through a small curved incision under the chin (also allows excess skin removal) to be very safe, quick, highly effective and far less invasive than a sliding genioplasty (requires extensive tissue dissection, bone cuts and placement of metal screws and plates to secure the cut segments of bone).  I perform chin implant surgery in 30 minutes or less, often using a local anesthetic alone.  I have performed many facial shaping procedures using dermal fillers, facial implants (cheek, chin), liposuction and/or facelifts for over 30 years.  In my experience and despite its recent increase in popularity, fat transfer (fat injection) offers "far" less of a reliable and predictable volume for facial shaping than an off the shelf dermal filler or silastic facial implant.  For that reason, I do not use fat to shape the cheeks, chin, lips or jaw line.  Tissue physiology is quite simple.  Tissue requires a blood supply in and out as well as lymphatic connections to remain viable and alive.  Once fat is removed from the body all of these things have been disrupted.  Just because the removed fat is mixed with PRP or something else doesn't make the blood and lymphatics magically re-appear.  The fat at that point is not living tissue which means that it's prone to being dissolved by the body (most likely in an uneven and unpredictable manner).  Injecting fat back into the face does not create the required elements to make the fat living tissue once again.  So the argument that fat is alive and viable in the face once it's been removed and re-injected makes no sense to me as a physician and surgeon.
 The other issue that I have with fat transfer is the lack of precision.  Fat is thick by nature which means it's not the same consistency as an off the shelf dermal filler.  Fat injections use an increased volume injected in an attempt to compensate for the volume loss that "will" happen.  This means a lack of specific shape and volume that simply can not begin to compare with the specificity of using a silastic facial implant of a "known" shape and volume.  In that regard fat offers too much of an unknown to make it a reliable and predictable method for facial shaping.  There's a significant difference between a 3mm and 5mm thick cheek implant.  You can imagine the magnitude of difference there is between retaining 60% of 25cc's of fat versus 35%.  In my humble opinion, I just don’t see how fat could possibly be used to precisely shape facial features?
Hope this helps.

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