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Archive for the ‘chin implants’ Category

Physiologic Tissue Adaptation to Face and Body Implants

Saturday, January 24th, 2015

 

Synthetic implants  are involved in some of the most common procedures performed in plastic surgery. From the skull down to the calfs, implants allow an instantaneous augmentation effect to be achieved of a variety of sizes and shapes. While rivaled more recently in some procedures by fat injection grafting, implants offers a permanent volume/augmentation effect that is simpler to achieve. (out of a box so to speak)

While implants offer many benefits, they also have their own set of potential complications. Infections, malposition and size issues are amongst the most common no matter where in the face and body an implant may be placed. These are obvious complications that occur in the short-term, within weeks or months after surgery.

But longer term changes which sometimes lead to complications with implants come about from a less obvious source. When a synthetic implant is placed in the body, the implant itself can never change as they are made of materials that do not degrade or change. (e.g., silicone) Rather the body must adapt to it and respond based on the pressure caused by the implant’s volume. Thus tissues change around the implant and these changes are almost always that atrophy. Surrounding tissues thin to varying degrees based on implant size and body location.

Chin Implant Settling Dr Barry Eppley IndianapolisOne of the classic examples of this response is that of the chin implant. Often erroneously referred to as ‘erosion’ (which suggests an inflammatory reaction which it is not) some chin implants can be seen on x-rays of being partially inside the bone. This is a benign but natural process of implant settling. As a response to the pressure of the chin implant, which causes its aesthetic effect by pushing off the underly bone on the soft tissues of the chin, the bone responds to this pressure over time by resorbing under the implant. This allows the chin implant to imprint into the bone. Once a ‘pressure release’ is obtained no further settling into the bone occurs. Interestingly it does not occur in all chin implants and rarely if ever occurs in any other type of facial implant.

Breast Implant Chest Wall Deformity Dr Barry Eppley IndianapolisAn often recognized example but one that is far more common is that of breast implants. The pressure release phenomenon occurs through the dual effect of overlying breast tissue thinning and underlying rib deformation. Every plastic surgeon has seen it in some women who undergo breast implant replacements. When the existing breast implant is removed, the remaining breast mound will look sunken in and deformed. This is one reason some women over time feel that their breast implants no longer look as big. The breast implant has never changed in volume but the surrounding breast tissue has become less and the implant may have settled down into the ribs more.

While this tissue response to chin and breast implants rarely causes any problems, such a response on the nose can be very problematic. Rhinoplasty that uses large implants for nasal augmentation is well known to cause thinning of the overlying soft tissues which is very thin. This can lead to implant exposure and infection.

Tissue atrophy and thinning occurs to some degree around every augmentative implant placed in the body. It usually does not cause any long-term problems but is one compelling reason to avoid very large implants at any face or body location.

Dr. Barry Eppley

Indianapolis, Indiana

Technical Strategies in Plastic Surgery – Combining Chin Implant and Sliding Genioplasty for Large Chin Augmentations

Friday, October 10th, 2014

 

Chin augmentation can be done by a variety of surgical methods including a chin implant and a sliding genioplasty. Each of these aesthetic chin techniques has a role to play and they have their own advantages and disadvantages. But both have the same limitation…a limit to how much the chin can be horizontally projected. Chin implants are not made with standard thicknesses that are greater than 10 to 12mms. A sliding genioplasty can only be moved as far as the thickness of the bone will allow which can vary between 10mm to 16mms.

The horizontal movements provided by standard chin implants and sliding genioplasties are sufficient for the vast majority of patients with chin/jaw deficiencies. But they can be inadequate for the few patients that have horizontal chin projection deficiencies that exceed 15mm and may be as significant as 25mms.

Sliding Genioplasty and Chin Implant Dr Barry Eppley IndianapolisChin Implant and Sliding Geniplasty in Large Chin Augmentations Dr Barry Eppley IndianapolisCombining a sliding genioplasty with an implant is a novel method to achieve larger amounts of chin projection that I have done for years. Through an intraoral approach, which is needed for a sliding genioplasty, the implant is placed on the chin bone just one would normally do. It does need to be secured into placed by screw fixation otherwise it would easily become displaced. A chin implant with long wings also has the advantage of covering over the bony step-off that often occurs at  the back end of the osteotomy.

