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Posts Tagged ‘chin augmentation’

The Vertical Lengthening Chin Implant

Sunday, January 24th, 2016

 

Chin augmentation is the most historic but still the most commonly performed facial augmentation procedure. While many other types of facial implants have been developed, increasing projection of a deficient lower face is still the most potentially dramatic facial augmentation change of them all.

Chin implants have evolved considerably over the past few decades with numerous new styles. The fundamental concept of these style changes has been to create a more natural chin augmentation look or augment different regions of the chin area. But the one constant of all the chin implant styles is that they create a straight horizontal dimensional increase. This is so because all of the implant remains on the front edge of the chin bone.

But some chin deficient patients have more than just a horizontal bone deficiency. Certain short chins are also vertically deficient as well. Historically the only surgical method to substantially increase chin height was an opening wedge sliding genioplasty.  While effective some patients would prefer to avoid a bone cutting surgery.

While it is true that a standard chin implant can be placed very low on the  bone(on its ledge so to speak), this is not how the implant is designed or made to be used. This makes it potentially unstable to sit on the lower end of the bone and, even in doing so, produces a a very limited vertical lengthening effect.

Vertical Lengthening Chin Implant vs Standard Chin Implant Dr Barry Eppley IndianapolisTo address the combined horizontal and vertically lacking chin with an implant, the vertical lengthening chin implant (Implantech) has been developed. What is unique about this chin implant style is that the projection of the implant goes down from the chin at 45 degrees. This creates a combined horizontal and vertical increase. The implant actually sits on the ledge of the chin by design and thus it is more stable. To ensure optimal stability and positioning, a single 2.0mm screw can be placed through the implant to the bone when done from a submental incision. When done intraorally, a 1.5mm screw can be placed through the top edge of the implant to prevent any risk of upward migration. (which actually should be done with all chin implants placed intraorally)

Vertical Lengthening Chin Implant result 1 Dr Barry Eppley IndianapolisVertical Lengthening Chin Implant result 2 Dr Barry Eppley IndianapolisProper patient selection for the vertical lengthening chin implant is critical. It should only be used in patients with a significant vertical deficiency of the chin that also has a horizontal shortness as well. Most of these patients with have an almost 45 degree backward slant between the lower lip and chin. In general, the shorter the horizontal chin deficiency the more likely there will chin height shortness as well. Because it is an implant the width of the chin will also get bigger as the chin gets longer with greater horizontal projection. (a key aesthetic consideration)

Vertical Lengthening Chin Implant result 3 Dr Barry Eppley IndianapolisIn some men with slight or even no real vertical deficiencies, the addition of chin height will create a stronger or more masculine lower facial appearance. While this may be effective for some men, this is not a good strategy for women.

Vertical Lengthening Chin Implant data-lazy-sizes Dr Barry Eppley IndianapolisDifferent sizes (angulations) of the vertical lengthening chin implant are available which can increase the vertical up to 7ms while increasing the horizontal up to 12mms. Such chin augmentation changes may allow some patients to avoid an osteotomy of the chin.

The vertical lengthening chin implant is truly the first 3D chin implant ever made as it increases all three chin dimensions.

Dr. Barry Eppley

Indianapolis, Indiana

Chin Implant Imprinting

Wednesday, August 26th, 2015

 

The use of a chin implant for an increase in lower facial projection is often combined with other procedures (e.g., rhinoplasty) as well as done as an isolated chin augmentation. It has a long history of use in aesthetic facial surgery dating back over fifty years and nearly every available biomaterial has been tried as some form of a chin implant. But the use of silicone chin implants today constitutes the majority of chin augmentation devices used.

One phenomenon of placing a silicone chin implant (it also occurs with other biomaterials as well) is that of ‘chin implant erosion’. This is an erroneous term that implies that a chin implant is actively eating into or destroying the chin bone underneath it. (aka an active inflammatory process occurring as a a result of a bone reaction in response to a leaking of silicone molecules from the implant) That perception and propagated term is far from what actually occurs.

