Chin Projection Research Articles

Determining Chin Dimensions for Feminizing Genioplasty: An Anatomic Study.

Feminizing genioplasty warrants chin modification to achieve feminine characteristics. This study compared female and male facial skeletal dimensions and shape to guide feminizing genioplasty. Skulls stored at the Cleveland Museum of Natural History were analyzed. Sex, age, and race were documented. Heights and widths of the face and chin were measured, normalized, and compared. Forty-three male (43.58±12.52-y-old) and 43 female (40.48±12.04-y-old) skulls were included. Within each group, 25 skulls were of African American (AA) origin and 18 were of Caucasian (C) origin. Absolute chin heights were larger in AA and C males compared with females (P<0.05). After normalization to lower facial height, there was a trend toward greater chin height in AA males compared with females (P=0.07). Parasagittal chin width in AA males was significantly larger than AA females (P=0.0006). Interforaminal chin width in C males trended toward being significantly larger than females (P=0.08). Following normalization of chin widths, no significant sex-based differences were noted for AA skulls except for the interforaminal/intergonial ratio, which was smaller in AA males (P=0.04). For C skulls, most normalized ratios were significantly smaller in males (P<0.05). C females had wider angles at the point of maximum chin projection (P=0.007) and wider symphyseal inclinations (P<0.0001). These differences were not present in AA skulls (P>0.05). Regardless of race, male chins appeared square, whereas female chins were round. While chin width reduction is not needed for most patients, height reduction could be considered. Chin contouring is the most central component of feminizing genioplasty.

Quantification of Changes in Chin Morphometric Parameters Following Feminization Genioplasty.

Genioplasty is frequently performed in facial feminization surgery, typically aiming to reduce chin height and projection for more feminine appearance. Quantification of the bony changes occurring during surgery have to date not been published. This study presents a method for segmentation of the chin using CT imaging to quantify changes to the chin after feminization genioplasty. CT scans of 21 patients before and after feminization genioplasty were segmented in Mimics to isolate the chin region. Surface area, volume, vertical chin projection, and horizontal chin projection were measured before and after surgery. Patient outcomes were evaluated using the FACE-Q and World Health Organization Quality of Life patient-reported outcome measures. Surface area, volume, and vertical chin projection demonstrated statistically significant decreases after surgery. The magnitude of changes in surface area and vertical chin projection were significantly associated with their presurgical values. In particular, patients with greater presurgical vertical projections experienced greater decreases in vertical projection after surgery, with some patients having increases in postsurgical vertical projection. Patient FACE-Q scores improved significantly on all scales, including chin, jawline, and neck satisfaction. This study demonstrates a method for evaluating bony changes on CT scan after feminization genioplasty. The measured changes cohere with the changes expected to create a more feminine chin. Furthermore, changes created by feminization genioplasty are in the context of the patient's overall facial harmony and are not uniform across all patients.

Impact of Overjet Severity and Skeletal Divergence on the Perioral Soft Tissue Area

Overjet (OJ) and skeletal divergence affect the perioral soft tissue. However, no previous study has investigated the combined effects on perioral soft tissue, which includes the upper lip (UL), lower lip (LL), and chin projection. We explored the impact of OJ severity and skeletal divergence on the perioral soft tissue. Lateral cephalograms of 133 untreated skeletal Class II adult patients were allocated into three categories according to the degree of skeletal divergence: hypodivergence (Hypo), normodivergence (Normo), and hyperdivergence (Hyper). Furthermore, OJ was classified as normal OJ (NOJ), moderately excessive OJ (MEOJ), and severely excessive OJ (SEOJ). A matrix of skeletal divergence and OJ variables produced the following groups: NOJ-Hypo, MEOJ-Hypo, SEOJ-Hypo, NOJ-Normo, MEOJ-Normo, SEOJ-Normo, NOJ-Hyper, MEOJ-Hyper, and SEOJ-Hyper. The skeletal, dental, and soft tissue parameters were measured. Statistical analyses showed that increased hyperdivergence and OJ severity corresponded with a more retruded mandibular perioral soft tissue (MPST), except for the Pog’ in the SEOJ-Hypo group, which was insignificantly more prominent than the MEOJ-Hypo group. Unlike the LL, the UL was similar among the groups. Multiple regression indicated that greater OJ and skeletal divergence significantly influenced MPST retrusion and increased vermilion lower lip thickness (VLLT) while independently affecting deeper mentolabial sulcus depth (MSD) and a more obtuse lip-chin-throat angle (P &lt; 0.05). The effect of OJ was most significant at the LL and gradually decreased down to the chin; conversely, divergence increased downwards. The SEOJ-Hyper group displayed the greatest retruded MPST, thickest VLLT, and deepest MSD, which highlighted the combined effect of OJ and divergence.