Very large chin deficiences can be managed by the creation of a custom implant but combining an implant and a sliding geniplasty may be sufficient in some of these cases. In my experience there has been no higher infection risk when placing an implant on top of a sliding genioplasty than when using a chin implant alone.

Dr. Barry Eppley

Indianapolis, Indiana

Five Things You Didn’t Know About Chin Augmentation

Wednesday, December 18th, 2013

 

Chin Implant Augmentation Indianapolis Dr Barry EppleyChin augmentation is one of the most commonly performed aesthetic facial surgeries and has a long history in plastic surgery. Other than rhinoplasty, in which it is often concurrently performed, it is the most frequently changed facial skeletal structure for cosmetic enhancement. While historically done with bone and cartilage, it is almost always done today by a large collection of preformed synthetic implants that offer a wide range of three-dimensional changes  of horizontal projection, width and vertical length.

While chin augmentation is often perceived as a simple and straightforward procedure, both by surgeons and patients alike, there are numerous issues that must be considered for a successful result.

Chin Augmentation is a Three-Dimensional Facial Enhancement. While the historic assessment of chin deficiency, and the success of chin augmentation, has been based on the amount of horizontal augmentation, this dimensional consideration alone is inadequate. Adequate chin augmentation should take into consideration its width as well as its height or vertical length. These dimensions can be almost as important as horizontal projection when one is viewed or seeing themselves in the frontal and oblique facial views. Many of these dimensions can be changed by contemporary chin implant designs.

The Shape of the Chin Is Different in Men and Women. The shape of the face has some very gender specific differences and the chin is no exception. Men want a stronger chin that can aesthetically have more projection and width. (squareness) Conversely, a woman’s chin can be a little bit weaker (less projection) and should have more of a triangular shape, it should also not be too vertically long. The most frequent aesthetic chin augmentation ‘complication‘  is a chin augmentation result in a women that looks too big, often being too wide.

The Chin Is Connected to the Rest of the Jawline. Deficiencies in the chin almost always reflect other jawline issues since the chin is just an extension of the total mandibular bone and its growth and development. For these reason, short chins will almost always have a high jaw angle. For men this may mean that they may aesthetically benefit by the placement of jaw angle implants with their chin augmentation to really given them a much better shaped overall jawline.

The Path of Chin Implant Insertion Can Affect The Results. Chin implants can be inserted through either inside the mouth or from under the chin. While patients understandably are focused on avoiding a scar under the chin, the intraoral route is associated with a far greater risk of complications and poor implant positioning not to mention recovery…all due to disruption of the insertion of the mentalis muscle. It actually takes much greater technical skill to get a good chin augmentation result when done from the ‘scarless’ method of chin implant placement.

Not All Chin Implants Come Preformed Out Of A Box. While there is a wide variety of styles and sizes of chin implant available today, a performed implant may still not be the most ideal for some patients. If the jawline/chin has asymmetry or the amount of chin augmentation is extreme and may require an extended chin implant, a custom designed chin implant can be the much better way to go. While it does add cost, an unhappy result or revisional surgery may end up costing more later.

Dr. Barry Eppley

Indianapolis, Indiana

The Myth of Silicone Chin Implant Erosion

Monday, October 14th, 2013

 

One of the most commonly performed facial augmentation procedures is the placement of a chin implant. Whether it is done for significant microgenia (short chin) or as a complement in rhinoplasty and facelifts for less severe chin deficiencies, chin implants represent an historic and usually straightforward aesthetic facial procedure. Chin implants date back as far as the 1950s and were the first type of synthetic implant placed in the face. While other materials had been used both before that and since, the use of silicone is by far what makes up the vast majority of chin implants that have ever been placed.

Chin implants have a history and a much talked about issue of potential ‘erosion’ into the underlying chin (mandibular symphyseal) bone. This issue has raised all sorts of concerns from patients considering chin augmentation, fearing that it is a destructive process that eats the bone and ultimately poses other problems. For some potential patients, this is issue is so dissuasive that they will either not have an implant for their chin augmentation or will choose a sliding genioplasty or another implant material because they feel it is safer.

