Chin reinforcement using the hyaluronic acid injectable filler VYC‐20L and VYC‐25L

The chin is an essential element of the facial unit and influences how people perceive facial aesthetic appeal. Hyaluronic acid (HA) gel injections are tried‐and‐true therapies for regenerative therapies with a record of success in efficacy and safety.


| A C A S E
A 35-year-old man with retro-ganthia proffered to the outpatient department, science birth.He was class I occlusion.He has lip incompetence.The lower third of the face's height is small regarding facial proportion.The parameters were as following: No facial asymmetry.Labiomental angle = 140°, Cervicomental angle = 130°, Riedel line and nose-chin line not harmonized.The best soft-tissue reference plane to quantify chin assessment is E-line (Figure 1).
Labiomental angle formed by the lower lip and chin, and it was determined by the lower incisor orientation and anterior lower face height (110-130° is the average).Cervicomental angle is ideally 105-120°.Riedel line: in overall, the lower lip must be 2-3 mm posterior to the upper lip, and the pogonion shouldn't ever protrude outside this line.Nose-chin line (E-line): the chin projection must preferably be 3 mm posterior to a line drawn in the nose-lip-chin plane.

| ME THOD
The face was washed properly prior to the actual injection.An anesthetic topical cream was applied for 20-30 min to ease the pain.
At the moment of the intervention, the patient was semi-recumbent.
The injection sites were thoroughly cleaned with a topical antiseptic solution.The chin and surrounding zones were sanitized twice with ethanol.
First, VYC-25L HA was implanted as a bolus technique into the C2-5 at the supraperiosteal plane using a 27-gauge needle (Figure 2). 80.5 mL bolus was implanted into each point on both sides.The goal of this intervention was to enhance the volume and contour of bone in the paragonion region and define the transverse width of the mentum.
Second, VYC-20L HA was administered subcutaneously into C1, C6, JW4, and JW5 using a round-tip 25-gauge, 3-cm cannula (Figure 2). 8The cannula was inserted at the junction of the upper and middle thirds, just lateral to the marinate line, and 0.5 mL was injected on both sides.A fanning technique was used.The goal of this inoculation was to enhance the volume of soft-tissue, slacken the contouring, and sleek the chin transformation.An aspiration test was conducted for a minimum 10 s prior to internention, as well as during the filling process.To verify the destination and protect product outflow into the inferior border of the mandible, the index finger of the other hand was positioned at the inferior edge of the mandible.The skin's color scheme was noticed, and the regional pressure was palpated well with a finger.The administration was instantly stopped if there was an unusual response, such as unexpected pain or local bleaching.To reduce bruising, instantaneous pressure was applied to the injection site for 5 min, followed by an ice compress for 20 min.Fortunately, no adverse effects were observed.
The consequences were assessed instantly following the injection, and after 6 months, side effects were noticed and recorded.
The patient was encouraged to return for a check-up if he encountered any issues or consequences.

F I G U R E
After 6 months of intervention from the second intervention visit, the parameters were as follows: Labiomental angle = 110°, Cervicomental angle = 125°, Riedel line, and nose-chin line harmonized than before (Figures 3-5).

