In Hollywood, where most of the talent trades on their facial attractiveness, it has been common for both men and women to enhance their profiles with chin enhancement. Especially in men a strong jawline and profile are a must for matinee idol handsomeness. In an industry where attractiveness is the primary currency, chin surgery has always been common; more common than anybody suspected. So it is not a surprise that the American Society of Plastic Surgeons statistics show that chin augmentation with chin implants has risen 71% making it the fastest growing plastic surgical procedure. Slightly more men than women are undergoing the procedure which is not a surprise due to the large cachet placed on a strong chin and jawline in men.
Implants for chin augmentation have been around for 30 years or more so the science behind the procedure is fairly well worked out. Commonly, an incision is placed in the mouth below the front teeth on the bottom (a skin incision below the chin is also feasible). A pocket is then created over the boney part of the chin or mentum. This pocket is carefully placed below the tooth roots and away from the nerves that supply sensation to the lower lip. Small improvements of 4-5 mm are easily achieved with a variety of silastic (silicone) implants with various shapes and sizes. Most experienced surgeons would agree that a chin augmentation of 10mm or more is more difficult to obtain with an implant. These large augmentations are associated with a small chin (microgenia) as well as a poorly defined, obtuse, neck contour. Simply placing an implant gives minimal improvement to the neck. Large implants are more likely to cause boney erosion of the chin due to their size and the tension required to advance the tight soft tissues. For this reason, large chin advancements of a centimeter or more are frequently achieved with a different operation known as a genioplasty. A genioplasty is performed again through an oral incision, but rather than placing a silastic implant, the chin bone is cut in a horizontal direction below the tooth roots so that the small chin may be advanced and fixed in position with titanium plates and screws. If the small amount of titanium hardware becomes a problem it may be removed after healing of the bone at about 6 months post-operatively. The intrinsic beauty of the genioplasty is that the neck muscles are left attached to the boney chin and as the chin is moved forward to effect the augmentation, the neck muscles are also tightened improving the once obtuse neck line. In the rare instance of a chin implant infection, removing the implant and performing a genioplasty can salvage the result as the small amount of titanium used for fixation almost never causes an infection.
The most common complications of chin implant surgery are the rare infection, rare boney erosion involving tooth roots, and more commonly prolonged lip numbness (rarely permanent) with the most frequent complication being inadequate chin projection as well as over-projection of the chin giving a profile in women that it too strong and sometimes masculine. Occasionally, a chin implant that is not properly healed can shift causing the chin to be asymmetric. Even years after fully healing, a trauma to the chin implant can cause a secondary hematoma and inflammation necessitating implant removal. On a very rare occasion a lower jaw (mandibular) tooth abscess can secondarily infect a chin implant, but not a genioplasty.
Over the years, many creative surgeons have tried to create chin implants with mesh material such as mersilene or prolene mesh. The primary problem with porous materials is that they can get chronically infected causing prolonged oral drainage. Also, these porous implants become incorporated into the chin soft tissues and thus are impossible to revise (bigger or smaller) and can be very difficult to remove. The good news is that these so called “chin cripples” can be salvaged by a well performed genioplasty.
Chin augmentation is one of those procedures that lends itself to facial imaging. Using the already well known proportions, the exact profile can be agreed upon pre-operatively so that no misunderstandings develop post-operatively.
All in all, chin augmentation is one of the easiest and most satisfying operations performed by Plastic Surgeons. Naturally, when studying the profile, the nasal profile comes under scrutiny and in many cases rhinoplasty and chin augmentation are done simultaneously to overhaul the entire profile all at once. Again, facial imaging can predict the profile that is desired. One warning is in order: Many times dental malformations (malocclusions) can mask themselves as a weak profile. A good dental evaluation to rule out malocclusions and dental caries, especially in the lower jar, is indicated pre-operatively. Beware the dentist/orthodontist with today’s fancy facial imaging software. Not everyone with minor malocclusions needs $5,000 of orthodontics on a fully formed jaw. These orthodontists many times feel the need to recommend both nasal and chin surgery acting like they and their referrals are a necessity. This is the tail wagging the dog. It should be very easy to identify fully trained Plastic Surgeons to perform both chin augmentation as well as the rhinoplasty in a single operation.
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