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Chin reduction is a far less commonly performed chin procedure than a chin implant or chin augmentation. I would have to estimate that I perform only one chin reduction for every 20 to 25 chin enlargements or enhancements that I do. Not only is it a more uncommon chin procedure, it is also one fraught with many more potential cosmetic complications. Like most of plastic surgery, it is always easier to enlarge a body part than it is to aesthetically reduce it.

Chin reduction may be beneficial when, in side view, the projection of the chin exceeds a vertical line dropped down from the forehead. Anthropometrically, the chin should fall either on this line or slightly behind it to be classically adequate and pleasing. However, chin reduction (or more accurately narrowing) may also be beneficial if the chin in a frontal view is too wide or square. This is usually an issue in women and not men.

In minor cases of excess chin, camouflaging procedures such as cheek implants or rhinoplasty may negate that appearance if those surgeries are indicated. Usually, however, only some form of chin reduction will make the necessary aesthetic difference. Chin reduction surgery is done through an incision under the chin in the skin crease. Muscle is lifted up off of the chin bone (front part of the jaw) and a burr is used to reduce the prominent central area, feathering out into the sides of the chin bone. While any amount of bone can be removed, excess reduction is not advised as this will create a soft tissue redraping problem. Once the bone is reduced, you actually need less muscle and skin underneath. If the muscle is not adequately resected and tightened, you may end up with a ‘witch’s chin’ deformity where the soft tissue sags off of the bone due to lack of support for that amount of tissue. This is a common problem with this operation when done by someone inexperienced and unappreciative of the nuances of the chin reduction procedure. Problems are usually avoided of the bone reduction is not overly aggressive and attention is paid to good soft tissue resuspension and support.

I always advise patients that, unlike a chin augmentation where a very big difference can be achieved, chin reduction is about a more subtle change and is never as dramatic a difference. It is, nonetheless, a gratifying procedure when done well and the recovery is no more significant than a chin augmentation. Chin reduction, when combined with other midfacial enhancement procedures at the same time, produces an even better aesthetic change in one’s facial profile.

Dr. Barry Eppley

http://www.eppleyplasticsurgery.com

http://www.ologyspa.com

Clarian North Medical Center, Carmel, Indiana

Clarian West Medical Center, Avon, Indiana

Indianapolis

While chin enhancement in both increased projection and width is desireable in men, the exact opposite is true in women. A narrower more refined chin helps contribute to a more oval facial form. When one looks at a woman’s face and it is more square, the question is whether this is due to a bony prominence at the mandibular (jaw) angles, whether it is due to a square chin shape, or both. If a wide square chin is the main contributor to the undesired lower facial contour, then bony reduction of the chin can be performed.
Bony chin reduction by burring or shaving down the lower border, in my experience, produces only a minimal result. In addition, it also has the risk of creating a soft tissue sag due to the extensive stripping of the soft tissue off of the bone in order to be able to do the procedure.In the July2008 issue of Plastic and Reconstructive Surgery, Park and Hoon Noh from Korea address chin narrowing by a chin osteotomy and midline resection. This is an easy variation of a chin osteotomy and I have also found it very successful for chin narrowing. (and it can be used for chin widening as well) One of the key technical points is to make sure to burr down the edge of the bone where the lateral side of the chin is moved in and to resuspend the mentalis muscle well. The risk of temporary mental nerve numbness should be the same as with shave reduction only as nearly same amount of soft tissue stripping is needed.
Like all chin osteotomies, there is more swelling and temporary numbness than will occur from a chin implant for example. But the long-term result is worth it. Chin narrowing, combined with mandibular angle reduction, can be very effective in the most square of faces.
Dr. Barry Eppley
http://www.eppleyplasticsurgery.com
http://www.ologymd.com
Clarian North Medical Center, Carmel, Indiana
Clarian West Medical Center, Avon, Indiana
Indianapolis