Facial Plast Surg 2019; 35(02): 140-148
DOI: 10.1055/s-0039-1683854
Original Article
Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.

Nonsurgical Chin and Jawline Augmentation Using Calcium Hydroxylapatite and Hyaluronic Acid Fillers

Amir Moradi
1   Private Practice, Vista, CA, USA
Azadeh Shirazi
2   La Jolla Dermatology and Laser Surgery Center, La Jolla, CA, USA
Roy David
3   David and Rossi Cosmetic Surgery, La Jolla, CA, USA
› Author Affiliations
Further Information

Publication History

Publication Date:
03 April 2019 (online)


The shape of the jawline from the mandibular angle to its most forward point at the chin has a profound effect on an individual's appearance and is an area of concern for many seeking esthetic procedures. Dermal filler injections alone or in combination with other modalities, such as skin tightening energy devices, allow enhancement of the jawline while avoiding the need for surgical procedures. The authors introduce new anatomical zones and nomenclature to enhance safety and outcome when enhancing the jawline. Cadaver dissections were performed to better understand landmarks and potential risks and a topographic guide proposed to assist clinicians to create an esthetically pleasing jawline. Techniques for jawline rejuvenation with calcium hydroxylapatite (CaHA) and high G prime hyaluronic acid (HA) fillers are described. When considered as an esthetic unit, the jawline can be broken down into masseteric, buccal, and mental zones, each with their own injection protocols and safety considerations. Dermal fillers suitable for jawline rejuvenation include either CaHA with or without integral lidocaine, a high G prime HA filler, or a hybrid mixture of CaHA and HA, depending on the desired esthetic outcome and the individual's needs. Small volumes of product per injection point achieve the most natural esthetic outcome and minimize serious adverse events. With these techniques, the angle of the mandible is better defined, the pre- and postjowl hollows are filled, and as a result the jawline appears visibly straighter. CaHA and high G prime HA fillers are effective nonsurgical treatments for redefining the mandibular angle and straightening the contour of the jaw. For optimal results, the jawline should be considered as an esthetic unit and careful consideration paid to anatomical landmarks that influence efficacy and safety.

  • References

  • 1 Mommaerts MY. The ideal male jaw angle--an Internet survey. J Craniomaxillofac Surg 2016; 44 (04) 381-391
  • 2 Dallara JM, Baspeyras M, Bui P, Cartier H, Charavel MH, Dumas L. Calcium hydroxylapatite for jawline rejuvenation: consensus recommendations. J Cosmet Dermatol 2014; 13 (01) 3-14
  • 3 Agarwal A, Dejoseph L, Silver W. Anatomy of the jawline, neck, and perioral area with clinical correlations. Facial Plast Surg 2005; 21 (01) 3-10
  • 4 Park S, Lee TS. Strategic considerations for effective sagittal resection of the mandible to achieve a slim and attractive jawline. Plast Reconstr Surg 2018; 141 (01) 152-155
  • 5 Lemmon ML, Hamra ST. Skoog rhytidectomy: a five-year experience with 577 patients. Plast Reconstr Surg 1980; 65 (03) 283-297
  • 6 Terino EO. Facial contouring with alloplastic implants: aesthetic surgery that creates three dimensions. Facial Plast Surg Clin North Am 1999; 7: 55-83
  • 7 Joyce CW, Joyce KM, Rahmani G. , et al. Fat grafting: a citation analysis of the seminal articles. Plast Reconstr Surg Glob Open 2015; 3 (01) e295
  • 8 Coleman SR. Structural fat grafting: more than a permanent filler. Plast Reconstr Surg 2006; 118 (3, Suppl): 108S-120S
  • 9 de Maio M, Wu WTL, Goodman GJ, Monheit G. Alliance for the Future of Aesthetics Consensus Committee. Facial assessment and injection guide for botulinum toxin and injectable hyaluronic acid fillers: focus on the lower face. Plast Reconstr Surg 2017; 140 (03) 393e-404e
  • 10 Narins RS, Carruthers J, Flynn TC. , et al. Validated assessment scales for the lower face. Dermatol Surg 2012; 38 (2 Spec No.): 333-342
  • 11 Lee HJ, Won SY. , O J, et al. The facial artery: a comprehensive anatomical review. Clin Anat 2018; 31 (01) 99-108
  • 12 Furukawa M, Mathes DW, Anzai Y. Evaluation of the facial artery on computed tomographic angiography using 64-slice multidetector computed tomography: implications for facial reconstruction in plastic surgery. Plast Reconstr Surg 2013; 131 (03) 526-535
  • 13 Prendergast PM. Anatomy of the face and neck. In: Shiffman MA, Di Giuseppe A. , eds. Cosmetic Surgery Art and Techniques. Berlin, Heidelberg: Springer-Verlag; 2013. , chapter 2:29–45.
  • 14 Jones D, Moradi A, Narins R, Narurkar V, Flynn T. Development and reliability of a new Merz jawline grading scale for photographic and live assessments. J Am Acad Dermatol 2017; 76 (6, Suppl 1):AB98, Abstr. 5643
  • 15 Moradi A, Shirazi A, Moradi-Poehler J, Turner J, Howell DJ. A blinded, randomized, split-face pilot study of bruising and pain with hyaluronic acid for correction of perioral lines using no lidocaine, lidocaine alone, and lidocaine and epinephrine. Aesthet Surg J 2015; 35 (04) 443-455
  • 16 Simons RL. Adjunctive measures in rhinoplasty. Otolaryngol Clin North Am 1975; 8 (03) 717-742
  • 17 Yutskovskaya Y, Kogan E, Leshunov E. A randomized, split-face, histomorphologic study comparing a volumetric calcium hydroxylapatite and a hyaluronic acid-based dermal filler. J Drugs Dermatol 2014; 13 (09) 1047-1052
  • 18 Yutskovskaya YA, Kogan EA. Improved neocollagenesis and skin mechanical properties after injection of diluted calcium hydroxylapatite in the neck and décolletage: a pilot study. J Drugs Dermatol 2017; 16 (01) 68-74
  • 19 Baspeyras M, Dallara JM, Cartier H, Charavel MH, Dumas L. Restoring jawline contour with calcium hydroxylapatite: a prospective, observational study. J Cosmet Dermatol 2017; 16 (03) 342-347
  • 20 Juhász MLW, Marmur ES. Examining the efficacy of calcium hydroxylapatite filler with integral lidocaine in correcting volume loss of the jawline-a pilot study. Dermatol Surg 2018; 44 (08) 1084-1093
  • 21 Loghem JV, Yutskovskaya YA, Philip Werschler W. Calcium hydroxylapatite: over a decade of clinical experience. J Clin Aesthet Dermatol 2015; 8 (01) 38-49
  • 22 Buckingham ED, Glasgold R, Kontis T. , et al. Volume rejuvenation of the lower third, perioral, and jawline. Facial Plast Surg 2015; 31 (01) 70-79
  • 23 Braz A, Humphrey S, Weinkle S. , et al. Lower face: clinical anatomy and regional approaches with injectable fillers. Plast Reconstr Surg 2015; 136 (5, Suppl): 235S-257S