After over 30 years of doing chin augmentation in every way possible and seeing every conceivable implant material used for it, I have never seen what one would consider to be a pathologic or destructive bony process of the chin. This does not mean I have not seen many chin implant indentations and impressions on the bone but this should not be confused with an erosive process.

The  biology of any implant that is placed in the body under pressure is that it will cause some surrounding natural tissue absorption. The implant itself is chemically inert so when it pushes on the overlying tissues, as all augmentation implants do, the body adapts to the pressure of the implant by some natural tissue resorption to relieve the pressure or push of the implant. This is well known, for example, in breast augmentation. Over time, the thickness of the breast tissue between the implant and the overlying skin thins due to the pressure of the implant on it. This is why saline breast implants develop more visible rippling over time and women with any type of implant feels that their breasts are a bit smaller. This is a passive tissue remodeling process not an active inflammatory erosive reaction in response to the composition of the material.

Many, but not all, chin implants will develop a minor amount of adaption of the underlying bone which is best called ‘implant settling’. Usually it is not more than a millimeter or two. It is not uncommon to see the the implant sizing number or other markings of the implant on the bone as part of the settling process. When the implant is properly positioned over the thicker bony cortex of the lower chin, this is about the implant settling one will see. In very large chin implants in very short chins, the amount of implant settling may be a few millimeters more.

However, if the implant is placed too high up on the chin bone (which often happens with an intraoral approach), it sits over the much thinner alveolar bone adjacent to or over the incisor tooth roots. This bone is less thick than the lower cortical bone and is more prone to see deeper implant settling. This can look very dramatic and ominous in x-rays and there probably have been a handful of such chin implant cases where lower tooth sensitivity resulted. It is these type of x-rays that has undoubtably led to many of the descriptions of  ‘chin implant erosion’ and such poor implant positioning was common decades ago.

But the number of true chin problems (tooth root exposure, infection) that have resulted from such radiographically seen cases of implant settling is extremely rare and very few cases have ever been reported in the medical literature. (I actually know of none…but I will assume that there have had to be several in the past fifty years)

In conclusion, the phenomenon of chin implant erosion is a myth. Rather it is the mislabeling of a natural process of tissue adaptation to the presence of an implant. It is neither active, inflammatory or a progressive process. Rather it is a passive tissue remodeling process that is self-limiting and of no aesthetic or biologic concern. It is not exclusive to silicone chin implants and can occur with all chin implant materials. With proper chin implant positioning below the apices of the incisor tooth roots, even this remote possibility of potential impingement is eliminated. Interestingly, such tissue remodeling is not seen on any other facial implantation site other than that of the chin.

Dr. Barry Eppley

Indianapolis, Indiana

Case Study: Extreme Chin Augmentation with Combined Osteotomy and Implant

Monday, December 3rd, 2012

 

Background: Chin augmentation is a very common plastic surgery procedure that helps bring into balance the lower face with more projecting upper facial features. It is by far most commonly done with synthetic implants that provide varying amounts of increased horizontal projection as well as some width changes. Less frequently, sliding genioplasties (chin osteotomies) are done for chin augmentation when more horizontal projection is needed than implants can provide and/or vertical lengthening is aesthetically beneficial as well.

In more extreme cases of chin deficiencies, neither implants or an osteotomy is really adequate. When the chin is really short, this indicates that the entire lower jaw is underdeveloped and an overlying malocclusion (bite deformity) exists as well. While this type of patient should ideally have orthodontics and subsequent orthognathic surgery for jaw correction, this may not be an option for many so afflicted patients. While one could argue that an implant or an osteotomy is better than nothing, and that is most certainly true, they will fall far short of the needed amount of augmentation.

Extreme cases of chin deficiences require a novel approach to get visible and satisfactory results that often must approach 20mms of increased horizontal projection. Combining an osteotomy with an implant is relatively unprecedented although there is no reason why they can not be done together. The implant can merely be placed on the front edge of the osteotomy which is naturally denuded of soft tissue for the execution of the bony cut. Because there is no defined soft tissue pocket, it would be critical to secure the implant to the bone to avert displacement later.

