Nonsurgical Correction of the Chin and Jawline Gallery

A woman in her mid 60’s who is bothered by her facial appearance especially her jawline and weak chin.   She has had a “ thread lift”  to her jawline and face while in Florida and did not notice any difference.  She does not wish to have a facelift or chin implant at this time but wants some improvement if possible.

She is shown before and again, 3 weeks after 5 syringes of RHA 4 to the jawline and chin.  A good improvement is seen.  She also had Daxxify to the lateral canthal lines (crow feet area) and to the mentalis ( chin muscles- look “prune-like” on animation before)  She had Botox to the corrugator lines.

Discussion:  Although her jawline and chin are not perfect and as dramatic as we might obtain with a facelift, she has a nice improvement after 5 syringes of RHA -4.  Non-animal stabilized hyaluronic acid” = NASHA, and are dissolvable with the enzyme hyaluronidase if she were to have any problems with them.  High ” G’ prime” is a measure of the amount of “bounce” or firmness of the filler in pushing back against the tissue. I have used the other brands of high-g prime fillers in the chin and jawline of other patients with a similar effect.  The results with the RHA 4 can typically last for 22 months

I also did a “blended” or “hybrid” approach with her neurotoxin.  The Daxxify in my early (8 months) experience is stronger and has a more dramatic effect than the short-acting neurotoxins, and is especially powerful in the lateral canthal lines ( “crows feet”).  But one potential problem we have seen is a higher incidence of pseudoptosis of the eyelids:  both short-acting neurotoxins such as BOTOX brand and the first long-acting neurotoxin, Daxxify had a similar incidence of true ptosis or drooping of the eyelids in studies, about 1-2 %.  However, we have seen a significantly higher number of patients who have some subtle eyelid ptosis before treatment that is made more prominent by Daxxify and is therefore more bothersome to the patient after treatment.  Because this patient has some early eyelid ptosis ( drooping) on her left eyelid I used Botox instead for her corrugator lines.

A woman in her early 20s who has a “weak”  chin, also called hypoplasia of the chin, did not want a chin implant or genioplasty.

She has elected for a “nonsurgical genioplasty” or “nonsurgical chin augmentation” which was performed in the office by placing two syringes of RHA-4.  This takes about 15 minutes in the office and is performed under topical anesthesia.  She reported some mild “bumpiness” for the first 10 days and some mild soreness and bruise for the first weeks but is thrilled with the dramatic improvement that appears natural.  RHA4 is a Non-Animal Stable Hyaluronic Acid filler (NASHA) that is reversible with an enzyme called hyaluronidase.  It is a high “G Prime” filler which means it is thicker and has more “bounce” than lower G prime fillers.  I have also used other brands of high G prime fillers such as Juvederm Voluma and Restylane Lyft to contour the jawline.

The RHA4 is typically expected to last 22 months or longer and we suggested that she consider returning for a “touch-up” in two years.

A woman in her middle 60’s who is bothered by an aged appearance, but is on a blood thinner, Eliquis.  After discussions, she elected to try nonsurgical facial improvement by replacing some of the age-related volume loss with Resilient Hyaluronic fillers, or RHA.  These are one line of Non-Animal Stabilized Hyaluronic Acid fillers distributed in the US by Revance.  Other NASHA lines include the Restylane line by Galderma and the Juvederm line by Allergan.  The NASHA fillers have the benefit of being reversible with the ability to dissolve them with an enzyme, hyaluronidase.  The RHA line has the added benefit of being especially flexible and resilient, which is a benefit in parts of the face that move.

In her case, I placed one syringe of Redensity (which would be RHA 1) in the “tear trough” area, where it is frequently used off-label in Europe.  I then placed 2 syringes of RHA 4 (firmer but flexible) in the cheeks, and 1 syringe of RHA 2 (firmer than 1, softer than 4 but still flexible ) in the upper nasolabial creases.

She did not have much problem with bruising despite being on Eliquis and returned for Daxxify, a long-acting neurotoxin for frown lines and crow feet lines, where I have found that it excels in both strength of effect and duration over the short-acting neurotoxins on the market.

The overall effect of these two treatments is dramatic and does not require surgery.

A woman in her mid 60’s who is bothered by an aged appearance of the jawline and nasolabial creases.  She is shown before and again, 1 month after Botox to the frown lines ( the ‘11’s” , RHA 3 to the nasolabial creases and RHA 4 to the jawline.

Discussion: I see many patients who have started to lose their jawline.  The best treatment is a facelift, but not everyone wants surgery.  In my experience, thread lifts do not help significantly, nor do energy based devices that attempt to tighten the skin.  But augmentation along the jaw line in front of and behind the jowl area can improve the jawline in a satisfactory way and the fillers here can last close to 2 years.

A woman in her mid 50’s who is starting to lose her jawline but not yet ready for a facelift.  In my experience energy based skin tightening devices and thread lifts  have not been helpful for my patients.  But just like NASHA fillers can help with volume loss in the cheeks, they can also help when placed in front of and behind the jowl to give a better jawline.