In early June, St. Petersburg hosted the VIII International Training Course for Cosmetologists (IECTC-2018) on non-surgical methods of rejuvenation. The speakers of the event were leading experts in aesthetic medicine, who invited the guests to discuss the most pressing issues of aesthetic correction of the face and body. estet-portal.com offers readers an overview of Marina Soykher's presentation at the forum "An interdisciplinary view of undesirable phenomena in the aesthetic correction of the chin area".
What characteristics of the chin should be considered when choosing rejuvenation methods
A beautiful face of a person should have harmoniously developed and clearly defined features. One of the signs of a proportionally balanced face is high cheekbones and a slightly protruding chin.
Chin – this is the part of the face that is located downward from the lower lip. The shape of the chin is determined by the structure of the bones of the lower jaw and muscles – mental, square muscle of the lower lip and triangular, the amount of body fat, as well as facial factors.
To describe the features of the chin area, we use the following anthropometric indicators:
• height of the chin, which should be equal to the length of the eye;
• the length of the chin, which is equal to the width of the wings of the nose.
The individual harmony of the chin area depends on the so-called facial features:
• corner of youth – 90 degrees,
• labio-chin angle – 110-130 degrees,
• nasal-chin angle of Ricketts – 120-132 degrees.
The shape of the chin depends on the position of the lower jaw in space. It can be located distally and have a number of characteristic features. Why are we focusing on this particular class? Because in our population today, according to various authors, up to 83% of people have a distal type of location of the lower jaw. That is, patients with such facial features most often come to us with aesthetic problems.
When the lower jaw is pushed forward in relation to the upper one, we will also see a number of facial features that will characterize the patient's appearance.
Specific facial features that are important in the selection of rejuvenation methods
The position of the chin and its most protruding point are the basis for determining the so-called profile angle, which should be equal to 10 degrees. Then we see a beautiful chin in profile. But when this angle changes, we notice a number of specific facial features.
• If the profile angle is greater than 10 degrees, it is a convex profile. This may be accompanied by both a decrease in the height of the lower third of the face, and a sign characteristic of it – pronounced chin fold. In this case, both a decrease and an increase in the lower third of the face can be observed. And for this aesthetic problem, the state of hypertonicity of the chin muscle and a decrease in the tone of the circular muscle of the mouth are very important.
• If we have an increase in the height of the lower third of the face and a convex profile, then here, on the contrary, against the background of hypertonicity of the chin muscle, we also see hypertonicity of the circular muscle of the mouth.
• When the profile angle is less than 10 degrees, we have a concave profile, which can be accompanied by both an increase in the lower third of the face, and a decrease.
What is the practical significance of this information? When using a 15 mm needle in patients with a small chin, inadvertent insertion is possible or diffusion of the toxin into the orbicular muscle of the mouth. The distance from injection points to the lower lip should be at least 2 cm to prevent diffusion of the toxin into the orbicular muscle.
What practical points are important to consider when correcting the chin area
The depth of the chin crease is of great aesthetic importance. How to define it? From the point at the base of the nose (the deepest) we draw a perpendicular line to the most protruding point on the chin. If this distance is 4 cm, then this is the average depth of the chin crease, if more – then this is a deep chin crease.
The depth of the labio-chin sulcus depends on the malocclusion in the vertical or sagittal plane.
In the area of the chin, with a moderate thickness of the dermis, the epidermis layer is much larger than on other parts of our face. The boundary between the dermis and the epidermis forms an uneven line where the connective tissue fibers are compact and penetrate the hypodermis.
Read also: Perfect chin without surgery: Radiesse features for facial correction
Why is this important in practice? The skin is thickened, inactive due to fibrous cords going deep. They permeate the subcutaneous fat. In this regard, hematomas and inflammatory processes are limited here.
When carrying out procedures, it must be remembered that in this area there is an intensive blood supply (facial and hypoglossal arteries), innervation is represented by the system of trigeminal and facial nerves. The maxillofacial nerve carries innervation from the skin of the chin to the lower anterior teeth and the medial portions of the submandibular triangles.
Deep injections in the projection of the neurovascular bundles can lead to vascular compression and blood supply disturbance, can be painful and cause changes in skin sensitivity.
How to classify sensory and pain disorders in the perioral region due to damage to the mental nerve:
• 7-10 days after manipulations in the area of the lower lip and chin, monotonous pains occur that radiate to the area of the frontal teeth on the lower jaw;
• sensory disorders – crawling sensation, itching, areas of numbness;
• feeling of the patient – debilitating ache in chin region;
• the pain gradually regresses, but slowly.
Violations in this area can occur not only from the injections that you give, but also dental procedures. And most importantly, the presence of chronic foci of infection can complicate the course of postoperative processes. Therefore, before you plan an aesthetic correction, it is advisable to refer the patient to a dentist in order to exclude an odontogenic infection.
Principles of safety of botulinum therapy in the chin area:
• Narrow Therapy Window
• equal dose and symmetry rule;
• small volumes;
• Strict adherence to the recommended needle orientation.
We must first analyze the individual characteristics for each patient and follow strict rules for the introduction of the drug in this area. Chin muscle – the deepest. If we inject the botulinum toxin preparation more superficially, then it can diffuse into the region of the muscle that lowers the lower lip, the relaxation of which will lead to functional and aesthetic disorders. Similar complications can be obtained when using diluted solutions of botulinum toxin. Because the mentalis muscle has a small volume, and the introduction of a large volume of saline can lead to its spread into the orbicularis muscle of the mouth.
Read also: Why a second chin is formed and how to get rid of it
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