A Differential Analysis of Preferred Feminine Facial Contours for Transfeminine Individuals.

Facial feminization surgeries are important gender-affirming procedures for transfeminine individuals. The literature provides guidance on classically feminine facial features but the aesthetic preferences of transgender patients have not been studied. This study aimed to define the preferred feminine facial proportions of transfeminine patients and compare them to a mixed population of US adults. An online survey was designed consisting of virtually modified images with progressive degrees of change in 6 facial features: forehead, nasal dorsum, chin projection, nasolabial angle, mandibular angle, and chin height. It was administered to transfeminine patients in a large-scale health system as well as the general population using an online market research instrument. Respondents ranked each image on a 7-point Likert scale from "very unattractive" to "very attractive" for a feminine face. Both groups agreed that a moderately convex forehead without supraorbital ridge prominence, slightly sloped nasal dorsum, ∼105-degree nasolabial angle, and decreased chin height were considered most attractive. In addition, very concave nasal slope and ∼110-degree nasolabial angle were rated significantly higher by transfeminine respondents compared with controls. The most classically masculine versions of each feature were considered significantly more unattractive by transfeminine patients when compared with controls. Transfeminine individuals share significant preferences in feminine facial features with control respondents. However, transfeminine patients were more averse to traditionally masculine features on a feminine face and more accepting of the most traditionally feminine versions of nasal contours. Understanding these differences can facilitate surgical planning between surgeons and patients and potentially improve patient satisfaction.

Using injectable fillers for chin and jawline rejuvenation.

As the population ages, facial plastic providers must remain aware of the treatments to prevent and reverse the external signs of aging. In the mandibular region, skin laxity and soft tissue sagging in the jawline may lead to jowling and chin ptosis along with reduced chin projection. While surgical procedures, including chin implantation, may be performed, nonsurgical procedures are becoming increasingly popular due to their temporary, noninvasive, yet effective methods. This review covers the use of hyaluronic acid, calcium hydroxylapatite, poly-l-lactic acid, and polymethyl methacrylate in the jawline. PubMed was searched for data on the mechanism of action, pertinent anatomy, indications, contraindications, technique, and evidence supporting the safety and efficacy of the fillers. There are a wide variety of fillers available for use in the lower face with unique characteristics and application methods. While the advantages of injectable fillers include relatively affordable cost, minimal patient discomfort, and limited recovery times, taking measures to prevent short- and long-term complications is necessary for optimal results. Understanding the benefits and limitations of injectable fillers in the jawline can help providers appropriately counsel and treat patients.

Orthodontic Treatment of Severe Bimaxillary Dentoalveolar Protrusion with Skeletal Class II Malocclusion Without Using Miniscrews

Bimaxillary dentoalveolar protrusion is characterized by the proclined anterior teeth, protrusive lips, and a convex profile. A proper orthodontic treatment modality for efficient anchorage control is necessary to retract the anterior teeth and improve the facial esthetics significantly. The commonly used miniscrew could provide absolute anchorage, however, it is accompanied by some risks and complications, especially in adolescent females. This case report described a 16-year-old female with diagnosis of skeletal Class II, normal mandibular plane angle, and Angle Class I malocclusion associated with proclined upper and lower anterior teeth, excessive overjet, and a convex profile with lip incompetence. We extracted her four first premolars first. Then, the Tip-Edge Plus bracket system and differential force method were applied to replace the temporary anchorage device. The total treatment duration was 27 months. Her dentoalveolar protrusion was decreased, both lips were significantly retracted, the mentalis strain was reduced, and her chin projection was improved. This case demonstrated that differential tooth movement with controlled light orthodontic forces could be an effective strategy to treat severe bimaxillary protrusion.

