I hate my butt chin! Could I be a chin implant candidate? Would fillers work? (photo)

Question

I have a butt chin and I hate it! It seems that it is more cost effective to go with an implant (vs. fillers), but I have been reading that an implant won’t correct a “split/butt chin” and could make it worse. I have also been reading about the muscles bunching up over the implant. I’m wondering if fillers would even help a chin like mine, as I don’t really have a dimple to fill but a dip or a groove and the right side of the “butt chin” is a little larger than the left side. HELP!

Michael P. Morrissette, DDS, FACS · Answer

Chin implants are excellent permanent solutions for changing the shape of the chin. In your case, a chin implant would give your lower face a more narrow feminine look. I have seen cases similar to yours where the indentation is diminished following implant surgery alone.  In a few cases, I have performed subcision and placed some fat beneath the skin to create separation of the skin and muscle. In other cases, Botox can help relax the muscle. Good luck

Zoran Potparic, MD · Answer

It seems that first step should be temporary correction with soft tissue filler. Once you find that it works to your liking you may consider a more permanent solution with fascia, dermal or fat graft. Good luck.

Jonathan Kulbersh, MD · Answer

You have a few options to achieve a stronger-looking chin and profile. If you’re not sure you’re ready for surgery, but still want to improve and strengthen your chin and profile, I’d suggest augmenting your chin with Sculptra and/or Voluma. I’d also remove the fat underneath your chin with liposuction or Kybella. If you like your new look, you can make it permanent with a chin implant.

William Portuese, MD · Answer

A full set of photographs from all angles( Not upon animation) are required to make a determination about being a candidate  for a chin implant. Chin implants will not get rid of a "butt" chin, since that is a soft tissue problem. Chin implants augment the bony mandible. The small fascia graft can be placed in the cleavage of the chin as long as they cleavage is present at rest, not  when smiling. For many  before and after examples of chin implants, please see the link and the video below

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

Hi, I have performed many facial shaping procedures, including Chin Augmentation with dermal fillers or silastic chin implants, for over 30 years.  Non smiling photos of your face from the front and side would help in the evaluation.  Chin implants are used to correct a "weak" chin.   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.   When a cleft exits in a weak chin, using a silastic chin implant will soften but not completely remove the cleft.  That approach however, would not be used in a cleft chin that wasn't weak.  In that scenario using a dermal filler to soften the cleft would be more appropriate, in my humble opinion.  The non smiling photos, mentioned above, would determine which course of action would apply in your particular case.  Permanent fillers have too many unwanted side effects and fat transfer is not as reliable as an off the shelf dermal filler. For that reason, I do not use fat to shape the cheeks, chin, jaw line or lips. See explanation below. 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 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.

Val Lambros, MD, FACS (retired) · Answer

Unfortunately you didn't send non smiling pictures. The first thing to do would be to inject some botox or dysport into the mentalis muscles. to see if some of the animation deformity could be corrected that way. I have done it a few times and it has improved things. It should be done by someone who has done it before so as not to paralyze the lip.

I hate my butt chin! Could I be a chin implant candidate? Would fillers work? (photo)

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