Strawberry chin

Individual cost plan after consultation

Strawberry Chin — the dimpled, restless chin surface from a permanently tensed chin muscle. Botulinum toxin type A relaxes it with a small dose (consensus: 6–8 units total), deep at the bone, at a distance from the lower lip depressor. The muscle is dome-shaped in 86%, flat in 14% — visible on ultrasound. No substitute for chin augmentation when the chin is too short. Treatment by a board-certified anesthesiologist.

Expression lines · Mentalis muscle · Chin

Strawberry Chin

An overactive chin muscle pulls together the skin above it — creating the dimpled, restless surface many notice on themselves while speaking or thinking. Botulinum toxin type A relaxes this muscle with a small dose. The chin becomes smooth, the lower lip keeps its function — provided the injection reaches the muscle where it actually sits.

Dose6–8 unitsTotal, distributed on both sides — the average of 16 international consensus papers from 2004–2024.

Duration of effect3–4 monthsAs with other expression-line regions.

Onset3–7 daysFull effect after 10–14 days. Follow-up appointment falls within this window.

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In short

The strawberry chin — in the literature "peau d'orange" or "golf ball chin" — results from a permanently tensed chin muscle (mentalis). The muscle runs from the jawbone into the chin skin and lifts the chin and lower lip during pouting, speaking, and thinking. In some people it stays active even at rest; the skin above it gets pulled into small dimples. Botulinum toxin type A interrupts this overactivity for several months. A 2026 Italian consensus paper, which reviewed 16 international recommendations, names strawberry chin as the main indication for treating this muscle. It should be distinguished from a receding or too-small chin — that's a question of shape, not muscle, and needs hyaluronic acid.

Dr. Thomas Ackermann's practice · Clinical approach

The chin muscle stabilizes the lower lip. Relax it too much, or in the wrong spot, and the lower lip no longer closes properly when drinking. That's why the unit count doesn't interest me here as much as the shape: in most people the muscle is dome-shaped, in some it's flat — and it sits up to a centimetre deep. That's visible on ultrasound, not from the outside.

— Dr. med. Thomas Ackermann · Board-Certified Anesthesiologist

Anatomy · A small muscle with two shapes

Why location decides the outcome

A note on terminology: Many patients search for “Botox” — a brand name of one single product that has become a colloquial umbrella term. The active substance is botulinum toxin type A, contained in several licensed medicinal products. All of them are prescription-only and are injected exclusively by the physician after a medical examination. This page uses the substance name throughout — it refers to the same treatment commonly known as a Botox treatment.

Structure	Function	In treatment
Chin muscle (mentalis), paired	Lifts chin skin and lower lip; stabilizes lip closure	Target muscle — bilateral, at the lower attachment near the bone, 6.7–10.7 mm deep
Muscle shape	Dome-shaped in 86%, flat in 14% (2021 anatomical study)	Determines point and depth — not visible from outside, seen on ultrasound
Depressor labii inferioris (lower lip depressor)	Pulls the lower lip down, important for speaking and drinking	Must be spared — substance here disrupts lip closure
Depressor anguli oris (corner of mouth depressor)	Pulls the corners of the mouth down	Neighbor; specifically co-treated for marionette lines, otherwise spared
Chin-lip crease	Horizontal fold between lower lip and chin	Softens when the chin muscle relaxes; hyaluronic acid added for a deep crease

Anatomy per Choi et al. 2021 (PMID 33514053): 44 dissected facial halves and 66 measured by ultrasound. The muscle sits 5–10 mm from the midline and 20–30 mm below the mouth-corner line. The 2026 Italian consensus paper explicitly emphasizes the importance of ultrasound for identifying individual anatomical variants in the lower face.

Safety profile

What you can realistically expect

Observation	Frequency	Duration
Bruising at the injection site	occasional	3–7 days
Pressure or numbness at the chin	common in the first few days	1–3 days
Asymmetry when tensing	occasional, with an asymmetrically stronger muscle	2–6 weeks, correctable at the follow-up
Residual activity, dimples partly remain	occasional with a flat muscle type or too superficial an injection	adjustable
Lower lip doesn't close fully, drinking or speech impaired	rare — when substance reaches the lower lip depressor or the dose is too high	until the effect fades, 6–12 weeks
Chin looks "loose" or longer	rare, from too high a dose	until the effect fades

The lower face is considered more demanding than the upper face in the consensus literature, because the muscles there carry functions — speaking, drinking, lip closure. Frequencies per Fundarò et al. 2026 and Sommer/Bergfeld/Sattler 2007; general safety profile per Brin et al. 2009. More detail in the safety overview.

