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Smartlipo of the Neck and Chin Augmentation - An Early Facial Rejuvenation Approach
Author: barryeppley
The chin and neck angle relationship is one of the most significant facial markers that has a significant influence on the age of one’s appearance. A well defined chin point and a contoured neck angle are what most of us had in the first three to four decades of life. Aging changes the neck angle and, combined with even a slightly weaker chin, creates that loss of youth look.
The combination of neck liposuction and chin augmentation is one the most effective and relatively simple facial procedures. The best patients are generally under the age of 55 (average range 35 to 50 years old) who do not significant neck skin looseness or laxity. The neck skin may have some wrinkling and sun damage but one should not be able to pinch more than an inch of loose skin. (not bunching up fat, just loose skin) The key is patient selection for a good result. If significant loose skin exists, some form of a necklift (facelift) is needed.
Candidates for this combination often seek out or have already had non-surgical treatments like Thermage or SkinTyte. These minimally invasive neck and jowl treatments do not have the capability to really change facial contour. While they do create a minor amount of skin tightening and wrinkle reduction, they often leave patients disappointed. They are not capable of removing a double chin or a jowl sag.
For patients with a good chin profile, neck liposuction alone is all that is needed. I prefer the use of Smartlipo as it can be comfortably and effectively be done under local or sedation anesthesia. With Smartlipo, a 1mm fiber is threaded through a small stainless cannula for insertion under the neck skin. The cannula keeps the fiber from bending and breaking. The tip of the fiber sticks out beyond the cannula just a bit to deliver the heat energy to the fat. The fiber has an aiming beam so one can always see the laser point under the skin and know exactly where the laser is. The key to laser lipolysis is that it is performed with temperature monitoring so the neck tissues do not get too hot. The wavelengths of the laser has three beneficial effects. Its effect on hemoglobin seals off blood vessels which results in less bruising. The heat is very effective for breaking down and melting fat. Additionally, by heating the underside of the skin significant tissue tightening will result. While there is debate about how much skin tightening occurs after laser liposuction, it is fair to say that it is greater than that which is achieved by liposuction alone.
The recovery after Smartlipo of the neck is a maximum of ten days. Often it is within just a week. In some cases, the addition of simultaneous skin resurfacing can be done if there is any pre-existing wrinkles. This will not increase the recovery time at all as less than 50 micron depths are used.
The potential benefit of a chin implant with neck liposuction must be looked at carefully. Many neck contour changes can be enhanced by some more chin projection. Rarely does one need an implant of any significant size, 3 to 5mms of increased horizontal projection can be enough. With flexible silicone implants, they can be placed through the same under the chin incision used for neck liposuction, just slightly larger. Incision lengths less than 15mms are all that is needed.
For the right patient, Smartlipo of the neck with or without chin augmentation provides a very visible neck change, is cost effective, and does not have a long recovery.
http://www.eppleyplasticsurgery.com
Indianapolis, Indiana
Chin augmentation is one of the best values in facial surgery because it is both simple and tremendously effective for many patients. Changing the projection of the chin affects one’s profile and balance of facial proportions Because of its relative simplicity, it is widely performed by cosmetic surgeons at all levels of experience and training. It is the chin implant’s apparent simplicity, however, that can led to surgical mishaps and unhappy patients. Surgeons often offer chin implants as a relatively minor procedure, offering them as part of a rhinoplasty or facelift.
A chin implant is essentially a space-occupying mass that pushes out the overlying soft tissue. Within this soft tissue envelope lies the mentalis muscle, which must not only have one end lifted off the bone to insert the implant but will also end up stretching out the muscle as well. While some chin implant problems are related to the position or size of the implant, the most troublesome ones to correct are the result of what has happened to the overlying soft tissues.