Case Study: This 35 year-old male presented for chin augmentation. He had seen other plastic surgeons who told him his chin was too small for an implant. He did not want at this point in his life to undergo the orthognathic surgery process. In addition, he did not have the quality of dentition that would support in good health a prolonged course of orthodontics. By measurement in photographs using the Frankfort horizontal plane, his soft tissue chin point was deficient by 29mms from an ideal horizontal position. At this amount of horizontal deficiency, he also had a vertical chin deficiency as well.

Through an intraoral approach, an obliquely-oriented horizontal chin osteotomy was done staying 5mms below the mental foramen. The chin was downfractured and then advanced and held into a maximally advanced position with a step plate secured with screws above and below the osteotomy line. A maximal advanced position is one in which there still remains a small amount of bony contact between the front edge of the upper chin bone and the back edge of the advanced chin segment. The step plate was bent downward to create some vertical lengthening as well.

To get more chin projection than just that of the bone, a 7mm extended synthetic implant was placed on the front edge of the advanced chin bone. It was secured to the chin bone with a screw on each side of the midline. The wings of the implant extended back along the advanced chin bone to ensure that they covered the end of the osteotomy site where a bony notch typically occurs. The mentalis muscle was then reattached and closed in two layers with a single mucosal layer closure.

His postoperative course was typical for any sliding genioplasty patient. There was swelling and bruising along they jawline and neck that persisted for about three weeks after surgery. When seen at three months after surgery, all swelling had resolved and he had no residual mental nerve numbness. He had dramatic improvement in the appearance and shape of his chin, even if it still was mildly deficient. At ten years after his surgery, he has not had any implant or bone healing problems.

Case Highlights:

1)      Severe chin deficiencies are not optimally treated by synthetic implants or osteotomies alone. Neither are capable of increasing the horizontal chin projection more than approximately 15mms.

2)      Combining a sliding genioplasty with an implant in front of it can achieve horizontal projection increases of up to 20mms.

3)      Combining implants with a chin osteotomy requires screw fixation of the implant to the advanced chin segment and long enough wings of the implant to cover the notch at the end of the osteotomy cut.

Dr. Barry Eppley

Indianapolis, Indiana

Contemporary Implant Concepts For Surgical Jawline Enhancement

Monday, November 26th, 2012

 

‘All societies in history were and are preoccupied with facial beauty’

‘ Facial balance and symmetry are the key features to attractiveness’

‘All people regardless of race, class or age share a similar sense of what is attractive’

‘Square jawed males are viewed as more masculine, gain higher ranks in the military and have earlier and more frequent sex’

‘ A square chin and jawline frames the lower face, making it more symmetrical and defined’

‘Defined jaw points and angles are more attractive in both men and women’

These are just a few of the well known facial facts of beauty that are often quoted and specifically address the merits of a strong and well defined jawline. While some have it naturally, the vast majority of us don’t and must seek a surgical solution. While there are a variety of facial implants for jawline enhancement, there are numerous misconceptions about how they work and how a better jawline is achieved.

‘The jawline consists of three parts, the chin, body and angles, all which can be implanted although not equally effectively or in all dimensions’

The most well known jawline implant is that of the chin. It is the most frequently done of all facial implants and has been surgically implanted for over fifty years. While the styles and size of chin implants have improved dramatically over this time, chin augmentation only affects the front 1/3 of the jawline. While one could argue that this is the most important part of the jawline and has its U-shape provides very visible forward projection, a chin implant provides no change for the posterior 2/3s of the jawline.(body and angles) Even today’s extended anatomic designs rarely provide any augmentation to the body even though the tail of the implants may lay upon it. Today’s chin implants, while providing projection and even square shapes through increased width, can not provide vertical lengthening…an overlooked feature of chin implant designs.

Three-dimensional chin reshaping can be done by a sliding genioplasty which can add vertical lengthening as well as horizontal projection. In extreme chin deficiencies, an osteotomy can be combined with an implant in front of it for a few more millimeters of projection or the implant can serve to fill in the notching that often occurs in the bone in the prejowl area.