Validated 5-point photonumeric scales for the assessment of the jowls and chin.

The objective of this investigation was to create and to examine the reproducibility and validity of 5-point photonumeric assessment scales that allow objective assessment of chin retrusion and jawline sagging using a digital and a live validation. Two new 5-point photonumeric scales created to assess chin projection and jawline sagging were validated by 12 experts in a digital validation and by 5 experts in a live validation setting. Intra-rater agreement and inter-rater agreement were assessed. For the digital validation, an almost perfect intra-rater (Kappa: 0.89 [95% CI: 0.86-0.91]) and almost perfect inter-rater agreement in both sessions (Kappa: 0.80 [95% CI: 0.74-0.86] and 0.80 [95% CI: 0.74-0.86]) was achieved for the Croma Chin Projection Assessment Scale, while intra-rater agreement (Kappa: 0.88 [95% CI: 0.85-0.91]) was almost perfect for the Croma Jawline Sagging Assessment Scale and inter-rater agreement being substantial in the first session (Kappa: 0.76 [95% CI: 0.71-0.81]) and almost perfect in the second session (Kappa: 0.81 [95%CI: 0.76-0.85]). For the live validation, intra-rater agreement was almost perfect for the Croma Chin Projection Assessment Scale (Kappa: 0.82 [95%CI: 0.74-0.90]) and the Croma Jawline Sagging Assessment Scale (Kappa: 0.83 [95%CI: 0.77-0.89]), while inter-rater agreement was substantial in both sessions for both scales. The created chin and jawline photonumeric grading scales are valid and reliable tools for assessing chin projection and jawline sagging. The scales will be of value for standardized chin evaluation and quantifying outcomes in clinical research and daily practice.

Facial Masculinization from Procedures to Payment: A Review.

As the demand for gender-affirming procedures continues to increase, patients and providers have a greater imperative to understand the current state of facial masculinization. Facial reconstruction for transgender women has been shown to treat gender dysphoria effectively and reduce rates of discrimination and victimization. Although facial masculinization surgery for transgender men is less common, there are multiple surgical and nonsurgical options to supplement the effect of hormone therapy on facial appearance, including but not limited to: receding the hair line, flattening the forehead, expanding the supraorbital ridge, increasing the dorsal nasal projection, squaring the jaw, and augmenting the chin. This review aims to summarize these techniques for providers who wish to inform transgender male patients about their options and discuss them in the context of patient satisfaction and availability of insurance coverage.

Nonsurgical reshaping of the nose, chin, and jawline: A retrospective analysis using experience-based eligibility criteria.

Nonsurgical reshaping of the nose, chin, and jawline with hyaluronic acid fillers is becoming increasingly popular. Appropriate patient selection is essential. To assess the safety and efficacy of nonsurgical treatment of these facial areas using experience-based eligibility criteria and injection of the high G' filler, VYC-25L. This was a retrospective analysis of patients undergoing aesthetic improvement of the nose, chin, and/or jawline with VYC-25L, selected based on detailed criteria derived from extensive experience and imaging assessments. In a subgroup of subjects, high-resolution 3D imaging was used to assess nasal angles, nasal hump height, and chin projection. A total of 135 patients were included (n=106 females; mean age, 43.4±14.3years; n=44 nose treatment only, n=24 chin/jawline only, n=67 both). Mean treatment volume was 3.3±2.0ml. In total, 111 individuals (82.2%) were injected in the nose (mean volume: 0.9±0.2ml) and 91 (67.4%) in the chin/jawline (mean volume: 3.8±0.8ml). Most complications were injection site-related (bruising, n=27 [20.0%]; pain, n=1 [0.7%]). One patient (0.7%) experienced lip herpes, successfully managed with antiviral therapy. Thirty-two individuals underwent 3D imaging, which showed substantial mean changes from baseline in nasofrontal angle (3.5±1.6 degrees), nasofacial angle (2.2±0.8 degrees), and nasolabial angle (3.9±2.6 degrees); decreases in nasal hump height (1.7±0.9mm); and increased chin projection (2.7±1.5mm). Nonsurgical reshaping of the nose, chin, and jawline was safe and effective using experience-based eligibility criteria and VYC-25L.