One of the most common causes of chin implant problems is when an intraoral approach is used. Disrupting the upper attachment of the mentalis muscle can be risky. If the muscle is not properly put back of during closure, the muscle will contract and pull the chin soft tissues downward. (chin ptosis) If there is sufficient contraction, the lower lip will be pulled down and excess lower teeth will show. It only takes but a few millimeters of downward lip movement for patients to notice. Correction of chin pad ptosis requires re-entering through mouth, freeing up of the muscle, and re-suspension back up on the bone. Or when an indwelling implant, back up over it and secured to the bone. The whole corrective operation depends on the method of securing it to the bone. I have successfully used both small metal screws and resorbable bone anchors. The bone anchors are the easiest to use and two or three of them work quite nicely.
To avoid this potential problem, chin implants should be placed from below with a submental incision. It is much a more assured way to get the wings of the implant properly placed, has less risk of nerve injury, and the mentalis muscle can be easily sutured back together. Any scar concerns are misplaced as submental scars almost always turn out excellent. Intraoral chin implant surgery is not ‘less invasive’ than an extraoral approach.
Chin implant removal invariably causes soft tissue problems. In addition to inducing chin pad ptosis, the pocket where the implant used to reside can contract or even fill with fluid, leading to subsequent visible deformities and irregularities of the skin of the chin. To ideally avoid these difficult problems, consider replacing the implant with a smaller one (so the space does not completely collapse) or an advancement osteotomy. If one is possessed about having no implant or considerably less chin projection, one should consider doing a submental tuck-up from below where the expanded soft tissues can be reduced and tightened.
Because of the location of the mental nerves, some chin implant placements can develop neuropathies or numbess of the lower lip afterwards. A little tingling of the lower lip is one thing which almost always resolves in a matter of weeks after surgery. More significant changes in lip/chin sensation is a different matter. Profound numbness of either side must be dealt with early to avoid permanent nerve damage. The pressure of an impinging implant can cause resorption of its axons which may not regenerate. If lip numbness presents beyond 2 weeks, the implant needs to be adjusted. At the least, re-operation is necessary to ensure that the wing of the implant is sin the proper place. The risk of this potential problem can be assessed by looking at a panorex film and see if the canal lies lower than normal. Greater than 1 cm. of distance between the canal and the inferior border of the mandible is a good safety margin.
Dr. Barry Eppley
http://www.eppleyplasticsurgery.com
Indianapolis Indiana
Chin augmentation using an implant is a very common and highly successful procedure.With easy access to the front of the lower jaw (mandible) and few anatomic structures in which to be concerned about injuring, changes in the chin are quick and predictable. As a stand alone procedure or in combination with numerous other facial changes, chin implants provide a great tool for structural facial enhancement.
But like all implants used anywhere on the body, they are not complication-free. Mishaps and untoward outcomes do occur and secondary surgery is occasionally needed. Most of these problems are eminently improveable by implant adjustment or replacement and/or soft tissue modification.
Unhappiness with chin projection or shape after augmentation is a function of implant selection. There are now over seven styles of chin implants that offer more than a set amount of horizontal advancement. How far the implant goes back along the jawline and how much fullness to the side of the chin that is created can be altered by chin implant options that are now currently available. By comparison to the original operation, replacement with a new chin implant is a relatively easy operation since a pocket already exists. In some cases, a chin implant may have been asked to do too much. If the amount of forward chin movement needed is greater than 10mms, one may consider an osteotomy instead for such large chin changes. It will be prone to less potential complications.
Chin implants can shift as they are placed along a curved bone surface. Such shifting can occur horizontally or vertically. Most commonly, an implant that has shifted to the right or left is easy to spot as the central chin point is off-center. The center of the chin and its underlying implant should be along a vertical line drawn down from the center of the lower lip and through the midline between the mandibular central incisors. To prevent shifting during initial placement, a centrally-placed screw through the implant to the bone can be used. Similarly, correcting a deviated implant uses the same approach.
Vertical malposition (up too high) is usually the result of the implant being placed through an intraoral (inside the mouth) approach. With an open path from which it was inserted, it can easily slide up from the inferior border of the chin. It is more important to use a screw with the intraoral approach than from an incision under the chin where upward migration is limited by the superior extent of the pocket dissection during placement.