Chin Implant Imprinting 3 Dr Barry Eppley IndianapolisThe chin is a unique facial area for augmentation because it is a projecting bony structure with tight tissue attachments that wrap around it. Thus when an implant is placed between the chin bone and the overlying soft tissues it will exert some forces (pressure) on the underlying and overlying soft tissues. The body will relieve this pressure with passive adaptation to it. Since the chin implant can not change due to its synthetic inert structure, the surrounding tissue must. As a result, the chin implant will often (although not always) settle a millimeter or two into the bone as a form of pressure relief. This can be seen in great detail as the serial number, size indicator or any grooves or markings on the implant can be seen on the bone surface as the implant is removed.

Chin Implant Imprinting Dr Barry Eppley IndianapolisThis passive bony remodeling phenomenon to a chin implant is benign and self-limiting. It has little to no impact on the external aesthetic chin augmentation result and does not affect the quality of the underlying bone. Because most chin implants are placed in the subperiosteal plane this settling will also allow some bony growth to often extend up along the sides of the implant. Such bony overgrowth can be seen clearly intraoperatively as well as on CT scans. This bony overgrowth further implies that the implant is not causing a destructive bony process.

There are very rare cases where chin implant settling has placed the mandibular incisor tooth roots at risk or has caused some dental sensitivity. This is a direct result of a chin implant being placed far too high over the much thinner cortical bone near the tooth roots. As a result, passive implant settling may occur deeper into the bone and appear very close radiographically to the tooth roots. This is the direct result of an incorrect chin implant placement.

It is time to eliminate the term ‘chin implant erosion’ due to its biologic inaccuracy and replace it with a term that correctly identifies it with the passive bony remodeling process that it is. The better descriptor would be ‘chin implant imprinting’.

Dr. Barry Eppley

Indianapolis, Indiana

Case Study: Sliding Genioplasty for Lower Facial Elongation

Tuesday, April 14th, 2015

 

Background: A sliding genioplasty is a well known and historic procedure for changing the shape of the chin. It was originally described in the 1940s but has evolved considerably due to the use of rigid fixation using plates and screws. While once clever osteotomy designs and wire fixation methods were used for stabilization of the bone segments, which limits how much the chin position could be changed, plate and screw fixation now makes virtually any bony chin change possible.

Sliding Genioplasty Indianapolis Dr EppleyFor chin augmentation, the chin implant is often compared to the sliding genioplasty as creating similar effects. But the reality is that this is only partially true and they are only comparable when it comes to pure horizontal movements as seen in the profile view. Vertical and width (narrowing) changes can not be done with an implant. (although newer vertical lengthening chin implants have recently become available)

The real benefits for a sliding genioplasty are when vertical elongation of the chin is needed and when the amount of chin advancement desired exceeds that of which standard implants can achieve. This would be particularly useful in women who can aesthetically tolerate a more narrow chin as it comes both forward and down. The other benefit for a sliding genioplasty in these more substantial chin changes is that it ‘carries’ the soft tissue of the chin pad with it and does not create a devascularizing effect due to maintaining most of the soft tissue attachments (and resultant perfusion) to the bone.

Case Study: This 26 year-old female had a short chin in both horizontal and vertical dimensions. Her lower facial height was disproportionate to the rest of her face. As a result, she appeared to have a full neck/double chin.  She knew she wanted her chin augmented but was just not sure how it should be done.

Sliding Genioplasty result side viewSliding Geniop[lasty result oblique viewUnder general anesthesia, she underwent an intraoral sliding genioplasty. A low horizontal bone cut was done and the chin was advanced 16mm forward and 8mms downward. This was the maximum amount of chin bone movement that could be done while still maintaining some bone contact between the segments. Rigid fixation was achieved by a titanium step plate and screws. The bone gap (step between the upper and lower bone segments was filled with demineralized bone particles. The mentalis muscle was resuspended at closure.

Sliding Genioplasty result front viewThe vertically opening sliding genioplasty can help make the lower face more proportionate by making bringing it forward and down. This will make the jawline have more of a V-shape and will also help get rid of a double chin problem due to lack of bony projection.

Case Highlights:

1) A sliding genioplasty is historically the only chin procedure that can provide both horizontal and vertical elongation of the chin. (custom made implants can now do that also)

2) A vertically opening sliding genioplasty with horizontal advancement will make the chin more narrow as a result of these bony movements.

3) Unless the bony chin movements are extreme, bone grafting of the interpositional gap between the chin segments is not necessary. Even when needed demineralized bone substitutes can be successfully used.

