46 Fat Grafting to the Chin

Rod J. Rohrich and Raja Mohan

Abstract

One major adjunct in facial rejuvenation is autologous fat transfer or facial fat grafting to various facial fat compartments of the face (Fig. 46.1). One important region to consider is the chin where deep rhytides are often seen in the aging face. Some patients may have mild microgenia. Autologous fat grafting to this region adds volume to areas that are hollow or have become deflated. It can also add volume to patients who have microgenia.

Fat grafting – chin augmentation – facial aging – fat transfer

46 Fat Grafting to the Chin

**Fig. 46.1** Fat compartments of the lower face. (Reproduced with permission from Pessa JE. Facial Topography. Thieme; 2012.)

Key Points

Fat grafting to the chin is a useful adjunct in facial rejuvenation and does not carry the risks of implant-based or osseous genioplasty.
Autologous fat grafting to the chin is indicated in patients with mild microgenia or facial rhytides requiring volumization.
This technique also helps to address asymmetries and contour irregularities that cannot be adequately corrected by chin implants.

46.1 Preoperative Steps

46.1.1 Analysis

A thorough preoperative analysis of the lower third of the face to identify areas of volume deflation and tissue laxity is performed.
Areas of volume deflation as well as deep rhytides are marked preoperatively in the mental region to determine areas requiring volumization.
Microgenia is assessed based on a plumb line drawn from the upper lip to the menton.
When analyzing the lip–chin relationship with this plumb line, patients with mild underprojection (<5 mm) are good candidates for autologous fat grafting to the chin.

46.2 Operative Steps

See Video 46.1 and Video 46.2.

46.2.1 General Technique of Autologous Fat Harvest and Transfer

Adipose tissue is harvested from the medial thighs using a 10-mL syringe with a 14-gauge (3 mm multihole) cannula.
No wetting or infiltration solution is used for the harvest.
The harvested lipoaspirate is centrifuged at 2,250 rpm for 1 minute followed by removal of the infranatant and supernatant to isolate the fat for transfer.
The harvested fat is collected in 1-mL syringes.
For any facial fat compartment, the 1-mL syringe with the harvested fat is connected to a 16-gauge blunt cannula and injected at a low pressure with anterograde and retrograde motions.

46.2.2 Injection Technique for Mental Region

Using a 1-cc syringe attached to a 16-gauge blunt cannula, small aliquots of fat are transferred to areas of the mental region requiring volumization.
Common areas to address are the labiomental sulcus, lateral chin hollowing, and midline cleft.
The access sites are the midline to address a midline cleft or bifid chin. Two lateral sites are used to address lateral chin hollowing. One site laterally is used for the labiomental crease.
To treat the midline, augmentation is performed by depositing fat (approximately 1–2 cc) above the periosteum. The cannula is then pointed laterally to treat areas lateral to the midline and approximately 1 to 2 cc is deposited.
The lateral chin hollows are accessed laterally and 2 to 3 cc of fat is transferred to these areas in a radial and longitudinal manner.
For a deep labiomental sulcus, 1 to 2 cc is injected to fill this depression.
Autologous fat can also be transferred along the inferior and lateral mandibular border if needed.
In general, fat concentrate of 1 to 2 mL is placed in each region and overcorrected by 50% in women and 100% in men.
Areas of fat transfer should be massaged and molded to achieve uniformity and symmetry.