Are chin and symphysis morphology facial type–dependent? A computed tomography-based study

The chin is a major determinant of the facial profile; hence, it plays a major role in orthodontics and orthognathic surgery. It is thus essential to follow and better understand its expression in different facial types. The major objectives of the current study were to characterize morphometrically the chin and symphysis and reveal their association with different facial types. Computed tomography scans of the head and neck of 311 adults (163 males, 148 females; age range, 18-95years) were classified into 3 facial types: short, average, and long. Height, width, projection, inclination, thickness, and area were measured on the chin and symphysis. The majority of the population (70%) manifested an average facial type; the other 30% were almost equally distributed between short and long facial types. The long facial type was more common among females and the short facial type among males. Chin projection, area, and size were significantly greater in short-faced patients. Chin width in males was similar for all facial types, whereas, in females, chin width was the widest in the short facial type and the narrowest in the long facial type. Symphysis height was significantly greater in long-faced patients in both sexes. The mandibular incisors' inclination relative to the mandibular plane was not significantly associated with the chin or symphysis morphology. Chin and symphysis morphology is facial type-dependent. Orthodontists and maxillofacial surgeons should be aware of the complex relationship between facial types and chin/symphysis size and shape when planning treatment.

Profile shape variation and sexual dimorphism amongst middle-aged Northern Europeans.

To explore profile shape variation in a large population of middle-aged individuals and investigate features of sexual dimorphism. Facial profile photographs of 1776 individuals (964 females and 812 males; 46 years old), members of the Northern Finland Birth Cohort 1966 (NFBC1966), were uploaded and digitized with Viewbox software. Profile shape was defined with 47 landmarks (4 fixed and 43 sliding semi-landmarks). Digitized images were reoriented and scaled with Procrustes Superimposition, and shape variation was determined with a Principal Component Analysis. More than 90 per cent of profile shape variation was explained by Principal Components (PC) 1-9. PC1, explaining the largest amount of variation (33.1 per cent) described changes in facial convexity, slope of the forehead, lip, and chin protuberance. PC2 (23.1 per cent variation) was more related to vertical changes of the lower facial third and PC3 (11 per cent variation) primarily described changes in lip protrusion and nasal projection. Shape analysis showed a significant difference between the average female and the average male profile shape (P < 0.001); however, this was not evident upon visual observation. The shape variable most associated with sex was PC3 (η 2 = 0.245; P < 0.001), which described changes in lip prominence and in projection of the dorsal nasal surface. An additional discriminant analysis showed that profile shape predicted sex in 76 per cent of males and 79.6 per cent of females. There is significant sexual dimorphism in facial profile among middle-aged adults. Profile shape variation was associated to changes in lip protrusion, nasal protuberance, and chin projection.

The Difficult Neck Patient-Practical Management: A Personal Approach.

With increasing global trends in aesthetic surgery, the facial plastic surgeon will undoubtedly encounter a variety of patient types including those with more unfavorable underlying anatomy. The "difficult" neck represents a cohort of individuals that exhibit both anatomical and patient-related factors that may limit overall surgical improvement. Anatomical issues that contribute to the difficult neck include excessive fat ("heavy" neck), ptosis of deep structures, obtuse cervicomental angle, and abnormalities of the underlying skeletal framework, such as a low set hyoid and inadequate chin projection. It is important that these factors are recognized and highlighted preoperatively, and that surgery is tailored appropriately to the individual. Although satisfactory results can be achieved, these may be ultimately limited, and it is important that patients understand this. We will present a review of current thinking alongside our own practice in the identification and management of these "difficult neck" patients.

Vertical Maxillary Excess Complicated with Mutilated Dentition Treated by an Interdisciplinary Approach

Vertical skeletal dysplasia can lead to excessive lower facial height and maxillary teeth elongation with gum exposure. Patients usually have long face, steep mandibular plane angle, usually with mandibular retrognathism. The clinical manifestations include narrow nose, narrow upper dental arch, excessive incisal display, a significant backward and downward rotated mandible as well as vertical maxillary excess (VME). Traditional classifications which mainly based on sagittal jaw relation is inadequate in describing the vertical skeletal discrepancy. The patient also suffered from multiple missing posterior teeth, that requires an interdisciplinary dental care. The main treatment objectives are to normalize overjet and overbite, improve chin projection, reduce the gummy smile, and establish satisfactory occlusion with stable posterior support. A three-pieces Le Fort I with a unilateral posterior segmental maxillary impaction was done to correct the over-erupted molars. In the mandible, sagittal split osteotomies with genioplasty were performed. An esthetic improvement and balanced oral function were both achieved after all teeth being restored. The benefit of this comprehensive approach among orthodontist, oral surgeon and prosthodontist to correct a severe dentofacial deformity were also discussed.

