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Posts Tagged ‘chin implant’

Case Study – Four-Piece Total Jawline Augmentation

Sunday, December 20th, 2015

 

Background: The desire for a more pronounced and visible lower jawline exists in both men and women. The surgical methods to do so are more commonly requested by men particularly when it comes to a substantially larger jawline change. Making a jawline more evident focuses on increasing the size and shape at its ‘corners’, that of the projecting chin and the back ends at the bilateral angles.

When creating a total jawline augmentation effect, there are two basic approaches.  The historic and still most commonly used method is a three implant approach of independently placed chin and jaw angle implants. In some cases the chin implant may be substituted with a siding genioplasty. The newer method of jawline augmentation is the fabrication and placement of a one-piece custom made jaw implant that wrap around the chin from angle to angle. It is the preferred method of total jawline augmentation given the preoperative designing of the implant and its smooth one-piece construct. But cost considerations may lead some patients to still undergo the classic three implant method.

Chin and jaw angle implants exist in standard styles and sizes. While for some patients these historic standard chin and jaw angle implant styles will effectively work, newer implants styles offer improved total jawline augmentation results for many patients. Newer vertical lengthening jaw angle implants have allowed for increased visible angularity of the back part of the jaw. When vertical elongation of the chin is needed either newer vertical lengthening chin implants can be used or the historic approach of an opening sliding genioplasty. When significant vertical and horizontal chin augmentation is needed, chin implants and a sliding genioplasty can be combined.

Case Study: This 25 year male wanted a total jawline change. Not only was his lower jaw horizontally short but it was vertically deficient as well. This was evident in the short chin and large overbite which are directly related. When he opened his mouth slightly the improvement in his chin and jaw height could be seen confirming the needed vertical dimension of his chin and jawline.

Chin and Jaw Angle Jawline Augmentation result side viewChin and Jaw Angle Jawline Augmentation result oblique viewUnder general anesthesia, he had an opening sliding genioplasty (7ms done and 7mms forward) with a chin implant overly (5mm horizontal augmentation) done through an intraoral approach. Through posterior intraoral incisions jaw angle implants that added 7mm vertical length and 5mm width were placed.

At one year after surgery the improvement in his jawline could be appreciated. Ideally longer vertical lengthening jaw angle implants would have improved his result and are being considered. The sliding genioplasty and chin implant overlay produced a satisfactory improvement to the front part of his jawline

Total jawline augmentation can be effectively done using a non-custom implant approach. It can require the thoughtful application of newer chin and jaw angle implant styles and the selective use of sliding genioplasty techniques.

Highlights:

  1. Total jawline enhancement consists of front (chin) and back (jaw angle) augmentation.
  2. Preformed chin and jaw angle implants is the historic and standard approach to total jawline enhancement.

3. Vertical chin augmentation in total jawline enhancement can be done by a combined sliding genioplasty with a chin implant overlay.

Dr. Barry Eppley

Indianapolis, Indiana

Technical Strategies – Intraoral Chin Implant Placement

Sunday, November 22nd, 2015

 

Chin implants are the most common permanent method of facial augmentation. Chin implants of various materials have been used for almost fifty years. Whatever the material composition of the implant is and its shape and size, chin implants can be introduced from either a superior approach (intraoral mucosal incision) or from below. (submental skin incision) There are advantages and disadvantages of either incisonal approach as well as surgeon advocates for either chin implant introduction technique.

The submental incision for chin implants offers the most direct access to the bottom of the chin bone where the implant should be properly placed. It also provides a pocket which eliminates the risk of any upward migration of the implant provided the pocket is not made too high. Firm fixation of the implant can also be done to the bottom edge of the bone to ensure its midline positioning. Because of a sterile skin prep, it also has a very low risk of infection. From a recovery and potential complication standpoint it also does not disrupt the superior attachment of the mentalis muscle. Its only real downside is that it does create a scar under the chin which can be objectionable to some patients.

The intraoral approach offers a scarless method for chin implant augmentation as its main advantage. Because of going through the mouth (although this is not exactly true because the lower lip is pulled out and away from the oral cavity) and detachment of the superior mentalis muscle, many surgeons feel that it is associated with a higher rate of complications. Superior malposition of the chin implant is actually the most common problem with the intraoral approach.

Intraoral Chin Implant Placement Technique Dr Barry Eppley IndianapolisIntraoral Chin Implant Placement Technique 2 Dr Barry Eppley IndianapolisSeveral modifications of the intraoral approach can avoid most of the potential chin implant problems. First the intraoral incision should be vertical in orientation, paralleling the fibers of the mentalis muscle. This splits the mentalis muscle but does not separate the mentalis muscle attachments. With the lip pulled away from the teeth, it provides the angle to develop the subperiosteal pocket along the inferior edge of the anterior mandible.  Secondly, implant sizers are used to ensure that the pocket has been properly developed prior to inserting the formal chin implant. Lastly, the implant is inserted, positioned and then secured in its midline position with a single 1.5mm microscrew to prevent superior implant migration.

