CHIN PUCKERING AND DEEP LABIOMENTAL CREASE
The main cause is hyperkinetic m. mentalis. Its hyperactivity can provoke (willingly or unwillingly) appearance of localized dimpling or an overall puckering of the chin in a form of deep ridges and furrows while talking or making facial expressions. One is usually not aware of that except when others point it out to them. It mostly affects women.
Chin puckering can be quite troubling and it usually appears after chin augmentation procedure with an implant. When making a ‘pocket’ or implant bedding, the disrupted or moved threads of m. mentalis could not always be positioned at their exact pre-operation position. That can cause irregular crimping of the skin surface, either at rest or with each movement of m. mentalis.
In still another group of people, a hyperkinetic m. mentalis can cause deep fold at the intersection of the lower lip and chin (labiomental fold) that accentuates the frontal chin tip projection. An average viewer takes it as a sign of dotage or the so-called ‘’ witch’s chin ’’.
- mentalis is a short, stout, conical paired muscle of the chin, that originates from the anterior aspect of the mandible and inserts with multiple fibrous attachments into the skin of the apex of the chin.
How can we solve the problem?
- Two-point injection technique – if the patient has a central vertical mental cleft or a square chin, then 3-4 Botox units are injected into both sides, deep into the muscle at the chin tip.
- One-point injection technique – if the patient’s chin is narrow, rounded or pointed, then 4-6 Botox units are injected deep into the muscle into one site at the tip of the chin.
In both cases, Botox is injected quite away – under the labiomental fold.
SIDE EFFECTS are possible with inadequate injection techniques or when using inappropriate dilution of Botox.
If Botox doses are too high, they can provoke dribbling while drinking or drooling while at rest. Sometimes blurred speech or unclear sound pronunciation can occur.
If high doses of Botox are injected, or the technique is inappropriate it can result in Botox diffusion into orbicularis oris or depressor labii inferiors or both and cause motoric dysfunction of the lower lip and impaired labial sphincter.
RECOMMENDATIONS
- Botox treatment of the lower face should always include injecting m. mentalis.
- The use of Botox can prolong the effects of the soft tissue fillers in chin and around mouth areas.
- Quite often, when expressing certain feelings (sadness, doubt, despair) depressor anguli oris contracts jointly with m. mentalis, so that marionette line is accentuated. So it is recommended to treat chin wrinkling and marionette line during the same session.
- After the treatment, the intensive massage is not advised, as Botox may diffuse into the surrounding muscles and thus provoke unwanted consequences.