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Dr. McBride has a special interest in cosmetic chin surgery. He has published an extensive, seventy-page chapter on cosmetic chin surgery, in which he reviews the broad variety of techniques available to analyze and correct chin cosmetic problems.
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Importance of the Chin
The chin is as important as the eyes and nose in overall facial esthetics. In men, a strong chin is a very important contribution to the masculine look. Today, more women want stronger, more well-defined chins and noses than ever before. Everyone looks good with well defined chin and neck contours. Therefore, chin augmentation or other modification, should always be planned to provide the best neck improvements at the same time. The neck line is usually improved by chin augmentation. If there is too much fullness in the neck, liposuction can be performed simultaneously to create an optimal neck contour. This results in a nice trim, athletic neck contour.
A chin implant can create a more balanced profile by strengthening a weak, receding chin, reducing a deep fold under the lower lip, or widening a small chin. Solid silicone implants are extremely safe, and feel and look just like bone. Today a wide variety of implant shapes are available, so that a very natural, cosmetically ideal chin can be developed for any face. The implant can be customized by carving the silicone to create the best shape and size for your chin.
We perform computer imaging for all chin reshaping procedures. This lets the patient see how the chin and neck will look after any combination of surgical changes. The patient can select the procedure and the amount of movement they prefer to get the result they want.
In some instances it may be desirable to reduce the size of the chin. The bone of the chin can be shortened, narrowed, moved forward, moved back, or made more square or tapered, to provide the best esthetic balance.
Chin Augmentation Surgical Techniques (Genioplasty)
There are two surgical techniques for improving the shape and size of the chin:
1) Chin implant
2) Chin osteotomy
Genioplasty is the medical term for surgery to alter the shape or size of the chin. The chin implant technique is used to increase the horizontal projection (prominence) of the chin, and it can correct mild to moderate asymmetries. The chin osteotomy, also known as an anterior mandibular horizontal sliding osteotomy, involves cutting the chin bone and moving it forward. The chin osteotomy can be used to increase or decrease the profile projection of the chin, correct asymmetries, widen or narrow the chin, and vertically lengthen or shorten the chin.
Current chin implants provide excellent esthetic results with less surgery than osteotomies (bone cutting), and therefore provide faster, more comfortable recovery. Today’s implants blend in smoothly with the bone of the chin and they extend around the sides of the jaw to provide a beautifully natural contour. They can be used to increase chin projection (or profile prominence), and to widen the chin to make it more round or square. In addition, the surgical fees are lower because the surgical time is shorter. Chin implants are not used to lengthen or shorten the chin, or to reduce the chin size. The chin osteotomy technique is used to make these changes.
Chin Implant Surgical Techniques
Dr. McBride usually performs chin implants or osteotomies with the patient under light general anesthesia. In addition to providing excellent comfort and relaxation, general anesthesia can reduce bruising by lowering blood pressure during surgery. A long acting local anesthetic is injected to reduce bleeding and provide excellent comfort during and after recovery.
Two approaches are used for chin implants; the inside the lip, or intraoral, approach, and the under the chin, or extraoral, approach. The chin osteotomy is almost always performed from inside the lip.
Inside the Lip (Intraoral) Approach
The incision inside the lower lip for chin implants is placed in an identical position to that used for osteotomy advancements. The length of the incision required to place the implant is somewhat shorter than that needed to perform an osteotomy. The dissection is carried down to the chin bone. A tunnel is created along the front and sides of the jaw, below the sensory (mental) nerve on each side, until the pocket is large enough for the implant. Considerable care is taken to prevent injury to the sensory nerve (mental nerve) during the dissection and implant placement.
Temporary implants, called sizers, are tried in place until the implant size that produces the desired contour is identified. The selected implant is slipped into the pocket and the chin is checked to see if the desired contour has been obtained. If the desired contour is not obtained with the chosen implant, it can be sculpted to create the perfect contour. The chin can be made more square by trimming some material from the front of the implant, or more tapered by trimming material from the sides of the implant. After the adjustments, the implant is slipped into the tunnel, positioned exactly where it will produce the desired contour, and it is secured to the bone with one or two small, titanium screws.
