The popularity of injectable fillers has led some to consider and use their placement way below the skin level down to the bone. In essence, augmenting the bone with an injectable filler. For the cheek and chin area, this seems logical and, indeed, it can be done from a technical standpoint. The question is…is it a good idea?
I have used ‘injectable’ particle materials in the past for facial bone augmentation. At that time, I was occasionally using hydroxyapatite granules with collagen (avitene) powder to make an injectable paste. This was done through small incisions inside the mouth for cheek and chin areas and occasionally for some small forehead defects. The injected paste was mainly hydroxyapatite granules which are relatively permanent and do not dissolve and go away and very well accepted by the body. Furthermore, they became integrated on top of the bone amidst the scar that forms, becoming sort of part of the bone in a natural augmentation procedure.
Today’s injectable fillers, however, are not permanent and will go away, some sooner than others. But more pertinently, the sheer volume of material that it takes to make a difference at the bone level is significant. To really make a visible difference on the outside of the face, you have to add about 3 to 5 ccs at the bone level. You can quickly see that an injectable filler approach to bone augmentation is an expensive temporary solution. Traditional synthetic implants, or even old-style hydroxyapatite pastes are far more effective and are a better value for the money, even if it does requires a surgical procedure. But injectable filler can serve as as good initial test to determine if a more permanent chin augmentation would be beneficial.
Dr. Barry Eppley
Indianapolis, Indiana