Background <p>Chin augmentation is increasingly performed using both surgical (osseous genioplasty and alloplastic implants) and non-surgical (injectable fillers) techniques to improve facial harmony and profile. However, the long-term effectiveness, complication profiles, and patient satisfaction across these approaches remain incompletely characterized.</p> Methods <p>We conducted a systematic review registered in PROSPERO (CRD420251135340) and reported according to PRISMA guidelines. MEDLINE, PubMed, Web of Science, and Cochrane Library were searched from January 1975 to December 31, 2024, for English-language studies evaluating chin augmentation for aesthetic or functional indications. Eligible designs included randomized controlled trials, cohort studies, and case series with ≥10 patients reporting aesthetic outcomes, patient satisfaction, and/or complications after surgical or non-surgical chin augmentation. Data were extracted using a standardized form, and risk of bias was assessed using the Cochrane tool for RCTs and the IHE Quality Appraisal Checklist for case series. Owing to substantial clinical and methodological heterogeneity, no meta-analysis was performed and results were synthesized narratively, stratified by intervention type.</p> Results <p>Fifty-six studies (4,844 patients) were included. Surgical procedures (osseous genioplasty and alloplastic implants) generally produced durable improvements in chin projection and lower-face balance with high satisfaction, but were associated with complications such as infection, hardware or implant problems, bone resorption, and persistent neurosensory deficits. Filler-based augmentation (mainly hyaluronic acid and calcium hydroxylapatite) yielded rapid contour enhancement and high short-term satisfaction, with mostly transient adverse events (edema, bruising, pain), but rare serious vascular complications. Across all modalities, evidence quality was limited by retrospective designs, small sample sizes, non-standardized outcome measures, and inconsistent complication reporting.</p> Conclusion <p>Both surgical and non-surgical chin augmentation techniques can achieve favorable aesthetic outcomes and high patient satisfaction, but with distinct durability and risk profiles. No single technique appears clearly superior; treatment should be individualized. High-quality prospective studies with standardized aesthetic and patient-reported outcome measures are needed to better compare techniques and optimize safety.</p> Level of Evidence III <p>This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors <a href="http://www.springer.com/00266">www.springer.com/00266</a>.</p>