Dr. Barry Eppley

Indianapolis, Indiana

Minimal Incision Chin Augmentation

Thursday, March 12th, 2015

 

Chin Implant Styles Dr Barry Eppley IndianapolisChin augmentation using synthetic materials is both the most historic facial implant procedure and still the most commonly done. This is evidenced in that chin implants have the largest number of styles and sizes commercially available of any facial implant manufactured today. Chin implants are inserted by incisions either from the inside of the mouth mucosa or through the skin under the chin. There are advocates for either approach but successful chin augmentation results can be obtained either way with good attention to their unique technical details.

The placement of chin implants is most commonly done from a submental skin incision. It has the advantages of more limited disruption of the mentalis muscle of the chin, less risk of lower lip numbness and a more assured and sustained placement of the implant on the lowest portion of the chin bone. (where it belongs for its maximal effect) Understandably some patients are concerned about the final appearance of the submental scar. This concern is most significant in patients of intermediate skin pigments.

I have seen many submental chin implant scars and there are often much larger (longer) than they need to be. The use of silicone chin implants, even the longer anatomic or winged ones, allows for the implant to be inserted in a folded fashion, one half at a time. This enables a remarkably small incision to be used despite the length of the chin implant.

Small Chin Implant Incision Dr Barry Eppley IndianapolisThe key is to develop the subperiosteal tunnels along the sides of the chin bone in largely a blinded fashion. Once the incision is made down to the bone, small elevators are used to  made the subperiosteal tunnels along the inferior border of the mandible. It is important to make these tunnels longer than the wings of the implant on each side. By so doing half of the implant can be inserted and slide past its midline to one side. This will allow the opposite wing to be folded and inserted easily and then slide back to the midline.

Small Incision for Chin Implant Dr Barry Eppley IndianapolisOnce the implant is in the tunnels it can be slide back into the midline and secured by whatever fixation method one desires. (in this case of a vertical lengthening chin implant a 1.5mm screw was used)

Minimal incision chin augmentation can be very effectively done through a submental skin incision using preformed silicone implants.

Dr. Barry Eppley

Indianapolis, Indiana

Case Study: Juvederm Voluma Injections for Chin Augmentation

Sunday, June 1st, 2014

 

Botox injectionBackground: Injectable fillers along with Botox has revolutionized facial rejuvenation. While often confused from the public’s perspective, injectable fillers are used for soft tissue enhancement such as softening nasolabial folds and enlarging lips. But as the number and types of injectable fillers has grown over the past decade, their uses has been expanded to include more facial volumizing effects. One of these facial volume effects has been to create skeletal highlights of the bony prominences such as the cheeks, chin, jaw angles and brow ridges.

While no injectable filler can create a permanent facial skeletal enhancement effect, there are some benefits to a temporary one. For those who are interested in having a permanent facial implant but are uncertain that they might like the result, an injectable filler can be a good reversible test. If one does not like the result, the filler will eventually go away…all without ever having to undergo invasive surgery. Conversely, if one likes the effect repeat treatments can be done or one can convert to an actual facial implant.

While any injectable filler can be used for facial skeletal enhancement, many are not appropriate to be so used. To create a facial skeletal enhancement effect the filler must be capable of providing a good soft tissue push as it is injected along the surface of the bone.  The ability of any filler to create this push has been traditionally thought of being due to its G prime factor and its cohesiveness. From a rheologic standpoint this makes sense but has never been proven to be true. A recent study has demonstrated that a good lifting effect of a filler is due more to how its hyaluronic acid chains are manufactured and put together than just its G prime factor alone.

Voluma Injectable Filler Indianapolis Dr Barry EppleySome good injectable fillers for facial skeletal enhancement that provide a good soft tissue push are the newer Juvederm Voluma, Radiesse, and Perlane. All of these are also associated with a longer last effect due to their slower resorption times. Juvederm Voluma has been recently FDA-approved for midface/cheek augmentation but its good soft tissue lifting capabilities indicates that it would be good for other facial skeletal areas as well.

Case Study: This 31 year-old female has been having Radiesse injections into her chin for several years for a chin augmentation effect. They always lasted less than one year. The search for along-lasting effect led to try Juvederm Voluma.