One of the newer complications of contemporary chin implants (anatomic designs) is lateral wing malposition. While it is usually a benefit to have the implant extend back further along the jawline, it is necessary to have these wings tapered to blend into the bone as the implant ends. This makes the wings very thin and extremely flexible. It is quite easy for them to fold or bend at the back end of the pocket during placement. This can be felt as a bend or fold along the jawline at the implant-bone transition. The implant must be removed, the pocket extended and the implant re-inserted.
One of the well known chin augmentation problems does not involve an implant at all. When a chin implant is removed for whatever reason, the expanded soft tissues may not shrink back down. If they do not, and the larger the original implant the less likely they will, the chin soft tissues fall creating the classic witch’s chin deformity. This can be corrected by refilling the collapsed space with a new implant or an advancement osteotomy. Another option is to remove the lax tissues and tighten them from underneath the chin. (a submental tuck-up)
http://www.eppleyplasticsurgery.com
Indianapolis, Indiana
A full or fat neck is most commonly treated by liposuction, particularly if one is fairly young. The results from neck liposuction are significantly influenced by the quality of the overlying skin. Good taut or thick skin will respond by shrinking and adapting upward to a less obtuse neck-jaw angle. Loose or inelastic skin may shrink somewhat but it will be irregular with band and cords apparent to the eye. When neck skin is loose, the liposuction procedure must be combined with some type of facelifting procedure. Whether it is more of a limited or full facelift will depend on how much loose skin exists.
One often overlooked consideration in neck liposuction is that of the chin. Should the chin be brought forward or is its projection adequate where it is currently? In the spirit of what one is trying to achieve by removing fat from the neck…a more evident jaw and neck line…the chin should not be forgotten. In some cases, it can be a good complement to the look that liposuction creates.
One effect that neck liposuction does create is the illusion that the chin is a little more prominent. As the neck-jaw angle, technically known as the cervicomental angle, become less obtuse and positioned back somewhat, it can look like the chin is a little more prominent. That is easy to understand as the chin may look more forward because the neck has moved back. In some cases, changing the shape of the neck may be all that is needed to improve what one thinks is a short chin.
In other cases, neck liposuction should really be combined with a chin implant. The problem is not just too much fat in the neck but the chin is really short as well. This is a much more prevalent issue in men than it is in women. Men can aesthetically tolerate a more prominent chin anyway, women must be more careful about de-feminizing their appearance. A combined neck liposuction-chin implant procedure is a classic ‘ying-yang’ facial procedure where movements in opposite direction create a better overall effect than either one alone.
Whether a chin augmentation is an additive benefit to neck liposuction can be determined easily prior to any surgery with computer imaging. Imaging profile structures, where the skin is in contract to the background, is very accurate and predictive of what surgery can really achieve. One can have themselves imaged with neck liposuction alone, combined with a small chin implant, and then combined with a larger chin implant as well. Looking at all three changes can really help one decide what is best for themselves.
The shape and appearance of the neck is partially influenced by the forward position of the chin. In many ways, the chin is an extension of the horizontal vector of the neck. As with any neck reshaping procedure, the chin should not be forgotten in surgical consideration and planning
http://www.eppleyplasticsurgery.com
Clarian North Medical Center, Carmel, Indiana
Clarian West Medical Center, Avon, Indiana
Indianapolis
1. How do I know a chin augmentation will make my face look better?
One of the important elements in improving facial attractiveness is balance and proportion. Chin augmentation is about improving the proportions of the lower face in both horizontal (lateral view) and vertical (frontal view) dimensions. The beauty of chin surgery is that it can be visualized very accurately before having surgery through computer imaging. Morphing the profile of the chin in all dimensions can be quickly and easily done since it is a facial prominence that is isolated like a projecting rock from a cliff. While you or your plastic surgeon may feel that chin augmentation would be beneficial, the guess work can be taken out of that consideration by imaging of your photographs.
