The Labiomental Fold in Chin Augmentation

The labiomental fold (the horizontal crease between the lower lip and the chin) is a critical anatomic and aesthetic consideration in chin augmentation, whether with implants, osteotomy, or fillers.

Below is a structured, surgical-focused explanation.

1. Why the labiomental fold matters

The depth and shape of the labiomental fold strongly influence:

• Lower facial balance
• Perceived chin projection
• Lip competence and lower lip posture
• Overall harmony between the lip–chin–jawline unit

An improperly managed labiomental fold can make a chin augmentation look artificial, aged, or dysfunctional, even if projection is technically adequate.

2. Ideal labiomental fold aesthetics

• Depth:
  • Men: slightly deeper is acceptable
  • Women: softer, more obtuse fold preferred
• Angle (labiomental angle):
  • Typically ~110–130°
• Continuity: Smooth transition from lower lip to chin, not a sharp step-off
• Symmetry: Especially important in frontal view

3. Effect of chin augmentation on the labiomental fold

A. Chin implants

• Increase fold depth if:
  • Implant is too large vertically
  • Implant sits too high
  • Soft tissue envelope is tight
• Improve fold if:
  • Horizontal projection is increased without excessive vertical height
  • Implant is placed low and centered on the inferior mandibular border

? Common pitfall: Over-projecting the chin without addressing soft tissue ? exaggerated “witch’s chin” or “button chin” effect.

B. Sliding genioplasty (osseous genioplasty)

• Most controllable method for fold management
• Can:
  • Advance chin without deepening the fold
  • Reduce fold depth by controlled vertical lengthening
  • Correct mentalis strain

Vertical lengthening often softens a deep labiomental fold, while pure advancement may deepen it unless planned carefully.

C. Fillers / fat grafting

• Useful for:
  • Mild chin deficiency
  • Isolated deep labiomental crease
• Technique matters:
  • Overfilling the fold directly can look unnatural
  • Better approach: structural chin support first, then subtle fold blending

4. Role of the mentalis muscle

The mentalis muscle is a major determinant of fold depth.

• Hyperactive or high mentalis insertion ? deep crease
• In chin surgery:
  • Improper mentalis resuspension can worsen the fold
  • Meticulous reattachment is essential
• Adjuncts:
  • Botulinum toxin can temporarily soften a deep fold
  • Useful diagnostically before surgery

5. Common problems & how to avoid them

6. Key surgical principles

• Chin projection alone is not enough—fold behavior must be predicted
• Evaluate the fold at rest and animation
• Vertical and horizontal changes affect the fold differently
• Sliding genioplasty offers the greatest control
• Mentalis management is as important as bone or implant choice

Dr. Barry Eppley

World-Renowned Plastic Surgeon