The intraoral approach for chin implants is sometimes preferred by patients with more pigment in their skin, females and any patient that wants to avoid an external skin scar. The incisional technique should be different than that needed for a sliding genioplasty and other chin surgeries with a more limited and less dissected approach By so doing all of the potential disadvantages of the intraoral chin implant approach can be avoided.

Dr. Barry Eppley

Indianapolis, Indiana

Case Study: Sliding Geniopasty with Indwelling Chin Implant

Sunday, May 3rd, 2015

 

Background: Horizontal chin augmentation can be done using either a synthetic chin implant or a sliding genioplasty. There are advantages and disadvantages with either approach and they must be considered in an individual patient basis. The decision in any patient ultimately depends on their perception of an alloplastic vs. an autogenous approach, the risks of the procedure and its recovery and what other dimensional changes of the chin that are needed beyond just that of the horizontal change.

But the use of a chin implant does not always produce the desired amount of chin augmentation change that every patient desires. This may be due to inadequate implant selection, the chin implant settling into the bone thus losing some horizontal projection, chin implant malposition or an accommodation to the initial chin augmentation result.

When further improvement is desired after an initial chin implant augmentation, the options are either a larger implant or to convert it to a sliding genioplasty method. A larger implant is usually done as this is the simplest revisional approach provided that a new implant can create the desired horizontal change. When a larger chin implant offers but a modest additional augmentation (e.g., 5mms or less) the the sliding genioplasty option becomes a consideration. It would be either that or have a custom chin/jaw implant made.

Chin Implant Settling (Erosion) Dr Barry Eppley IndianapolisCase Study: This 26 year-old male wanted additional chin augmentation after having a prior chin implant placed several years previously. He always felt that is lower jaw was smaller. His original chin implant provided 7mms of horizontal projection but it could be seen that it had settled into the bone a few millimeters. He opted for a sliding genioplasty as he felt that would more reliably give him long-term augmentation.

Sliding Genioplasty with Chin Implant intraop Dr Barry Eppley IndianapolisUnder general anesthesia, an intraoral approach was used to access the chin. The chin implant was easily identified and it was nestled nicely into the bone. A horizontal osteotomy cut was made above it from side to side and the bone downfractured. The chin segment was then advanced 12mms and stabilized with a step plate and screws. The chin implant was never moved from its original position during the procedure.

Sliding Genioplasty with Chin Implant result Dr Barry Eppley IndianapolisSliding Genioplasty with Chin Implant 3D CT scan Dr Barry Eppley IndianapolisA sliding genioplasty can be successfully done with an indwelling chin implant. It can be argued that this is a good technique to take advantage of some of the prior procedure (and investment) and gain additional horizontal augmentation. Whatever implant settling has occurred into the bone has already reached its peak and no further inward change would be anticipated.

Case Highlights:

1) An unsuccessful chin implant result can be improved by a sliding genioplasty.

2) It is not always necessary to remove an existing chin implant when doing a sliding genioplasty.

3) A sliding genioplasty can be performed by making the osteotomy cut above the chin implant and moving both forward simultaneously.

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 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

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

Case Study: Female Jawline Implant Augmentation

Friday, October 25th, 2013

 

Background: An underdeveloped jaw or mandible has been historically treated by chin and jaw angle implants. A chin implant enhances the front part of the jaw while jaw angle implants augment the posterior part of the jaw. While these types of facial implants are tremendously effective at augmenting the two obvious prominences of the jaw, they neglect the intervening part of the jawline between the two of them known as the body area.

The mandible is a unique facial bone to aesthetically augment because it is a long curved bone that wraps around the lower face. No off-the-shelf implant currently provides a wrap-around augmentative effect of the entire jawline. Such an aesthetic need exists to make the entire jawline more pronounced and would be of value to make jawlines larger from a side-to-side standpoint. Because silicone is a very flexible material, a wrap around jawline implant could be used for just about any jaw shape and could be inserted through a very small incision.

Case Study: This 33 year-old female was having a skull reshaping procedure and wanted to improve her mildly weak chin as well. She felt her overall jawline was weak and not just her chin area but she did not want her jaw angles to be any bigger or flared. Her horizontal chin deficiency measured only 3 to 4mms in projection.

A new uniquely designed jaw implant was selected for her known as a jawline implant. It is essentially a very long and thin extended chin implant that extended back to the jaw angle area creating a wrap around effect along the inferior border. While the chin projection of the implant was 4mms, it tapered back along the jawline to a 2mm feathered edge. Because of its thin and long design, the stiffness (durometer) of the silicone material was stiffer than that used in other facial implants. That extra stiffness prevents the back tail of the implant from folding onto itself on insertion.

Under general anesthesia, a small 2cm submental incision was made down to the bone. A long extended periosteal elevator was used to make a long and narrow tunnel for the implant back along the lower edge of the jaw (inferior border) to the jaw angles. The implant was folded in half and inserted through the incision with both ends of the implant directed into their respective sides of the tunnels. The implant was easily slide into place and the central chin part of the implant was sutured into place to prevent migration. (although with an implant this long there really could not be an migration or displacement.