Chin asymmetries can be corrected by rotating the implant midline to the weak side of the chin, or by sculpting the implant to compensate for the bony asymmetry. The implant blends beautifully with the lower border of the jaw. The incision inside the lower lip is closed in two layers. A small pressure bandage is applied.
Under the Chin (Submental) Approach
A one and one half-inch long incision is made in the natural crease under the chin. A tunnel is created over the front of the chin and along the side of the jaw below the sensory nerve on both sides until the desired pocket is created for the implant. Once the desired pocket size is developed, temporary implants are tried in until the implant size that produces the desired contour is identified. The selected implant is slipped into the pocket and the chin is checked to see if the desired contour has been obtained. If the desired contour is not obtained with the chosen implant, it can be sculpted with a scalpel to create the perfect contour, and it can be shifted to the side to correct asymmetries, in the same way as in the inside the lip approach.
After the adjustments, the implant is slipped into the tunnel, positioned exactly where it will produce the desired contour, and it is secured to the bone with one or two small, titanium screws. The skin is sutured and an elastic pressure bandage is applied.
The chin osteotomy technique (anterior mandibular horizontal sliding osteotomy) permits correction of almost all cosmetic problems. However, it has some limitations, and is a more complex procedure than implant placement. The chin osteotomy involves making a horizontal cut through the chin bone above the bottom edge of the jaw, and sliding the cut bottom piece forward. It requires expensive instruments, bone plates and screws, substantial training and technical expertise, and more surgical time than implant techniques.
The incision is placed inside the lower lip in the same location as for an implant. The length of the incision required for an osteotomy is somewhat longer than that needed to place an implant. The dissection is carried down to the chin bone.
A tunnel is created along the front and sides of the jaw, below the sensory (mental) nerve on each side, until the pocket is large enough for the instruments required to cut the bone. A very fine electric saw is used to precisely cut the bone in a horizontal line about one-half inch above the bottom of the jaw. The cut tapers back through the bottom edge of the jaw bone. When the cut is complete, the bone on the bottom of the chin is loose and can be slid forward, backward, up or down, to produce the desired improvement. Bone can be removed from the middle of the chin to narrow the chin, or bone can be added to widen the chin. Bone can be removed between the segments to shorten the chin, or bone can be added between the segments to lengthen the chin. The bone can be trimmed in other areas to create the best contour.
Thin, titanium bone plates are adapted to the bone, and tiny titanium screws are placed in the bone through the plates, to hold the bone in the desired position. New bone will grow in the spaces between the bones, and the bone will heal into one solid shape. The screws and bone plates are left in place and are not noticeable.
Advantages of Chin Implants Compared to Osteotomies
1) Shorter, simpler procedure with faster recovery
2) Implants may be sculpted to create a custom contour
3) Less bruising and swelling
4) Lower cost of components (implant and screw vs. bone plate and multiple screws)
5) Various implants sizes and shapes can be tried in at surgery to identify the best result
6) Lower fee
Limitations Of Chin Implants
1) Cannot lengthen or shorten the chin.
2) Cannot narrow the chin
3) Can only correct mild asymmetries.
4) Minimal improvement in neck contour.
Advantages of Chin Osteotomies
1) Can vertically lengthening or shorten the chin
2) Can widen or narrow the chin
3) Can correct larger asymmetries
4) Improves the neck contour by stretching the neck muscles
5) Can be used in people sensitive to implant materials
Disadvantages of Chin Osteotomies
1) More swelling and bruising than with implants
2) Longer recovery than with implants
3) Requires expensive bone plates and screws for stabilization
4) May cause a deeper groove between lower lip and chin
5) Greater chance of temporary numbness in lip
Postoperative care is simple for most chin surgery. A tight bandage is applied to the chin in most cases. This will help to reduce swelling and bruising. The bandage can be removed the next day. Soft, easy to chew foods are recommended.
In general there is less swelling, bruising, and discomfort associated with implant placement compared to sliding osteotomies. Consequently, the patient’s “down time” is reduced and the lower lip function and overall chin contour may return to normal more rapidly. However, most patients will have some swelling and bruising, as well as decreased sensation on the lower lip, for several days even with an implant.
The patient should avoid pulling the lip down to see the surgical site. Starting on the forth day, an electric heating pad on a medium setting can be applied to the chin for twenty to thirty minutes, several times each day until the bruising has resolved. Brush your teeth gently.