Jaw angle implants are the least performed augmentations of any of the facial prominences. (chin, cheek, nose and jaw angles) While jaw angle implant designs have been around for nearly fifteen years, they have not garnered great use because their surgical implantation is more difficult and aesthetic interest is more recent. Current jaw angle implants produce mainly lateral augmentation (width) which actually is indicated for only the minority of patients seeking jaw angle enhancement.  For someone with a favorably low jaw angle point, width alone may produce a satisfactory enhancement.

Jaw angle deficiencies, however, almost always are the result of a high jaw angle which by definition implies a vertical deficiency as well. Getting current implant designs low enough is difficult if the surgeon does not do adequate soft tissue release and the implant does not have a design that can engage the lower border of the jaw angle for positional security. Jaw angle implant designs that provide both horizontal and vertical augmentation (inferolateral) are most useful to a larger number of patients, particularly men, who seek a more defined and prominent jaw angle area.

While chin implants augment the anterior two-thirds and jaw angle implants enhance the posterior two-thirds of the jawline, the missing area is the middle or the body of the jawline.  Sandwiched between the chin and the jaw angle, the body area has not specific implant for it. There is no ‘connector’ implant between the two. For those seeking a perfectly straight line back from the chin to the jaw angle point, this may be an aesthetic problem. While chin implants have extensions that go back and jaw angle implants have a forward reaching design, the two only connect over the body by overlapping their feathered edges if done together. This is why many jawline enhancement patients may have a visible step-off or break in their new surgically created jawline. For some combined chin and jaw angle patients, this body discrepancy is minimal and not an aesthetic issue.

The body gap becomes most manifest when the jawline deficiency has a vertical deficiency component to it, areas that are not optimally augmented with current chin and jaw angle implant designs. When a perfectly straight and well defined jawline is desired, a custom two-piece implant is ideally needed that augments the entire jawline from front to back in a perfectly smooth fashion. These are particularly effective when the lower jaw is vertically short and the implant can be made to extend the entire lower border of the jaw. These ‘wrap-around’ jawline implants can produce some dramatic jawline changes.

The most unique jawline problem that can only be addressed by custom implants is when the entire jawline is vertically deficient, creating a small lower face. This almost always is associated with a lot of overbite of the anterior teeth, indicating that the lower jaw is small and fits partially inside the upper jaw. This creates an overclosing of the lower jaw making it too short vertically. Making a custom implant that fits only on the lower border of the jaw and lengthening it from front to back is the only effective solution.

Jawline enhancement must be assessed carefully in every patient to get the right jawline implant(s) design and size. For many patients, a chin implant may only be needed. For others seeking a three-point prominence change, off-the-shelf chin and jaw angle implants will suffice. Improving implant designs and sizes will make using this implants even more effective in the near future. For those seeking a completely new jawline with existing front to back deficiencies, wrap around jawline implants are designed and custom made for each patient’s specific jaw anatomy.

Dr. Barry Eppley

Indianapolis, Indiana

Case Study: Jawline Enhancement in the Thin Male Face

Friday, November 2nd, 2012

 

Background: A strong jawline is perceived as a sign of masculinity and is a commonly desired feature of some men. Using implants is the only way to create a well-defined jawline through the triple approach of chin and jaw angle implants. While these implants are available in different materials from various manufacturers, their most important feature is the style and size that they offer. Picking these implant features for any male patient is a lot more art that it is science.

When picking implants for any facial area, it is important to take into account their facial shape and the overlying soft tissue thickness. Thick faces blunt the effects of implants and may simultaneously benefit from some defatting procedures as well. Thinner faces have less overlying soft tissue and the effects of implants can more easily be seen. These facial characteristics are particularly important at the jawline which is essentially a transition point between the face and the neck. Augmenting the front (chin) and the back part (jaw angles) of the U-shaped jawline can change its appearance dramatically.

The thin face and jawline has the benefit of being more easily skeletonized by implants. But implant size must be tempered lest their effects become too pronounced or big. The lower face must not overpower the upper face by being too wide or extending beyond the upper zygomatic width. It must also not become too square in appearance and still maintain some element of being thin and somewhat narrow, just with a more defined jawline.

