The amount of neurotoxin is distributed along the marked points, where a larger dose may be injected along the bulkiest portion of the muscle. A 33 G needle is introduced at each injection point, perpendicular to the mandible. The needle is advanced until it abuts the mandible. Once the needle is abutting the mandible, it is retracted 2–4 mm superficially, and 5–8 units of onabotulinumtoxin A are injected. After all three points are injected, the botulinum toxin is gently massaged. Tapering of the jawline should become noticeable at approximately 4–6 weeks post-treatment, peaking at 3 months. Maintenance treatment, or further treatment, is recommended at 6-month intervals.
One of the most frequent findings after this treatment is fatigue during excessive mastication, as well as decreased force when biting. Another possible side-effect is the appearance of sunken cheeks from excessive treatment of the masseter muscles. This can be prevented by reducing the starting dose and reviewing the patient at regular intervals before administering more botulinum toxin, if needed.
The chin is a dominant component of the lower third of the face and greatly contributes to overall facial aesthetic balance. Under-projection of the chin, for example, will give the appearance of greater nasal projection, while proper mental augmentation will decrease the perceived nasal projection.
Traditionally, the ideal aesthetic chin position is determined in profile and is based on the nasal tip, upper and lower lip position, and the pogonion. Patients with significant retrusion of the chin can have a foreshortened appearance of the chin when evaluated in frontal view. This appearance can accentuate the mandibular arch. Correction of the chin position leads to a more tapered, oval contour of the jawline (i.e. V-shaped face).
While chin implants have traditionally been used for augmentation purposes, the use of soft tissue fillers has increased dramatically as an alternative for the enhancement of this area. The ease of use and low morbidity associated with the injections has popularised these injectables from both the surgeon’s and patient’s point of view. The most important issues the doctor must consider when choosing an injectable soft tissue filler are safety, efficacy, and persistence.
Topical anaesthesia should be applied 10 minutes prior to the procedure to numb the area of treatment. Patients who are particularly concerned about swelling and bruising are encouraged to use Arnica and bromelain preparations immediately pre- and postoperatively. Ice compresses are applied before and during treatment to reduce pain, swelling, and bruising.
A number of techniques for the augmentation of the chin have been described. After experimenting with both cannula and sharp needle, the author has reached the conclusion that a sharp needle allows the greatest control in this area. While the use of cannulae is said to confer a reduced incidence of bruising compared with a sharp needle, the latter is not associated with a high incidence of bruising in this region when done carefully.
Approximately 1–2 cc of a high viscosity dermal filler, such as Perlane (Q-Med, A Galderma Division, Uppsala, Sweden) or Juvéderm Voluma (Allergan), can be injected directly into the chin region. The author usually uses a 2–3 point injection technique, placing the filler supraperiosteally. Careful moulding of the area is required immediately after the procedure. It is also important for patients to apply ice compresses to the treated area in the immediate postoperative period to limit tissue oedema and ecchymosis. If the ice compresses have been used as directed, there is usually little or no bruising and swelling, and patients can resume their normal activities with few or no restrictions. Patients may continue to ice at home through the rest of the day, but this is not necessary. Erythema is often noted immediately following injection, and is usually the a result of massaging by the injector and placement of ice in the area, and patients are reassured that this will subside by the end of the day. Occasionally, additional augmentation is needed and patients can return 2–4 weeks later for reassessment and another injection as necessary.
In recent years, Asian beauty concepts have diverged from their Western counterparts. Consequently, the rise of aesthetic techniques to meet these changing beauty perceptions has been apparent. Novel techniques to reduce a square jaw and create a more V-shaped appearance of the face are currently one of the most sought after treatments among Asian women.
It is important to recognise that we must not have a stereotyped concept of facial beauty. With the proliferation of traditional and social media, society may eventually conform to a single standard; however, ethnic and cultural diversity must be valued. Treatment of the Asian face involves a deeper understanding of the ethnic and cultural differences among Asians, as well as changing perceptions and desires.
as aesthetic practitioners must always be to enhance the lives of patients, keeping their best interests at heart. To do so, it is imperative to better understand the changing perceptions of beauty, and adapt techniques and skills to meet the fluctuating needs and rising expectations of patients. In doing so, we can all look forward to exciting and challenging years ahead as concepts of beauty evolve further, and hone our skills to meet these new challenges.