Injectable Chin Augmentation (Voluma) result side view Dr Barry Eppley IndianapolisAs an office procedures, Juvederm Voluma was injected with a 27 gauge needle into the point of her chin in three different locations injecting from the bone outward. The goal was to create a more triangular-shaped chin with a slight increase in horizontal projection. A total of 1cc or one syringe of Juvederm Voluma was used.

Injectable Chin Augmentation (Voluma) result front view Dr Barry Eppley IndianapolisThe use of injectable fillers for chin augmentation can be effective for small reshaping effects. Slight amounts of increased horizontal projection and chin narrowing or widening can be achieved by injection location. One or two ccs (syringes) of a longer-lasting filler should be able to create a chin augmentation that lasts up to one year after injection.

Case Highlights:

1) Injectable fillers can be used for facia skeletal augmentation of the cheeks, chin and jaw angles.

2) The type of injectable filler that works best for facial skeletal augmentation must generate a good soft tissue push based on his G prime factor, cohesiveness and how it is manufactured.

3) Juvederm Voluma injectable filler is approved for cheek/midface augmentation but can be used for chin enhancement as well either as a trial implant test or for a temporary augmentation effect.

Dr. Barry Eppley

Indianapolis, Indiana

Three Dimensional Chin Augmentation – The Vertically Lengthening Implant

Monday, January 13th, 2014

 

Chin augmentation is one of the more popular and historic facial contouring procedures. While often done alone for a ‘short chin’, it is just as commonly done with many other facial procedures such as rhinoplasty and facelifts. Other than rhinoplasty, it is one of the oldest of the facial restructuring procedures having been done in one manner or the other for almost 75 years.

Chin Projection Measurement Dr Barry Eppley IndianapolisWhen most think of augmenting the deficient chin, it is almost always perceived dimensionally as a lack of horizontal projection. Profile assessment, done by either lateral cephalometric or picture analysis, makes an assessment of where the most projecting point of the chin falls relative to a vertical line dropped down from forehead, nose or lip structures. Thus chin augmentation is most commonly seen as how many millimeters the chin point is deficient. Knowing what this horizontal chin deficiency is in actual numbers allows the plastic surgeon to choose a chin implant whose sizes is determined by their horizontal thickness. (which are in the range of 3mm to 10mm from most manufacturers)

While a deficient chin most assuredly does have a horizontal deficiency, this assessment alone make be inadequate for some ‘short chin’ patients. Since many short chins are associated with an overall underdeveloped lower jaw, other chin dimensions may be deficient as well. The vertical dimension has historically been overlooked or under evaluated in many chin augmentation patients.

A vertical chin deficiency can exist in isolation but most commonly occurs as part of a horizontal deficiency as well. The chin essentially is rotated backward and up due to the overall jaw shortness. When using traditional implants in this type of aesthetic chin problem, the soft tissue chin point comes forward but still doesn’t look quite ‘right’ as the vertical shortness of the chin is not corrected. (and may even look worse as it is magnified by the horizontal augmentation)

Every chin implant ever manufactured is based on correcting a horizontal chin shortness. The implants are designed to be placed low on the chin bone (pogonion) to provide maximal horizontal correction. While some small amount of vertical height increase of the chin may be obtained (1 to 2mms) by placing the implant very low on the chin bone (on the edge), this is not going to improve the really vertically challenged chin. Not to mention contemporary chin implants are not designed to sit that low and may be positionally unstable and prone to rotation and asymmetry.

vertical lengthening chin implant indianapolis dr barry eppleyA new design of a chin implant is now available that can address the combined vertical and horizontally deficient chin. Made to be positioned along the lower edge of the symphysis (anterior jawline) as opposed to in front of it, it provides a 45 degree directional augmentation to the chin prominence. (forward and down) The implant tapers back along the jawline to the parasymphysis and prejowl areas so as to blend into jawline without an obvious demarcation or step off in the jawline. While the implant does wrap around the lower edge of the chin and jawline, screw fixation is advised for optimal stability. (a small depression in the midline of the implant has been placed for central screw fixation if desired) Given the length of the screw needed, a 2.0mm titanium screw is recommended.

Vertical Lengthening Chin Implant data-lazy-sizes Dr Barry Eppley IndianapolisThe vertically lengthening chin implant offers better augmentation results in the patient who has more of a ‘three-dimensional’ chin deficiency. Proper patient selection is important to pick up a vertically short chin that may remain or become more evident with traditional horizontal chin augmentation.