Comparative evaluation of facial soft tissue characteristics inherited between parents and off springs in families native of Himachal Pradesh-A photographic study

The form and function of the craniofacial complex is determined by a complex interaction between genetic and environmental factors thus influencing facial morphology. Facial photographs taken in a standardized pattern assumes great significance in studying heritability of soft-tissue facial features between parents and their offspring. To evaluate the facial soft-tissue pattern of parents and their offspring with the help of standardized facial photographs and to find the degree of correlation between them. A total sample of 120 children within the age-group of 16-25 years and their parents were selected from ethnic Himachal Pradesh population. Standardized photographs (frontal and right lateral) of entire sample were taken and then traced. Twenty-four parameters involving linear and proportional measurements were measured. Statistically significant correlations between parents and their offspring were found for upper facial height, total facial height, lip length at philtrum, chin projection, upper lip to S line, Nasal prominence, true vertical to tip of nose, true vertical to subnasale, true vertical to pogonion, vertical lip-chin ratio. Stronger heritability was found between daughters to their mothers than to their fathers. Sons showed heritability from both parents for Upper lip prominence to E-line and True vertical to Subnasale. There was strong evidence indicating genetic contribution for both linear and proportional parameters. Highest correlations in inheritance of facial features was found between mother and daughter. Thus, parental data can be used to predict soft tissue facial form of offspring and information from siblings can also be used.

Reduction genioplasty for mandibular prognathism and long chin.

When evaluating patients' profile, surgeons usually note the lack of the chin projection and may suggest chin augmentation, but they rarely discuss reduction of an over-projecting chin. This is unfortunate, since there are quite many individuals who have macrogenia and would aesthetically benefit from corrective surgery, but the chin reduction is seldom offered. The reason for this is the lack of experience, lack of the technical equipment necessary, or sometimes lack of knowledge. The present study conveys 25 years of experience with the reduction genioplasty. From 1994 to 2019, 47 patients (39 females, 6 males, and 2 male to female transsexuals) underwent 49 chin reduction procedures. All patients were operated and followed up by the author. The transoral approach was used in 23 patients, and in 24 patients the procedure was done through the straight 4- to 6-cm-long submental incision. The air-driven pneumatic chisel was employed for reduction of the mandibular bone (MicroAire, Charlottesville, VA, USA). Forty-eight operations were carried out under dissociative and local anaesthesia on an outpatient basis, and one procedure was done under general endotracheal anaesthesia. Both mandibular bone and the soft tissues of the chin were reduced, or modulated according to the needs of each patient. Operations were technically easier when executed by the submental approach because of better exposure of the mandibular rim and the higher precision in the remodelling of the soft tissues. Thirty-six patients (77%) could be followed up for a mean of 2.5 years (range 9 months to 12 years). Twenty-eight of evaluated patients (78%) described the outcome as very good or good. Four patients described the result as acceptable and another 4 as bad. In the majority of cases the evaluation by the surgeon correlated well with the opinion of patients, but in five cases surgeon estimated result with the higher score than the patient. Overall good results were illustrated by the photographs of the clinical examples. Complications were few and manageable. Transient neuropathies were common and more frequent with the transoral approach. Five patients required minor intervention for skin indentations at the jaw line developed during the healing phase. Skilful chin reduction surgery is safe and the aesthetic improvement could be quite spectacular, which is also rewarding for the patients. Complications in this patient series were few and manageable. More surgeons should include chin reduction in their repertoire.

