Does chin filler or an implant cause bone erosion?

Hello. I’m Dr. Jo Hyun-woo of Ipjeok Plastic Surgery.

About 2–3 years ago, a paper was published in China that caused a huge controversy.

This paper included the following image and stirred up a lot of debate because it warned that bone resorption or erosion could occur after getting filler injections.

Many people said it was written by a doctor in China with insufficient clinical experience, and many others thought it was impossible.

In fact, people who get filler injections frequently usually do not get CT scans like this, so there may not be many ways to know when something like this has happened.

So today, I’d like to share what I have thought about while looking at patients’ CT scans.

Please note that this is only my personal opinion.

These are CT scans of a patient who visited us after undergoing chin implant insertion.

If you look at the chin in the image, you can see that the bone has eroded in the shape of the implant.

For a closer look, if you view it from the side:

You can see that the bone has eroded in the same shape as the implant. Cases like this have existed for a long time, which is why implants were often considered risky.

In fact, the mentalis muscle in our chin is a very strong muscle.

The accepted explanation was that the implant placed under this muscle is compressed by the muscle, creating pressure that causes the bone to resorb and erode.

So does an implant always cause erosion?

Not necessarily.

The center of the chin bone has very thin cortical bone, so erosion can occur more easily there. However, we found through multiple CT scans and patient follow-ups that if the implant is fixed precisely to the lower border of the chin bone, there is less bone erosion.

Therefore, when patients get an implant, I recommend that it be fixed in place, and I believe that avoiding overly large implants can help make the procedure safer.

So how does bone erosion happen with filler?

There are also several theories in this case. People say it may be because a large amount of filler was injected, or because it was not molded properly and clumped together, and so on.

In my opinion, it seems this can happen even with a small amount and even when molding is done.

In fact, chin filler is injected into the center front area to create a V-line appearance.

Then why are both sides so sunken in?

Let me show you more CT scans taken at our clinic. As you can see in the CT images above, both sides of the chin bone are surprisingly sunken in like that.

This is an anatomical image of the chin muscles. If you look closely at the image above, the mentalis muscle in the front of the chin is sunken in following its own shape.

As the filler placed in the chin is drawn toward the mentalis area by muscle movement, the enlarged mentalis muscle causes erosion of the thin cortical area of the chin bone.

When performing chin surgery, we find that more patients than expected already have bone erosion.

Fortunately, since this is not an area where fixation pins need to be used, there is no major problem when advancing and fixing the chin bone after surgery. However, there are occasional cases where the erosion is so severe that surgery becomes difficult.

I also asked several other doctors about this, and they said that the exact cause or mechanism has not been clearly identified.

So I will cautiously share my opinion only through this column.

So far, I have talked about whether bone erosion can occur with implants and filler.

This is only my personal opinion, but thank you for reading.