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Botulinum toxin to treat dimpling of chin appears effective, safe

Article-Botulinum toxin to treat dimpling of chin appears effective, safe

Key iconKey Points

  • Certain facial mimicking causes contracture of muscles around chin, resulting in "cobblestoning" of tip of chin over time
  • Injections of botulinum toxin must be carefully placed to avoid adverse events, such as drooping of lower lip

Treating chin dimpling can be a challenge, but a simple therapeutic approach using botulinum toxin coupled with a change in mimicking habits by the patient proves to relax the musculature in the chin area, resulting in significant, lasting aesthetic improvements.

The aesthetic indications for which botulinum toxin is used are always expanding. A little-known indication for botulinum toxin is for the aesthetic treatment of the "golf ball," or "orange peel," chin. This is a typical condition seen in people with certain facial mimicking that causes a contracture of the muscles around the chin. This predictable and recurrent habit results in an aesthetically unwanted dimpling, or "cobblestoning," of the tip of the chin over time.

Dr. Schlessinger
"'Golf ball' chin is a fairly uncommon but a very treatable condition," says Joel Schlessinger, M.D., F.A.A.D., F.A.A.C.S., president of, Omaha, Neb. "A few strategically placed injections of Botox (onabotulinumtoxinA, Allergan) or Dysport (abobotulinumtoxinA, Medicis) in the chin area can decrease or eliminate chin dimpling. The toxin effects a forced relaxation of the muscles of the chin and can smooth out the dimpling very effectively." For chin relaxation, Dr. Schlessinger typically uses 10 units of Botox, placing injections at four injection points including the depressor anguli oris (DAO), the midline of the chin and the mentum. According to Dr. Schlessinger, it is best to inject fairly superficially in order to avoid any deeper nerves.

CAREFUL TECHNIQUE Physicians need to carefully place the injections, as a potential adverse event could be a drooping of the lower lip. The relaxation of the muscles of the chin can last approximately three to six months, and in many cases, a one-time treatment suffices.

"I have performed this simple aesthetic procedure in hundreds of patients where necessary or indicated, and have achieved excellent cosmetic results in my patients," Dr. Schlessinger says.

Many physicians do not recognize that this entity exists, and mistakenly try to fill the dimple with hyaluronic acids or other fillers. They mistakenly believe they can impact a positive aesthetic outcome using fillers. Moreover, repeatedly injecting the chin area with fillers can be very costly to the patient, compared to a one- or two-time treatment with botulinum toxin.

"The cosmetic outcomes are very much appreciated by the patient, especially since many dermatologists and cosmetic surgeons either do not understand or do not know how to properly approach this condition. They usually try to fill it, which never works adequately," Dr. Schlessinger says.

PAIRING WITH FILLERS According to Dr. Schlessinger, the chin area can be treated with botulinum toxin in combination with fillers such as Restylane (hyaluronic acid, Medicis) to enhance the overall aesthetic outcome of the area. Maintenance treatments can be performed twice a year; however, the frequency of needed touch-up treatments depends greatly on the patient's degree of success in altering the mimicking habits and actively relaxing the muscles in the chin area.

While botulinum toxin can force a more aesthetically acceptable cosmetic result, a permanent cosmetic benefit will likely result if the patient can concomitantly change the habit of holding the chin in this manner.

"We do not know all that we think we know about Botox and Dysport in terms of their potential indications in the cosmetic arena. There are new and evolving indications for botulinum toxin in the aesthetic field, and its use in relaxing the chin musculature, effectively treating the dimpling of the chin, is just one example of botulinum toxin's therapeutic spectrum," Dr. Schlessinger says.

Dr. Schlessinger is a speaker for Allergan and Medicis.

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