Understanding The Anterior Chin: The Upside Down U

Aging of the chin area is one of the most confusing areas because people I believe focus on the wrong thing. Most oftentimes the concern is about a jowl or about a sagging puppet line. Alternatively, it is about the fine lines that can circumscribe the lips, also known as smokers’ lines. Although these problems can be important, we oftentimes really have no understanding of how the chin ages as we go forward from the late 30s and beyond.

The bony quality of her anterior chin is truly what makes her not look youthful. Filling this upside U deformity should be a part of a larger strategy of facial rejuvenation.

I have devised a way of evaluating aging of the chin that I think has revolutionized the way that I perform fat grafting, fillers and facelifts.  In any of these three strategies, I always look at the empty area in the front of the chin that arches from the area just in front of the jowl arcing upward toward the central chin then arcing back down to the other area in front of the jowl (or prejowl), which I call the upside U since that is the shape of it.  I am not specifically talking about the chin crease that sits in the middle of the chin that runs horizontally halfway between the lower lip and the jawbone.  However, the hollowness that occurs with aging does run right through this area but the goal is not to get rid of the crease.  The goal is to fill the bony hollowness that occurs there with aging.

What is interesting is that many surgeons use chin implants to make a face look younger.  I completely disagree with this approach. Chin implants further accentuate the bony jawbone and thereby further hollow the upside U, at least in the central limb of the U.  Therefore, chin implants are not a good idea to correct aging. (They are great for people with weak chins though.)

In order to understand how the upside U really develops as you age, just go back and look at your photos from your 20s and then each decade afterward.  You will see that you become hollower and hollower every 5 years in the central front part of the chin until your lower bony chin sticks out so much that it looks almost as if you have a chin implant there.  If this is confusing, I always encourage you to bring in your old photographs with you during your consultation so that I can help point out to you those changes and how best that I can help you correct and soften those elements of aging.

Samuel M. Lam, MD, FACS is a board certified plastic surgeon in Dallas, Texas. To learn more about Dr Lam’s chin augmentation procedures please visit our website www.LamFacialPlastics.com or call 972.312.8188 to schedule a consultation.