Common reasons patients come in

Does this sound familiar?

"In photos my chin always looks restless"

When speaking, smiling, and concentrating, the chin muscle tenses — and in every photo the chin shows the small dimples. Many only notice it when someone points it out. The treatment removes the constant tone from the muscle; the chin stays smooth even in motion.

"I push my chin forward without meaning to"

A strong chin muscle pushes the lower lip forward and creates a pouting expression that isn't intended. Relaxing it dissolves this expression without taking away your natural mimicry — the chin looks calmer, not stiffer.

"My chin is small — does this help?"

No, not alone. A receding chin is a question of shape, not muscle. Often both occur together, though: the muscle works against a chin that's too short. Then chin augmentation with hyaluronic acid and muscle relaxation complement each other — the filler material lasts longer when the muscle isn't constantly shifting it.

Important to know

What strawberry chin treatment is not

Not chin augmentation. A receding, too-short, or asymmetric chin has a bony or volume cause. Botulinum toxin relaxes a muscle; it shapes nothing. That's what hyaluronic acid is for.
Not a treatment without functional risk. The chin muscle stabilizes the lower lip, its neighbor lowers it. Both matter for speaking and drinking. That's why a small dose, deep injection at the bone, and distance from the mouth-corner-to-chin line.
Not a permanent solution. The effect lasts 3–4 months. Whether the interval lengthens with regular treatment is often reported but not solidly documented.
Not an approved use. Botulinum toxin type A is approved aesthetically for the upper face. Treatment of the chin muscle is off-label — like all treatments in the lower face — and is discussed during the consultation.

The process

Why this practice

Easy to inject. Hard to dose correctly.

Whether strawberry chin treatment has succeeded shows up when drinking from a glass and speaking: whether the chin is smooth and the lower lip can do everything it could before. Anatomy decides this — whether your chin muscle is dome-shaped or flat, how deep it sits, where its neighbor begins. A 2021 anatomical study showed it sits between 7 and 11 mm deep. This is not a region for guesswork.

As a board-certified anesthesiologist, I work daily with nerve pathways and muscle anatomy. I am a certified member of the DGBT (German Society for Aesthetic Botulinum Toxin Therapy) and hold the additional qualification in emergency medicine. I also treat patients who received a result elsewhere that they are not happy with — being able to correct a result changes how you dose from the outset.

How I think about the individual muscle groups: Overview: wrinkle treatment with botulinum toxin · Ultrasound-guided injection

How your appointment works

Assessment and expression test. Chin at rest, while speaking, while deliberately tensing. Is the surface restless because the muscle is working — or is the chin too short, so the muscle compensates? Symmetry of both muscle halves. Please disclose blood-thinning medication in advance — and never stop it on your own.
Dose planning. The international consensus papers cite an average of 6.5 units total, the 2026 Italian consensus paper 8 units. I start on the higher end with a strong muscle, lower with a subtle one — and adjust at the follow-up.
Injection. One to two points per side at the lower muscle attachment, deep toward the bone, with distance from the line between the corner of the mouth and chin — where the lower lip depressor runs. Ultrasound beforehand if the muscle shape is unclear. Very fine needle, a few seconds.
Immediately afterward. No downtime. On the day of treatment: no massaging, no exercise, no sauna. Speaking and eating are possible right away.
Follow-up appointment after 10–14 days. Chin while tensing, drinking from a glass, speech. Residual activity is topped up; asymmetry is corrected.

Detailed guidance for the first 24 hours and 14 days is in the aftercare overview.

The next step

First the assessment. Then the decision.

In your initial consultation, we clarify whether this treatment makes sense for you — and what is realistic to expect. Private practice in Herzogenaurach, twelve minutes by car from Erlangen.

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Frequently asked questions

About strawberry chin treatment

How do I know if I have a strawberry chin or just a small chin?

Tense your chin as if you were pouting. If dimples and unevenness appear, the muscle is at work — that's a strawberry chin. If the chin sits noticeably behind the lower lip in profile, it's a question of shape. Often both occur together: the muscle works to compensate for a short chin. The assessment clarifies this.

How many units are needed?

The review of 16 international consensus papers gives an average of 6.5 units total; the 2026 Italian expert panel recommends 8 units, distributed bilaterally. Noticeably less than the forehead or frown lines. More doesn't produce a smoother chin, it risks the lower lip.