Variants in the Hippo Signaling Pathway are Associated with Craniofacial Skeletal Form and BMI

Childhood obesity rates in the United States have demonstrated a marked increase since the late 20th century. Current research has suggested that obesity can cause increases in bone density and an acceleration of skeletal growth. While studies have shown that obesity may be associated with altered craniofacial form, the mechanism and associated factors through which this interaction operates remains poorly understood. This study explores a potential link between obesity and craniofacial skeletal form as a function of the Hippo signaling pathway, an important regulator of organ size, tissue development, and craniofacial development.Lateral cephalograms from a sample of n=64 patients between the ages 7 to 17 were obtained from the Midwestern University Multispecialty Clinic. BMI percentile was computed for all children in the study following CDC guidelines (normal weight n=37, overweight n=9, obese n=18). 45 2D landmarks were registered via Generalized Procrustes Analysis (GPA) in order to facilitate a geometric morphometric (GM) analysis. Healthy Eating Index (HEI) scores obtained from Block Food Frequency Questionnaire (FFQ) surveys were used to control for the effects of diet in all subsequent analyses. Shape residuals were submitted to Principal Components Analysis (PCA) and Canonical Variate Analysis (CVA) to identify which aspects of skeletal form differentiate individual phenotypes based on BMI. Finally, associations between these phenotypes and 23 single nucleotide polymorphisms (SNPs) in seven genes within the Hippo signaling pathway were explored.Principal Components (PCs) accounting for at least 1% of facial shape variation were examined in order to determine components that differentiate between normal and obese groups. Based on this, suggestive/significant differences were found in PC 8 (p=0.056) and PC12 (p=0.012) based on BMI category. PC 8 (accounting for 3.6% of the total shape variation) indicates that chin projection, nose length, and mandibular morphology differentiate between normal and obese children. SNPs in TEAD3 (p=0.04) and FAT4 (p = 0.02) were significantly associated with shape variation along PC8. PC 12 (2.6% of the total shape variation) showed significant variation in chin projection and decreased incisor size in the obese group relative to the normal weight group. Additionally, a SNP within LATS2 (p = 0.04) was significantly correlated with shape variation along PC12. Finally, results from the CVA identified two components with CV2 indicating a significant relationship with LEF1 (p= 0.02). CV2 demonstrates increased facial projection in individuals with obesity.Across all analyses, we found a consistent pattern in mandibular length, facial projection, and incisor size that differentiated between normal and obese individuals. SNPs within key genes in the Hippo signaling pathway were associated with these phenotypes, indicating a potential causative relationship. Future studies will explore this relationship further.

VYC-25L Hyaluronic Acid Injectable Gel Is Safe and Effective for Long-Term Restoration and Creation of Volume of the Lower Face.

BackgroundJuvéderm Volux (VYC-25L; Allergan plc) is an injectable hyaluronic acid gel designed to restore and create facial volume.ObjectiveThe aim of this study was to evaluate the safety and effectiveness of Volux for chin retrusion over 18 months and after repeat treatment.MethodsThis prospective, single-blind, controlled study enrolled subjects aged ≥18 years with chin retrusion (glabella-subnasale-pogonion facial angle 145°-165°). Subjects were randomized (3:1) to Volux at study onset or 3 months later (control group), and could receive a single repeat treatment during months 18 to 24. Assessments included mean facial-angle change from baseline, Global Aesthetic Improvement Scale (GAIS) responder rates (improved/much improved), improvements in 3 subject-reported FACE-Q scales, and safety.ResultsOf 132 enrolled subjects, 119 received initial Volux treatment and 89 received repeat treatment. Mean changes (95% confidence interval) in glabella-subnasale-pogonion angle from baseline for treatment and control groups, respectively, were: 1.15° (0.75°, 1.56°) and 1.16° (0.57°, 1.75°) at month 18, and 3.14° (2.68°, 3.61°) and 2.72° (1.78°, 3.66°) 1 month after repeat treatment. Investigators rated 52.5%/60.0% of treated/control subjects at month 18 and 96.9%/100% after retreatment as GAIS responders; subject-reported rates were 62.0%/64.0% and 93.8%/100%. Durable improvements in Satisfaction with Chin, Satisfaction with Lower Face and Jawline, and Psychological Well-Being were reported in 82.1%, 78.2%, and 60.3% of subjects, respectively, at month 18, and 92.3%, 93.8%, and 67.7% of subjects after retreatment. The safety profile was as expected.ConclusionsVolux injectable gel is a safe, effective, and durable alternative to surgical treatments for increasing chin projection and jaw volume, and results in high patient satisfaction.Level of Evidence: 2