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

Case Study: Facelift with Chin Augmentation

Friday, November 15th, 2013

 

Background: As the face ages the tissues above the jawline fall and descend over it. This ‘wax off the candle effect’ combined with a sagging neck create the need for a facelift procedure which reverses many of these facial aging effects. Contrary to the perception of many, a facelift only treats the lower third of the face and thus improves the shape of the neck and jawline

While a facelift reverses some of the effects of aging, what makes it fundamentally effective in the lower face is that it creates a more defined jawline. Or at the least it helps reshape the appearance of the jawline to the way it once was years before. By definition a more defined jawline helps create a more clear separation of the face from the neck.

But the effects of  a facelift are apparent on the sides of the jawline from the body of the jaw back to its angles. A facelift has no effect on the central part of the face whether it is the soft tissues around the mouth or in helping to better define the chin. Creating improved chin projection, which can help create a better overall jawline appearance or to correct a naturally short chin, requires concurrent implant augmentation at the time of the facelift.

Case Study: This 62 year-old female wanted to improve her sagging jowl and neck. She had completely lost her once sharp neck angle and the jowling had obliterated her mid- jawline. She had a naturally shorter chin with a forward projection that was well behind a vertical line drawn down from her lips. When all these features were put together she had a facial profile in which an oblique line could be drawn from her nasal tip projection down through the forward chin connecting point and the soft tissues of the neck could almost contact this imaginary line.

Under general anesthesia, she underwent a full lower facelift using incisions in and around the ears as well under the chin. Through these approaches the neck received liposuction and platysmal muscle tightening and the face had SMAS plication and skin lifting and tightening. Through her existing submental incision a silicone chin implant was placed on the lower end of the chin bone (symphysis) of an extended anatomic style of 5mm horizontal projection. It was sutured in place in the midline.

The benefits of chin augmentation in facelift surgery are well known. It has been a primary or adjunctive facial rejuvenative procedure for decades. When done with most facelifts, the existing submental incision can be used that already exists for the neck muscle work. As long as the size of the implant is not too big, the aesthetic benefits of chin augmentation always enhances the effects of the facelift procedure.

Case Highlights:

1) One of the principle objectives of a lower facelift is to create a more defined jawline as that is one of the aesthetic facial features of youth.

2) Many patients who are considering or having lower facelift surgery have a mild to moderately weak chin projection.

3) Chin augmentation is a beneficial procedure that can be added to a lower facelift with minimal extra time and no prolongation of the recovery period.

Dr. Barry Eppley

Indianapolis, Indiana

Plastic Surgery History: Marilyn Monroe’s Chin Augmentation

Wednesday, October 16th, 2013

 

There is no more iconic Hollywood figure or sex symbol than Marilyn Monroe. Despite her relatively short life, she remains a recognizeable face today many decades after her tragic death. But despite her beauty she, like many famous people, was apparently not entirely happy with her looks. Medical records have recently come to light that reveal she had a chin augmentation procedure done in 1950. While chin augmentation seems like it is a cosmetic procedure that has been around forever, how we know it today is not always how it has been done. Monroe had her chin augmentation done at a time before synthetic chin implants were available. (silastic chin implants were not formally manufactured until the late 1960s) As her medical records show, she had a bovine cartilage (cow cartilage) implant put in her chin for the augmentation. While that seems like a crude approach for a facial implant by today’s standards, such animal cartilage grafts were not uncommon back in the first half of the last century. (what else could they have used) Miraculously it never got infected but it did eventually dissolve away according to medical records years later. Back then chin implant augmentations were small (central button style) and were not the more extended chin implants that are used today. In addition, these older chin ‘grafts’ were not placed down at the bone but more up under the skin in the subcutaneous tissue level. This would have created some central chin roundness for correction of a less aesthetic ‘flat’ chin.

Dr. Barry Eppley

Indianapolis, Indiana

The Role of the Chin in Profileplasty

Sunday, July 28th, 2013

 

It is very common that multiple procedures are done on the face at the same time. Whether it be for anti-aging effects or for reshaping a face, combinations of procedures produce more profound changes. This is because the face is made up of many different parts and making significant changes often requires altering more than one facial area.

