Problem Area: Dimpled and Recessed Chin
Some may never even notice this problem area, but if you are self conscious about your chin to begin with this could be a game changer for you. It's funny because I never looked at chins as often as I do now thanks to my partner in crime. My mentors chin obsession (dramatic connotation, I know) started with her own chin and quickly trickled down to anyone in her line of sight. But you know what...she's spot on that a good chunk of our patients have weak chins. On top of having a weak chin, meaning a lack of appropriate projection in profile view, we contract the mentalis muscle and make it even weaker...and the skin looks dimpled, bumpy, and unattractive. This fix is as simple as our last post about the nasalis muscle. If I'm using filler in the chin to give more projection, I like to also do neurotoxin to keep the muscle activity quiet. It is not necessary to do both if you find that projection isn't an issue, just skin dimpling. When consulting with a patient, it's helpful to talk about what that patient's concerns are first and then build on that by giving your opinion and expertise in relation to their problem areas. I know I'm getting a little ahead of myself, maybe our conversation here was a bit of a tickler. For the purpose of this post, we are going to talk about treating the muscle contraction that causes the dimpled chin...the mentalis...and no, autocorrect, I'm not trying to type mentalist!
The Fix: Neurotoxin
To treat this we would use a neurotoxin to temporarily weaken the muscle contraction. Botox or Dysport are good choices for this treatment area. An average dose for females for the mentalis is 4-8 units of Botox or 10-20 units of Dysport.
The result is not seen immediately. It takes 2-3 days for the neurotoxin to uptake into the muscle. The product is completely active at 2 weeks out. On average, the result lasts for 3-4 months. I tell my patients to budget for their treatment 3-4 times a year, if they want to keep the results up. Some patients are able to stretch their appointments out and others have to come in sooner. Metabolism, skin quality and condition, under-dosing, and overall desired result can have an impact on how often you will have a treatment.
If you've read my other posts, you'd find that the paragraph above is repeated every time I discuss a neurotoxin onset and result. From personal experience, not only on myself but coworkers that I see or talk to daily, when the mentalis is treated with a neurotoxin it onsets in a unique way. On myself, I noticed my chin bunched up and contorted in ways I've never seen during the onset process in other facial muscles. It appeared to uptake on one side quicker than the other, which can happen with a split muscle like the mentalis. Once I hit the two week mark, things were looking great. Just a heads up in the event that you experience this and/or you can preemptively talk about this point with your patients. At first you'll think that you just need to add more product, but give it the full two weeks before you get trigger happy.
If you've read my other posts, you'd find that the paragraph above is repeated every time I discuss a neurotoxin onset and result. From personal experience, not only on myself but coworkers that I see or talk to daily, when the mentalis is treated with a neurotoxin it onsets in a unique way. On myself, I noticed my chin bunched up and contorted in ways I've never seen during the onset process in other facial muscles. It appeared to uptake on one side quicker than the other, which can happen with a split muscle like the mentalis. Once I hit the two week mark, things were looking great. Just a heads up in the event that you experience this and/or you can preemptively talk about this point with your patients. At first you'll think that you just need to add more product, but give it the full two weeks before you get trigger happy.
Anatomy Lesson: Mentalis
Your mentalis muscles elevates the chin and wrinkles and dimples the attached skin. It straddles either side of the midline of the chin. Feel the muscle contract under your fingers during your assessment. As you saw on the patient photos above, in anterior view the chin is dimpled and looks like she's pouting or about to start sobbing. The second set of photos with the chin in profile view, her chin looks recessed and weak due to the muscle contraction.
Treatment Pattern: Two Pokes
To successfully treat the mentalis, plan for two pokes from the injection needle. One poke on either side of the midline of the chin. Feel for the muscle activity underneath and plan your treatment accordingly. General rule of thumb with any neurotoxin treatment...you can always add more at a two week follow up visit.
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