title: Achieving Ideal Lower Face Aesthetic Contours: Combination of Tridimensional Fat Grafting to the Chin with Masseter Botulinum Toxin Injection.
abstract: BACKGROUND
  Lower face aesthetic contouring is in high demand among Asians with wide and short faces desiring a slim lower face. For this purpose invasive mandible angle reduction and genioplasty are complex procedures with significant risks and downtime. Non-invasive botulinum toxin A injection into bilateral masseters - while popular for lower face contouring - does not address facial length deficiency in wide and short faces. Autologous chin fat grafting is a simple minimally-invasive technique for facial lengthening.
  
  
  OBJECTIVE
  We present our experience pairing chin fat grafting and masseteric botulinum toxin injection for effective lower face contouring.
  
  
  METHODS
  Thirteen consecutive patients with relatively wide and short faces underwent chin fat grafting and 1 to 3 serial masseteric botulinum toxin A injections. Mean follow up after final intervention was 20 months (range, 6 months to 3 years).
  
  
  RESULTS
  The postoperative mean ratio of bigonial distance to total facial height improved from 0.599 to 0.569 (P < .01), closer to the ideal ratio of 0.561. The mean ratio of upper lip length to lower lip and chin length improved from 0.611 to 0.560 (P < .01), nearing the ideal 0.542. Postoperative lateral profile in all was ideal. There were no complications at follow up. Results were durable at latest follow up and most were satisfied with their final appearance.
  
  
  CONCLUSIONS
  Combined tridimensional chin fat grafting and botulinum toxin masseteric injection is an effective, simple, fast, inexpensive, safe, and minimally-invasive strategy for aesthetic lower face contouring of short and wide faces, with short downtime, long-lasting results, and high patient satisfaction.
  
  
  METHODS
  4 Therapeutic.
authors.affiliation: Dr Chang is an Attending Surgeon, Craniofacial Research Center, Craniofacial Surgery, Department of Plastic and Reconstructive Surgery, Chang Gung Memorial Hospital, Linkou, Taiwan; and a Faculty Member, Department of Chemical and Materials Engineering, College of Engineering, Chang Gung University, Taoyuan, Taiwan. Dr Kang is an Attending Surgeon, Craniofacial Research Center, Craniofacial Surgery, Department of Plastic and Reconstructive Surgery, Chang Gung Memorial Hospital, Linkou, Taiwan; and an Attending Surgeon, KK Women's and Children's Hospital, Department of Plastic, Reconstructive, and Aesthetic Surgery, Singapore.
authors.forename: Chun-Shin
authors.initials: CS
authors.lastname: Chang
authors.affiliation: Dr Chang is an Attending Surgeon, Craniofacial Research Center, Craniofacial Surgery, Department of Plastic and Reconstructive Surgery, Chang Gung Memorial Hospital, Linkou, Taiwan; and a Faculty Member, Department of Chemical and Materials Engineering, College of Engineering, Chang Gung University, Taoyuan, Taiwan. Dr Kang is an Attending Surgeon, Craniofacial Research Center, Craniofacial Surgery, Department of Plastic and Reconstructive Surgery, Chang Gung Memorial Hospital, Linkou, Taiwan; and an Attending Surgeon, KK Women's and Children's Hospital, Department of Plastic, Reconstructive, and Aesthetic Surgery, Singapore.
authors.forename: Gavin Chun-Wui
authors.initials: GC
authors.lastname: Kang
mesh_terms: D065087:Acetylcholine Release Inhibitors / Q000008:administration & dosage*; D000273:Adipose Tissue / Q000637:transplantation*; D000328:Adult; D059925:Anatomic Landmarks; D001905:Botulinum Toxins / Q000008:administration & dosage*; D002680:Chin / Q000601:surgery*; D003357:Cosmetic Techniques; D004954:Esthetics; D005260:Female; D006801:Humans; D007273:Injections, Intramuscular; D008406:Masseter Muscle / Q000187:drug effects*; D008875:Middle Aged; D017060:Patient Satisfaction; D019651:Plastic Surgery Procedures / Q000379:methods*; D012189:Retrospective Studies; D013997:Time Factors; D014182:Transplantation, Autologous; D016896:Treatment Outcome; D055815:Young Adult
chemical_list: D065087:Acetylcholine Release Inhibitors; D001905:Botulinum Toxins