2. What are chin implants made of?
By far, most of the chin implants used are made of silicone rubber, also known as silastic. This inert material is one of the most biocompatible of allbiomnaterials, is made in dozens of different shapes and sizes, and is inexpensive. Other implant materials are also used of which Medpor (polyethylene) is the most well known. It is a porous plastic material that is stiffer (needs a bigger incision to insert)and more expensive. Rarely used are other materials including Gore-tex and Mersilene mesh.
Given these different implant options, patients often ask which one is best. While certain plastic surgeons may advocate one over the other, the body does not really see them as any different. The shape or type of chin implant used is by far more important than the material from it is made. Given that today’s implants can change numerous dimensions of the chin, one should focus on these change possibilities and how they may be aesthetically beneficial.
3. What is the best way to place a chin implant, through the mouth or from under the chin?
Chin implants can be introduced through an incision inside the mouth behind the lower lip (vestibular) or through the skin from under the chin. (submental) While either approach will work, the submental incision is best in most cases for several reasons. First and foremost, this approach does not disrupt the superior insertion of the mentalis muscle so there is no risk of a chin sag afterwards. Secondly, there is no risk of the implant moving higher up on the chin bone since the upward end of the pocket stays naturally lower when made from below. Lastly, there tends to be less pain afterwards as the pocket dissection does need to be as big to get the implant in place.
4. Will I be able to eat and drink right after surgery?
Yes. Since the chin implant is on the front end of the jaw bone (mandible),it is does not interfere with jaw movement or opening one’s mouth. It is also places no restriction on chewing or swallowing. If an incision is used from inside the mouth, I merely tell patients not to bite food off but to use utensils to bypass what your front teeth normally do When the incision is used from under the chin, there are no restrictions at all
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5. I heard that the chin bone can be cut and moved forward (osteotomy) instead of an implant. Which is better?
Another well known method of chin augmentation is to move the chin bone forward rather than using a synthetic implant. While much less commonly performed than an implant, an osteotomy can be a good option for the right patient. Since it is a ‘bigger’ operation that takes longer to do and incurs more expense, proper patient selection is critical.
In my Indianapolis plastic surgery practice, I use the following three indications for a chin osteotomy. A young patient, the need for significant horizontal advancement, and if one is undergoing facial bone movements (orthognathic surgery)at the same time. The value of a chin osteotomy is that it can avoid a large implant that must remain complication-free over a long patient life-time.
A chin osteotomy can also do one thing that an implant can not. It can lengthen the chin vertically. While minor amounts of vertical height increase can be obtained by a low position of an implant, significant lengthening requires an interpositional graft after the chin segment is brought downward.
6. Can a chin augmentation be done with other facial procedures at the same time?
Yes. In fact, most chin augmentation procedures are usually part of combination facial plastic surgery. Most commonly, chin enhancement is done with rhinoplasty in a young patient and with a facelift in older patients. It is also one of the procedures in the facial ‘trifecta’ for men…chin, cheek, and jaw angle augmentation.
7. If I play sports, will having a chin implant be a problem?
The risk of getting hit in the chin is a common one in many types of sporting activities. Trauma to a chin implant will not cause it to break or fracture but it may move it shift or move out of place. For this reason, I prefer to place a screw to secure it into place in younger male patients who participate in any form of contact sports.
http://www.eppleyplasticsurgery.com
Clarian North Medical Center, Carmel, Indiana
Clarian West Medical Center, Avon, Indiana
Indianapolis
Plastic Surgery Case Study: Chin Implant Replacement - New Implant or Osteotomy?
Author: barryeppleyBackground: Like all surgical implants used in the body, chin implants do have some long-term effects. This is particularly true when they are used improperly or are inadequately positioned.
This is an interesting case of a 50 year-old female with the desire to improve her chin position. She had suffered with a short chin her entire life. But she had a history of having had a rhinoplasty and a chin implant in another country when she was 21 years of age. Despite this early surgery providing some improvement, she was still never really satisfied.
