Table 4.

Strategies for volume restoration and contouring in the lower face with HA

Treated area	Preferred product	Technique	Dosinga (per degree of severity of deficit)	Needles/cannulae (gauge and length)
Chin	LMWHA/HA	Layering technique Inject on periosteum for lift and fill Subcutaneous injection to correct irregularities	HA Mild: 1 cc Moderate: 2 cc Severe: 3 cc	27–30 gauge ½” 22 or 25 g cannula
TIPS/PEARLS	Chin continues to pre-jowl sulcus and must blend into this area In all cases, consider a neuromodulator to treat the “apple core” chin, mental crease and to increase the longevity of the HA Volume is usually necessary over the entire chin zone extending into the NL as well as the pre-jowl sulcus (PJS)
Pre-jowl sulcus/marionette	LMWHA/HA	Deep on bone and subcutaneous	HA Mild: 0.5 cc/side Moderate: 1 cc/side Severe: 2+ cc/side	27–30 gauge ½”–1” 22 or 25 g cannula
TIPS/PEARLS	Have the patient sit vertically (90 degrees) so that the lower face is accentuated (fewer re-touches required) Palpability of product may be increased in this area (patient should be informed beforehand); consider manual manipulation to avoid this Only soft tissue around the mouth; no bony prominence to lay the product on Caution not to masculinize the female face
Post jowl sulcus, mandibular angle and preauricular	LMWHA/HA	Deep subcutaneous	HA Mild: 1–2 cc/side Moderate: 2–3 cc/side Severe: 3–4 cc/side	27 gauge ½”–1½” 22 g or 25 g cannula
TIPS/PEARLS	Caution not to masculinize the face Do not inject into the parotid gland Mold, blend and feather

Note:

^aGeneral dosing range based on consensus group experience.

Abbreviations: HA, hyaluronic acid; LMWHA, low-molecular-weight hyaluronic acid.