The benefits of combination facial surgery are commonly seen in nose and chin surgery. Since the nose and chin make up the dominant structures of one’s facial profile, it is not surprise that the combination of rhinoplasty and chin augmentation have become known as a profileplasty. Profileplasty refers to any cosmetic procedure that would improve the appearance of the profile which is an aesthetic and proportionate relationship of the nose, chin and neck. Thus profileplasty is not just rhinoplasty and chin augmentation, although this is the most common one in the young, but also includes a facelift and chin augmentation which is most common in older patients.

It is easy to understand why rhinoplasty can be so important to profile changes as the nose sits at the center of the face. Even very subtle nose changes can be visually appreciated in the profile view. Lowering of the nasal bridge and reshaping the nasal tip in a large nose or augmenting the dorsal line and increasing tip projection in a smaller/flatter nose not only changes the shape of the nose but one’s profile as well.

Just like the nose the chin has an equal, if not greater, impact on one’s profile than even the nose. This is because the chin sits in the middle of the facial profile between the nose and the chin. Whether it is too small or too big, the chin influences the perception of both the nose and the neck. The nose, however, does not influence the appearance of the neck angle and a necklift does not alter the perception of one’s nose shape.

In many patients the best profile changes come from a change in the lower face. Chin surgery can improve facial proportion, creating a better balance between the upper face (forehead, nose and lips) and the neck. As a well known example, even a well shaped nose can seem larger if the face has a smaller chin. Even if some nose changes are done, the more important procedure might be chin augmentation on improving the appearance of the nose.

Chin surgery is often perceived as an augmentative operation but that is a limited view of the different types of available chin surgery. Chin augmentation historically is seen as an increased in horizontal projection, how much forward position of the chin is needed. While this can be done with either an implant to sit on top of the bone or to move the chin bone itself (sliding genioplasty), they change the shape of the chin differently. A chin implant can improve the horizontal projection of the chin but can do little for increasing the length or vertical height of the chin. Often more vertical height is needed when the chin is significantly short. Unlike a chin implant, a sliding genioplasty can not only bring the chin forward but can lengthen or shorten its vertical height as well.

While chin implants have historically lacked the ability for vertical elongation, new chin implants styles will soon be available that provide concurrent vertical lengthening as well. Rather than sitting completely on the bone, these newer designs sit on the ledge of the chin bone (halfway between the front and under edges of the chin bone) to create their effects.

While sliding genioplasties can lengthen the height of the chin, there are limits as to how much the bone can be moved forward. To keep the back of the moved chin bone in contact with the front edge of the fixed chin bone, the amount of bone advancement is usually limited to 10 to 12 mms. Very short chins often need much more than that to achieve an ideal chin position. In these cases a chin implant can be placed on top of the advanced chin bone (implant overlay) to achieve an additional 3mm to 5mms of further horizontal chin projection.

Chin reduction is not as commonly done for profile changes and has a checkered history. The most common chin reduction method is done as an intraoral burring or shaving of the front edge of the chin bone. While simple, it is rarely effective as no more than a few millimeters of bone is reduced and no change occurs in the soft tissue thickness. Often patients complain of seeing no change after this surgery and may even develop some soft tissue redundancy or sagging afterwards. The use of a reverse sliding genioplasty is also ill-advised as, while it does move the whole chin bone back, it pushes the attached soft tissues into the neck creating an undesired bulge.

The most effective chin reductions are done from a submental (under the chin) approach where the bone can be more dramatically reduced in all dimensions if needed and the excess soft tissues excised  and tightened. (tucked) While this does create a scar under the chin, it can remain imperceptible if its length remains curved to parallel the shape of the jawline and it stays within the confines of a vertical line dropped down from the corners of the mouth.

When considering profileplasty, or even an isolated chin augmentation or reduction procedure, the use of computer imaging is critical. It can not only confirm which procedures are beneficial but, more importantly, the magnitude of those desired changes. A plastic surgeon can never really know what ‘flavor’ of change any patient desires and such imaging helps to establish what that is. While computer imaging is never a guarantee as to how the final result will look, it provides a method of visual communication to help the surgeon not guess as to the patient’s profileplasty goals.

Dr. Barry Eppley

Indianapolis, Indiana


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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