Because she was currently in orthodontics for teeth straightening (more older people are doing it than ever before, I have even see a 65 year-old in braces!), a lateral cephalometric x-ray was available for review. It clearly shows a small chin implant that is positioned above the most anterior point of the bone. The implant has eroded into the bone by about 50%, exhibiting a well-described phenomenon known as implant-related ‘pressure resorption’.
Her surgical options were to remove and replace her old implant with either a new larger one in a better position or to move the chin forward (advancement osteotomy) after implant removal. While either approach is a better option than what she had, the amount of chin advancement that she needed made a bone-based operation the best choice. (it could move the chin the furthest forward without using a lot of foreign-material to do it)
The operation was performed through an intraoral approach. The old chin implant was found exactly where the x-ray showed it to be, on the bone at the level of the labiomental crease significantly above where it should ideally be placed. It has settled into the bone over time from the pressure of the overlying soft tissues.
The implant was removed and a horizontal chin osteotomy was performed. The chin bone was brought forward as much as possible, keeping the back edge of the chin bone against the front edge of the bone above the moved segment. It was plated into this new position with a specially-designed chin plate with a built-in movement of 12mms forward.
While a bigger advancement could have been tolerated, the aesthetic change was a big improvement. It would have been possible to enhance the advancement even further by placing an implant in front of the osteotomized chin bone. When done together, I call this procedure an ‘extreme chin augmentation’.
Case Highlights:
1) In cases of severe chin shortness, a large implant over time will eventually settle some amount into the underlying bone.
2) Chin implants placed through the mouth can move upward from their desired position on the pogonion. This can be avoided by screwing them into position.
3) When the chin deficiency is large (> 10mms), it may be better to consider a chin osteotomy long-term rather than an implant in some cases.
Dr. Barry Eppley
http://www.eppleyplasticsurgery.com
Clarian North Medical Center, Carmel, Indiana
Clarian West Medical Center, Avon, Indiana
Indianapolis
Chin augmentation has been a procedure that has a near seventy-five year history of being done in humans. It remains as a fairly simple and highly effective method for improving the most prominent area of the lower third of the face. Many different materials have been used to serve as a chin implant but synthetic technology accounts for most augmentations due to their ease of use, low cost, and long-term stability of the result.
For patients considering chin augmentation, there are three considerations one should ponder. While many plastic surgeons have their preferred methods, usually with good reasons, patients today are better educated and can participate more fully in preoperative planning.
The first consideration is that of the choice of implant material. Vulcanization technology has allowed for silicone rubber (silastic) to long be the only material of choice. Silicone chin implants are the least expensive and the most flexible and they can be inserted through the smallest of incisions. Medpor (polyethylene) and polytetrafluoroethylene (PTFE or Gore-Tex) are more recent chin implant materials who have a long history in many other types of surgical implants. Medpor is fairly stiff (needs bigger incisions to insert) and is porous, which in theory offers some biologic advantages. (vascular ingrowth) PTFE is softer than even silicone with some limited porosity on its surface.
The different chemical compositions and properties of the implant materials may seem confusing. But in my opinion, they are no proven biologic advantages to any of the implant materials. They all will work. The body still sees them as a well-tolerated foreign body which becomes encapsulated. The important differences between them, in my opinion, relates to the second consideration….what different styles, shapes, and sizes do the various manufacturers offer. Chin augmentation today can create a wide variety of geometric changes to this part of the lower jaw… from round to square, central to more lateral projections, to even include the creation of a chin cleft or dimple. Think about your chin shape carefully and how it will affect your overall facial shape. What shape does it have now and what would you like it to become? Do you want a more sculpted and more defined facial look? Do you want to overcome a larger nose and a shorter neck? Do you want it to look more masculine or feminine? Many implant styles and sizes exist. Consult carefully with your plastic surgeon to get the look you are after that best fits your face.