Case Study: This 45 year-old male felt that his entire jawline was weak. He had a chin implant placed four years ago and, while it provided some benefit, it was still not satisfactory. As part of the discussion about how to improve his chin, his highly angled jaw angle area was pointed out and it was agreed that jaw angle implants would be beneficial as well. He remembered that his prior chin implant was of mersilene mesh composition and that it was ‘large’ according to his original surgeon.

A square silicone chin was chosen to replace his existing chin implant. At least 9mms of additional horizontal augmentation was needed with a more square frontal shape. Silicone jaw angle implants that dropped the angle border down was also chosen but with a width that was not more than 7mms, keeping in line with the rest of the width of his face. The implants would have some overlap across the body of the mandible but with no augmentation effect in this area, which is common.

During surgery, the chin was approached through his existing submental scar. The mersilene mesh implant was heavily ingrown with tissue and was near the dermis of the skin. Removing it was felt to leave too little soft tissue between the skin and any new implant. It was elected to leave it in place and place the new square silicone implant between the underside of the mesh implant and the bone. The wings of the square chin implant went well beyond that of the mesh implant and had no problem providing a more square shape effect. The jaw angle implants were placed through an intraoral incision behind the molars. Dissection released muscular attachments off the angle and the inferior border so the jaw angle implants could be placed low enough. They dropped the border 5mms and had 7mms width. A single screw secured them in place to keep them low and to the back of the angle.

He had some moderate facial swelling, but like in all thin faces, it resolved fairly quickly within three weeks after surgery. He had a much improved jawline with better definition but a jawline width that stayed in line with his upper facial width.

Case Highlights:

1)      Jawline enhancement in men is most commonly performed by a combination of off-the-shelf chin and jaw angle implants.

2)      The style and size of chin and jaw angle implants must be chosen carefully and with an appreciation of the patient’s natural anatomy and soft tissue thickness.

3)      In the thin male face, jawline implants should not be too wide or over-sized as small implant can produce dramatic effects.

Dr. Barry Eppley

Indianapolis, Indiana

Options in Neck Contouring – 2. Hard Tissue Procedures

Saturday, August 25th, 2012

 

While the soft tissues dominate the surface area of the neck, they are not the only elements that give it its shape. Several hard tissue components comprised of bone and cartilage also make a contribution. The form of the jawline is on the upper edge of the neck and is the superior suspension point for most of the neck’s soft tissues. The thyroid cartilage sits in the midline of the lower neck and is barely noticeable unless it sticks out too far. The prominence of the thyroid cartilage also has gender significance in helping to define a male vs a female’s neck.

While manipulation of the hard tissues of the neck does not change the all-important cervicomental angle, it does help influence how that angle is seen. The stronger and more defined the jawline is, the greater is the perception of more youthful neck due to a longer upper limb of the cervicomental. If the thyroid cartilage is too prominent, the lower limb of the angle is disrupted creating an undesireable bump in the neckline. While for men this bump may be fine and even attractive, it is not so for women.

Chin Augmentation The jawline separates the neck from the face and is defined by both its length and it anterior projection. The chin is the most forward part of the jawline and its strength or weakness can help or hurt the appearance of the neck.  The horizontal projection of the chin can be easily increased using a variety of implant styles and sizes. Chin implants can be placed through either the mouth or from under the chin. For many patients, putting the implant in from under the chin assures proper positioning on the most forward part of the chin bone. Chin augmentation can be a very useful adjunctive procedure with any of the neck contouring procedures, particularly isolated liposuction and facelifts.

Tracheal Shave  The prominence of the thyroid cartilage often has little to do with one’s age. The size of the cartilages are genetically imprinted and not age-related. The one occasional exception is that seen after a facelift when the profile of the thyroid cartilage can become unmasked as the neck skin is tightened and pulled back. For those that have too strong of a neck bulge caused by the strength of the paired thyroid cartilages (more commonly known as an Adam’a apple), this can be reduced by shaving the prominence down. This is done through a small horizontal neck incision directly over the prominence. It is a virtually painless procedure with no recovery and a result that is immediate. Most patients obtain results where the size of the bulge is dramatically reduced and a few will get a completely smooth neckline in profile.