Chin Augmentation and Reshaping: Using Calcium Hydroxylapatite With Lidocaine (CaHA+) Filler

Adequate chin projection is associated with strength in the male jawline, youth in a female face, and a harmonious balance with the nose. Calcium hydroxylapatite plus integral lidocaine (CaHA+; Merz North America, Inc.) is a filler that has demonstrated immediate volume improvement for midface augmentation and for filling facial folds. There is a paucity of reports of the use of CaHA+ in the chin. The objective of this study was to assess the use of moldable CaHA+ injections to improve the chin profile. Twelve patients with microgenia were treated with CaHA+ chin injections for improvement of the chin profile. Deep, pre-periosteal, serial injections of CaHA+ were performed on the chin. Efficacy was assessed by the treating physician using sagittal profile views at 1-week, 1-month and 6-month follow-ups. Patients were monitored for complications. In total, 5 male and 7 female patients were treated to optimal enhancement of their chin profile. Average age was 47 years (range of 22-64 years). Patients received a mean total volume of 4.8 mL CaHA+. All patients were satisfied, and results persisted at the 6-month assessment. No complications were noted. CaHA+ can be used to augment the chin to enhance a recessed chin profile. This procedure is quick and effective, providing immediate results. Patients seeking a less-invasive alternative to surgery without the associated downtime may be ideal candidates for CaHA+ injections into the chin.

A Cross-Sectional Study to Understand 3D Facial Differences in a Population of African Americans and Caucasians.

Objective The purpose of this cross-sectional retrospective study was to use three-dimensional surface imaging to determine gender dimorphism and facial morphological changes from adolescence to adulthood in African American and Caucasian populations. Materials and Methods Three-dimensional images were captured and the total sample size included 371 subjects. Images were combined using Rapidform 2006 Plus Pack 2 software to produce a male and female facial average for each population. Comparisons were conducted within the following categories: (1) gender comparison within each race, (2) adult and adolescent comparison within each race, and (3) adult and adolescent comparison between the races. Results Adolescent gender comparisons within each race showed high percentages of similarity. However, adult females in both races showed more prominent periorbital, malar, and nasolabial regions and less prominent lower forehead, nose, and lower face compared with adult males of the same race. African American adult females showed increase in length and width of the face, increased nasal tip projection, and decreased periorbital regions compared with African American adolescent females. Welsh adult females had an increase in the nose and chin projection compared with Welsh adolescent females. Adult males of both races had increase in nose and chin projection, increase in length and width of the face, and decreased periorbital, malar, and nasolabial regions compared with adolescent males of the same race. African American adolescents had a wider alar base, more protrusive lips, and periorbital regions, and less prominent nose and chin compared with the Welsh adolescents. African American adults also had a wider alar base; more protrusive lips and periorbital regions; a broader face; and more retrusive chin, nose, nasolabial region; and lower forehead compared with Welsh adults. Conclusions Few differences were noted between genders within the same racial groups during adolescence. However, changes became more distinct in adulthood. From adolescence to adulthood, facial morphologies were similarly matched within the gender for females; however, there were significant changes for males. Lastly, facial morphology patterns tend to be established early in life.

A Validated Assessment Scale for Asian Chin Projection.

As the number of different aesthetic treatments increase, numerous photonumeric assessment scales have been developed and validated to measure the effectiveness of these new treatments and techniques. Photonumeric rating scales have been developed to objectively assess improvements in anatomical areas; however, these have been based on the features of Caucasian patients. To develop and validate a Chin Projection Scale for use in the female Asian patient population. During 2 validation sessions, 13 raters assessed full frontal and lateral facial views of 50 Asian subjects and also estimated their age and the aesthetic treatment effort required for each subject. Chin projection was rated on a scale from 0 (optimal) to 4 (very severely receding). Inter-rater reliability was 0.80 (substantial) for Validation Session 1 and 0.83 (almost perfect) for Validation Session 2. The results for Estimated Age and Estimated Treatment Effort were essentially the same. This study demonstrated the validity of the first photonumeric assessment scale for assessing the appearance of the female Asian chin. This new scale will provide a standardized measure of chin projection for Asian patients in clinical practice and clinical research settings.