Lastly, what insertion route for the implant do you prefer? They can be placed through an incision under the chin (submental) or through the inside of the mouth. (vestibular) Each has its own advantages and disadvantages. In the right hands, either approach can work successfully. The most versatile and least prone to potential problems is the submental approach. Many patients worry about the potential scar but that is an unnecessary concern. Coming from below has the advantages of getting the implant down at the inferior edge of the bone, permits easy screw insertion if desired, and allows neck liposuction or submentoplasty to be performed through the same incision. The submental approach is also associated with the least potential for mentalis muscle dysfunction and lower lip incompetence.
Chin augmentation today offers subtle but important aesthetic options for patients to consider. There is no one single way or one implant that is better than another. Consult with a plastic surgeon who is well versed with the different materials and approaches so you are not getting just the ‘standard approach’, but a chin augmentation surgery that has been designed for you.
Dr. Barry Eppley
http://www.eppleyplasticsurgery.com
Clarian North Medical Center, Carmel, Indiana
Clarian West Medical Center, Avon, Indiana
Indianapolis
I frequently get e-mailed and asked…’What can I do to get a stronger jawline?’ This is exclusively a male question and usually, but not always, is from a younger patient. In looking at a lot of photographs of male patients with this concern, the most common problem is that the chin is short and the jawline is ill-defined. Some cases are more severe while others are much more mild. In either case, the strong jawline of male models and some famous male actors has set a beauty standard for males to aspire to.
In making a jawline more distinctive, there are three areas to consider improving or highlighting. Anterior projection (chin), posterior lateral width (jaw angle) and inferior border or circumferential jawline are the areas that can be surgically augmented with implants. Other than the chin, there are no bony moving or bone grafting procedures that will work.
From a practical standpoint, the two most common and easiest implants to place are the chin and jaw angle. The available implants are well made with numerous styles (chin) and a good range of sizes that will fit all but the very largest, or most bony deficient, patients. By bringing the chin forward (and more square) and making the back of the jaw (jaw angle) wider, the jawline becomes much more distinctive. This approach will work for the vast majority of male patients.
The use of a chin and jaw angle implant for jawline augmentation does leave a gap in the body of the mandible between the two. Depending upon the type of chin implant used (how far back the wings of the chin implant goes), that gap can be up to several cms. in length. While this may seem unfavorable, it is usually not discernible and the aesthetic benefits of considering ‘filling in that gap’ are not usually worth it in my Indianapolis plastic surgery experience. Having three separate implants (five actually along the entire jaw) is bound to have some irregularities that certainly will be felt.
Implants for the body (middle) of the jaw are not commercially available. No such stock implants exist. That fact should tell you that their need, or more pertinently their importance, is really quite limited. To use such an implant, it has to be hand-carved during surgery. Actually this is not that difficult as the use of Gore-tex blocks or sheets can be easily used and shaped. I have no qualms about the ability to shape or place them but my concerns revolve around the ability to feel them, particularly the transition with the chin implant on the front edge and the jaws angle implant on the back edge. Because of these concerns, there has to be a really compelling reason to use them.
There is an alternative to a piece-meal implant approach to total mandibular augmentation. A one-piece custom implant can be fabricated before surgery off of a 3-D CT mandibular scan of the patient. This is best used when the objective is vertical lengthening of the jawline as this is how it must be placed. It can not be used to provide posterior width like a traditional jaw angle implant.
Barry L. Eppley, M.D., D.M.D.
http://www.eppleyplasticsurgery.com
Clarian North Medical Center, Carmel, Indiana
Clarian West Medical Center, Avon, Indiana
Indianapolis
Chin augmentation is a popular procedure for bringing out the prominence of the lower third of the face. It can have a powerful effect on the facial profile, particularly in men. Most commonly, the chin is brought forward in a horizontal direction elongating the jawline and improving the look of the neck angle which lies underneath.