| DISCUSS ION
The labiomental groove apically, the labiomandibular sulcus sidewards, and the submentocervical groove caudally specify the chin. 9ooth chin and jawline are regarded as aethetic requirements and could impact psychosocial well-being. 10l chin enhancement methods were intended to modify or imitate the perfect aesthetic shape.Aesthetic implants and surgical genioplasty are more comprehensive procedures that can rectify all deficits.Each of these surgical techniques requires intensive dissection, which increases the risk of serious complications up to 7.2%. 11The most prevalent chin implant-related consequence was bone resorption or erosion, rejection of implant or migration, subsequent to displacement, asymmetry, scar formation, dissatisfaction, second infection, hematoma, resorption of bone, mucosal irritation, nerve injury, pain, and lasting chin alteration that may not look real. 11,12tologous fat grafting-related complications such as intravascular injection or migration necessitate neurological or neurosurgical intervention and frequently result in long-term damage or death.Fat hypertrophy, necrosis, cyst formation, abnormalities, and asymmetries necessitate restoration.Prolonged edema or erythema require no surgical intervention.Despite the fact that the total complication rate for face fat grafting is estimated to be around 2%. 13 HA injection, on the other hand, provides a temporary nonsurgical option that necessitates no incisions or general anesthesia and enables individual to resume work on a few hours.For even more than a decade, HA has been used to correct vertical, sagittal, and transverse chin deficits, in addition, to treating adjoining constructions such as the nose and lips.Some of the following problems were reported which is not serious (36.4%): bruising and hematoma, swelling and edema, erythema and redness, discomfort, and tenderness in the injection site.All of the reported problems had no effect on the injection procedure. 14Four cases had serious complications, including persistent unilateral sensations of paresthesia of the tongue, cutaneous necrosis, and increasing ulceration. 14,15yomodulation involves strategically placing dermal filler near the facial mimicry or sphincter muscles, whether to accommodate or inhibit muscle action. 16Convexity in the overburdened muscles is caused by the deep, profound fat partitions of the face. 17This convexity is dropped as fat and bone regress with age, causing muscle straightening, and a stronger influence of oppositional depressors. 16 a result, a bolus of filler underneath the muscle just next to its origin could replace the mechanical stability dropped from adipose and osseous tissues.The filler gives a central axis, attempting to recreate the muscle's convexity and strain and, thus, a rising force of contraction or trying to restore tonus at rest. 16Muscle action is restricted by filler placed superficially on the muscle in the subcutaneous tissue or intramuscular injections.Muscle action can also be reduced by introducing filler near the muscle's skin insertion. 16e multidimensional plane approach is an injection approach that relies on morphological rationale.A variety of substances can be utilized, depending on the plane of injection and their elasticity, to get a natural result with minimal adverse effects. 18C 25L with a high G* is suitable for injection into bone (supraperiosteum) and static deep fat compartments.Injecting on the bone to maximize vertical tissue expansion while minimizing lateral spread.This is for restoring form and strength.If injected in the superfacial plane, it will cause clumping and swampy swellings.VYC 20L with moderate G′ and G″ is utilized to provide adequate material distribution across the superfacial planes for the superfacial dynamic fat compartment, with a filling effect that can be improved with a delicate massage for contouring and a natural appearance.It is our belief and experience that if it is injected in a deep plane, it will not be able to reestablish or persist as long as it does not withstand muscle shearing.

F I G U R E 2 MD codes anatomical correlates and in relation to
We believe that injecting VYC 25L in C2-5 in the supraperiosteal plane with a needle yields better outcomes and improves chin topography.VYC 20L, on the contrary hand, is preferable for normalizing the shape in smooth lines when used subcutaneously in C1, C6, JW4, and JW5.We do not advise using VYC 25L superficially above the muscle or with a cannula for injection, and we also do not recommend using VYC 20L in the supraperiosteal plane.VYC-25L improved lift and projection to the midface when compared to HA gels crafted for wrinkle and fold correction.

| CON CLUS ION
We advise using VYC 20L superficially above the muscle or with a cannula for injection, and we recommend using VYC 25L in the supraperiosteal plane.This approach may be beneficial for individuals with a mild form of retrogenia, but it is not appropriate for individuals with a moderate form, microgenia, labiomandibular, or prejowl groove, which require more detailed therapies.

FU N D I N G I N FO R M ATI O N
There are no sponsors or funds for the research, and the author supported it.

CO N FLI C T O F I NTE R E S T S TATE M E NT
There are no conflicts of interest.
1 [A, before injection] yellow line: Labiomental angle = 140°, Blue line: Cervicomental angle = 130°, Red line: Riedel line, the lower lip anterior 2-3 mm to the upper lip, and the pogonion >2 cm behind this line.Black line: nose-chin line (E-line), the pogonion >2 cm behind this line.[B, immediately after the first injection] yellow line: Labiomental angle = 120°, Blue line: Cervicomental angle = 130°, Red line: Riedel line, the lower lip anterior 2-3 mm to the upper lip, and the pogonion <2 cm behind this line.Black line: nose-chin line (E-line), the pogonion >1 cm behind this line.[C, immediately after the second injection] yellow line: Labiomental angle = 110°, Blue line: Cervicomental angle = 120°, Red line: Riedel line, the lower lip anterior 2-3 mm to the upper lip, and the pogonion <2 cm behind this line.Black line: nosechin line (E-line), the pogonion within this line.[D, after the second injection] yellow line: Labiomental angle = 110°, Blue line: Cervicomental angle = 125°, Red line: Riedel line, the lower lip anterior 2-3 mm to the upper lip, and the pogonion <2 cm behind this line.Black line: nosechin line (E-line), the pogonion within this line.

8 F I G U R E 3
the topographical anatomy of the chin (b).Red codes denote alert areas.Anterior view of the patient.[A, before injection], [B, immediately after the first injection], [C, immediately after the second injection], and [D, after the second injection].

F
I G U R E 4 45° view of the patient.[A, before injection], [B, immediately after the first injection], [C, immediately after the second injection], and [D, after the second injection].F I G U R E 5 Lateral view of the patient.[A, before injection], [B, immediately after the first injection], [C, immediately after the second injection], and [D, after the second injection].The best soft-tissue reference plane to quantify chin assessment is E-line.