Can I speak and drink normally afterward?

Yes, with correct dose and placement. The chin muscle helps with lip closure; its neighbor lowers the lower lip. If either is hit too strongly or incorrectly, the lower lip may not seal properly when drinking from a glass for a few weeks. This can be avoided with deep injection at the bone and distance from the mouth-corner-to-chin line.

Why do you mention ultrasound?

Because the chin muscle is dome-shaped in 86% of people and flat in 14%, sitting between 7 and 11 mm deep — this cannot be seen from outside. The 2026 Italian consensus paper explicitly highlights ultrasound for the lower face. When the assessment is unclear, I check beforehand: Ultrasound-guided injection.

Does the treatment also help the crease between lip and chin?

Partly. The chin-lip crease is deepened by the chin muscle; when it's relaxed, the crease softens. A deeply etched crease additionally needs hyaluronic acid — this is assessed during the consultation.

Can I combine this with marionette line treatment?

Yes, that's common. The depressor anguli oris lies right next to the chin muscle and is specifically co-treated for marionette lines. Both in the same appointment, with separate planning.

How long does the effect last?

3–4 months, as with other expression-line regions. It makes sense to repeat it on the same rhythm as the other regions.

Does the treatment hurt?

Two to four injections with a very fine needle, deep at the bone — most describe a brief pressure. No numbing needed.

What does the treatment cost?

Physician services are billed according to the German fee schedule for physicians (GOÄ). What applies to your treatment, I discuss transparently in advance during the consultation.

Evidence base

What the studies show

There are no approval trials for the lower face, but a well-documented consensus position and current anatomical work.

Fundarò S, Molinari P, Brunelli G et al., 2026. Italian Consensus and Review in Lower Face Mimetic Muscle Treatment with Botulinum Toxin-A. Toxins (Basel) 18(8):332. PMID 42646760. Three-round consensus process with 14 experts plus review of 16 international consensus papers from 2004–2024. Main indication for the chin muscle: "peau d'orange" chin and overactivity. Recommended total dose 8 units (international average 6.5), combined intramuscular and intradermal. Emphasizes the growing importance of ultrasound for individual anatomical variants in the lower face.
Choi DY, Bae H, Bae JH et al., 2021. Effective Locations for Injecting Botulinum Toxin into the Mentalis Muscle; Cadaveric and Ultrasonographic Study. Toxins (Basel) 13(2):96. PMID 33514053. 44 dissected facial halves and 66 measured by ultrasound: the chin muscle is dome-shaped in 86%, flat in 14%, sits 5–10 mm from the midline, 20–30 mm below the mouth-corner line, and 6.7–10.7 mm deep. Basis for the injection depth and placement on this page.
Melley LE, Altman A, Bloom JD, 2025. Nonsurgical Chin and Prejowl Modification. Facial Plast Surg 41(5):583–594. PMID 40389235. Review of non-surgical chin procedures: botulinum toxin for muscle overactivity, hyaluronic acid and biostimulators for volume and projection. Emphasizes the need for anatomical precision.
Lembo S, Macias-Arias P, Uribe Posada MP et al., 2026. A Novel Intraoral Technique for Botulinum Toxin Type A Application in the Mentalis Muscle. Cureus 18(3):e105783. PMID 42037878. Technique report in three patients: injection at the muscle origin to avoid spread and preserve lower lip function. Small case number, but evidence that the muscle origin at the bone is the target.
Brin MF, Boodhoo TI, Pogoda JM et al., 2009. Safety and tolerability of onabotulinumtoxinA in the treatment of facial lines: a meta-analysis of individual patient data from global clinical registration studies in 1,678 participants. J Am Acad Dermatol 61(6):961–970. PMID 19744746. Pooled safety data from approved regions: no serious treatment-related events, no distant spread.
Camargo CP, Xia J, Costa CS et al., 2021. Botulinum toxin type A for facial wrinkles. Cochrane Database Syst Rev 7:CD011301. PMID 34224576. 65 randomized trials — none on the chin muscle as its own region. The evidence for strawberry chin is consensus and anatomy, not a placebo-controlled trial.
Sommer B, Bergfeld D, Sattler G, 2007. Consensus recommendations on the use of botulinum toxin A in aesthetic medicine. J Dtsch Dermatol Ges 5 Suppl 1:S1–S29. PMID 17229195. German-language consensus on anatomy, injection technique and complication management.

Study details researched via PubMed. The studies cited describe the state of the scientific literature and do not constitute a claim about the outcome of any individual treatment.