Chin augmentation can be done by two completely different methods and is the only facial area which can be enhanced by such diametric approaches. By far, the placement of a chin implant on top of the bone makes up how it is done by most plastic surgeons. Using a variety of different implant options, the chin can be quickly and reliably brought forward in similar dimensions and shape of the implant selected. Conversely moving the chin bone, known as an osteoplastic genioplasty, can also be done to create a similar effect. Cutting the bone is technically more involved and takes longer, but in experienced hands is just as reliable as an implant.
These two chin surgery methods have their proponents and the merits of each have been debated for years in plastic surgery circles. Chin implants are usually preferred because of their ease of placement and ‘easier’ recovery. But the choice of either approach should not be based on what is easiest but what is most anatomically correct and will have the least long-term risk of complications. Each has its own place in the properly selected patient.
For small to moderate amounts of horizontal advancement, regardless of patient age, the advantages of a chin implant makes it an easy choice. Moving the chin bone for the sake of 5mms or less of movement is not worth the greater complexity of the procedure or its increased risk and costs. When the amount of chin advancement starts to get closer to 8 and 10mms, the consideration of an osteotomy starts to be a good consideration. This is particularly poignant in the younger patient in their teens and twenties. Large chin implants over a long lifetime are not without some risk of eventual problems.
What may tip the balance for an osteotomy over an implant is if there is a vertical dimension issue along with being horizontally short. While an implant can bring the chin forward, it can not obviously shorten it. Shortening a long chin can only be done by removing a wedge of bone with an advancement osteotomy. Conversely, however, an implant can lengthen a chin somewhat as it brings it forward. By positioning and securing the implant on the lowest edge of the bone, a few millimeters of vertical height can also be obtained. But more significant lengthening is best done by osteotomy where the whole chin complex and its attached soft tissue are brought down with it. This makes the vertical change in the chin more natural and physiologic.
This being said…which is better…implant or osteotomy? The answer is the blending of the considerations of patient age, the dimensions of the chin deficiency, and one’s tolerance of the amount of physical recovery. Large horizontal deficiencies, vertical changes that are needed, and a young age make the osteotomy preferred over the more commonly used method of implant augmentation.
Barry L. Eppley, M.D., D.M.D.
http://www.eppleyplasticsurgery.com
Clarian North Medical Center, Carmel, Indiana
Clarian West Medical Center, Avon, Indiana
Indianapolis
A facelift primarily provides a rejuvenative effect along the neck and jaw line. By removing neck fat, tightening the platysma muscle, and removing excess skin back and up towards the ears, a more defined neck angle is created. Such changes are largely seen in the profile or three-quarter view which is how we are viewed by most other people.
One technique to enhance the change in the neck angle is to lengthen the jaw line at the same time as the facelift. This is most commonly and easily done with a chin implant. By bringing the point of chin projection further forward, the length of the jaw line becomes more pronounced and the neck angle looks even better. It is surprising on photographic analysis how many women are slightly chin deficient by classic profile analysis. When one is younger, a mild chin deficiency adds to a juvenile appearance. When one is older, however, the reverse is true and it makes one look older and more frail.
Placing a chin implant in most facelifts involves no additional incisions. In a full facelift, a submental crease incision is used for the midline neck work. By going north instead of south, the end of the chin bone is easily found. Dissection and implant placement is quick and simple with little extra operative time.
A legitimate concern for many patients is that the fear that the implant may be too big. This can be avoided by doing a preoperative profile prediction analysis . (which is standard in my Indianapolis plastic surgery practice) This not only helps identify whether a chin implant may be beneficial to one’s facelift results but provides a good feel for what size it should be.
Facelifts and chin implants are a common combination for many female facelifts and much less commonly so for men. A slightly stronger chin and defined jaw line creates a more youthful appearance and should be considered as part of the overall facial rejuvenation strategy. Some plastic surgeons debate about what type of chin implant is best to use. I think the material choice is irrelevant as long as gthe plastic surgeon is familiar with its handling.
Barry L. Eppley, M.D., D.M.D.
http://www.eppleyplasticsurgery.com
Clarian North Medical Center, Carmel, Indiana
Clarian West Medical Center, Avon, Indiana
Indianapolis