Tracheal Augmentation In rare cases, a more dominant or even an evident thyroid cartilage bulge is desired. This masculinizing neck procedure requires the placement of a specially-shaped implant on top of the thyroid cartilage to build out its projection where the paired cartilages meet in the midline. When combined with a submentoplasty above it, a more prominent tracheal bulge can be created.

Dr. Barry Eppley

Indianapolis, Indiana

The Rise In Chin Augmentation Surgery

Tuesday, April 24th, 2012

The chin has a prominent role in defining facial shape and its aesthetic look. Whereas a strong prominent chin has been associated with strength and increased masculinity, a short chin portrays the opposite appearance of weakness. As a result, cosmetic chin augmentation with an implant has been done in plastic surgery for more than four decades. It is as common to be done by itself as often as it is combined with other facial procedures to improve one’s profile.

While having been done for a long time, chin augmentation surgery has undergone a surge in the numbers of procedures performed. In 2011, a 70% increase in chin augmentations was reported compared to the previous year according to statistics published by the American Society of Plastic Surgeons. News outlets have picked on this increase in chin augmentation surgery and have credited it to such recent electronic device interactions such as Skype on the internet and Facetime on the iphone. It is theorized that seeing one’s face on web cameras and smartphone pictures has increased awareness of chin deficiencies.

While this explanation is intriguing and a bit trendy, it likely has little to do with why more chin augmentations are being done. There are better explanations that make more sense and are reflective of a variety of different factors. First, there are more chin implant options today than ever before. Most of them are made of silicone which makes it easy to create new styles and sizes. Go to any facial implant manufacturer and you will see that there are more chin implant options than almost all other facial implants combined. One of the more popular facial implant manufacturer has 14 different styles not to mention different sizes within each style. One may argue how really different many of these implant styles are but they give surgeons a lot of options. When more options are available, more procedures end up being done.

Another major driving force is the rise in two other specific facial procedures, rhinoplasty and facelifts. Both are being done by an increasing number of surgeons but facelifting treats a problem that eventually affects all of the population. The rise of numerous types of limited or less invasive facelifts has spurned a lot of attention in the younger patient with earlier signs of aging. This has drawn a lot more attention to how one’s face looks as it ages. Since facelifts focus on the shape of the jawline and the neck, any chin deficiency will be quickly recognized. Chin augmentation adds length to the jawline which helps in improving the smoothness of the jawline and the sharpness of the neck angle.

There may also be some influence, as had been suggested, that more people are seeing themselves than ever before. Whether by digital camera, smartphone or on Facebook, people are having to see more of themselves particularly in profile. When combined with an ever increasing desire to remain competitive in the workplace, change in social circumstances such as divorce and an ever increasing emphasis in society on looking and feeling younger, all types of facial rejuvenation procedures are increasing.

Put together, there are many reasons chin augmentation is increasing. But the main reason it continues to grow is because it is works. It is one of the most significant structural changes of the face, whether it is a small increase to complement a facelift or a major change to improve a naturally short jaw.  

Dr. Barry Eppley

Indianapolis, Indiana   

Plastic Surgery’s Did You Know? The Rise in Chin Augmentation

Wednesday, April 18th, 2012

The fastest growing cosmetic plastic surgery operation in 2011 was…chin augmentation. Done primarily with an implant, enhancing one’s profile by improving the projection of the chin increased over 70% last year. The rise in chin augmentation has been linked to the increasing use of Skype and FaceTime, applications where you are forced to look at yourself while talking to others. The distortion of webcams rarely improves one’s appearance and often makes the face look fatter. More likely the increase is due to new chin implant sizes and styles and the growing number of different types of facelifts which are often combined with chin implants to create a more defined and smoother jawline and neck angle.


Dr. Barry EppleyDr. Barry Eppley

Dr. Barry Eppley is an extensively trained plastic and cosmetic surgeon with more than 20 years of surgical experience. He is both a licensed physician and dentist as well as double board-certified in both Plastic and Reconstructive Surgery and Oral and Maxillofacial Surgery. This training allows him to perform the most complex surgical procedures from cosmetic changes to the face and body to craniofacial surgery. Dr. Eppley has made extensive contributions to plastic surgery starting with the development of several advanced surgical techniques. He is a revered author, lecturer and educator in the field of plastic and cosmetic surgery.

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