The jawline implant offers a new type of jaw augmentation implant that is uniquely different from the chin and jaw angle styles. By making the jawline more distinct and adding some slight width, it makes a more prominent jawline in a subtle but aesthetically pleasing manner. It is not designed to create an overpowering jawline augmentation but a subtle enhancement.

Case Highlights:

1) A more defined and distinct jawline is a desireable feature for both men and women and is the result of a more defined inferior border of the mandible.

2) A jawline implant is different than other jaw implants such as a chin or jaw angle implants as it accentuates the mandibular inferior border from the chin back to the jaw angles.

3) Jawline implants can be used alone to enhance a mildly weak jawline or as an additive benefit to facelift surgery.

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

Profileplasty by Rhinoplasty and Sliding Genioplasty

Saturday, July 13th, 2013

 

While one does not see their face in a profile view naturally (only in pictures), the world sees your face in three-quarter view or in profile. Thus the perception of one’s own facial profile is important and it is stressed in many plastic surgery procedures. The two most important hard structures that make up the profile is the nose and the chin. As such the combination of a rhinoplasty and genioplasty is often done together. When done simultaneously, this combination has even been called a profileplasty.

These two profile structures influence each other even if only one is surgically changed. It is well acknowledged that reducing a large nose makes the chin look bigger and chin augmentation can make the nose look smaller. Certainly it can be a very powerful profile changer when a larger nose and a smaller chin are simultaneously corrected.

While a reduction rhinoplasty can be done by various methods based on the actual deformity, these represent relatively minor technical differences in the manipulation of the bone and cartilages. In contrast, a genioplasty can be done by fundamentally different techniques…an implant or an osteotomy. (sliding genioplasty) There are advantages and disadvantages to either type of genioplasty but most patients undergo the ‘simpler’ implant augmentation. Only a minority of chin augmentations are done by a sliding genioplasty although this is often the common chin augmentation technique for oral and maxillofacial surgeons.

Long-term outcomes of combined rhinoplasty and genioplasty patients are rarely reported probably because most plastic surgeons correctly assume that patients are very happy and there is little to gain by looking at the long-term results. But no studies to my knowledge have ever been reported looking at combined rhinoplasty and sliding genioplasty augmentation.

In the July 2013 issue of the Archives of Facial Plastic Surgery, a study was published entitled ‘Combined Rhinoplasty and Genioplasty: Long-term Follow-up’. In this paper, a total of 90 cases of combined open rhinoplasty and augmentation/reduction genioplasty over a three year period were reviewed to assess the stability of the aesthetic results. Specifically the chin was studied by anthropometric measurements. Soft tissue pogonion projection to the true vertical line and mandibular height (incisor to menton) were measured. The average horizontal augmentation genioplasty had 7mms advancement and the average vertical lengthening genioplasty had 5mms increased height. The measurements shows a 100% stability after three years. In reduction genioplasty, half of the patients had 100% stability after three years. The results of this study showed that there is minimal change (less than 1mm) in the chin position as part of a profileplasty.

While rhinoplasty and genioplasty is common, doing the genioplasty portion by a sliding osteotomy rather than an implant is very uncommon. The only advantage that a bony genioplasty has over an implant in most typical aesthetic patients is when a vertical chin change is needed. Given the average amount of horizontal advancement in this study that movement alone is well within the range of what an implant can do. The stability of the bony movements of a sliding genioplasty has been extensively studied before without being done at the same time as a rhinoplasty. This study corroborates what many studies have shown before, bony chin changes are fairly stable and any relapse or bone resorption is not clinically observable or significant.

Dr. Barry Eppley

Indianapolis, Indiana

Case Study: Sliding Genioplasty with Implant Overlay for Chin Implant Replacement

Saturday, July 6th, 2013

 

Background:  Chin augmentation is the most common implant enhancement procedure of the face. It is usually highly successful as long as the chin is not horizontally too short. Once horizontal chin deficiences approach 10mms or more, it will also have other dimensional issues as well being also vertically short.Trying to make a chin implant correct an overall short chin will leave the patient with a suboptimal result.

Once a chin implant augmentation procedure is deemed inadequate, one has to consider whether a new implant or a sliding genioplasty would be better. With greater than a 10mm horizontal deficiency, only a custom computer-designed implant will suffice. Besides that no existing commercially-made chin implants do not exceed 11mms, none provide any vertical lengthening at all. The other option is a sliding genioplasty. The downfractured chin segment can be moved as far forward as the thickness of the chin bone which almost always is more than 10mms. The other benefit that a sliding genioplasty provides is that the chin can be vertically lengthened by opening up the chin segment as it is brought forward.

While a sliding genioplasty can provide significant horizontal and vertical chin changes, it is not always a perfect chin augmentation procedure either. The amount of horizontal projection increase can not exceed the thickness of the chin bone so very short chins may still be left aesthetically deficient. In addition as the u-shaped chin segment is brought forward, the chin shape will actually become more narrow as the projection is increased. This may be an aesthetic disadvantage for some men who prefer or desire a more square or wider chin appearance in the frontal view.

Case Study: This 50 year-old male wanted to make one final effort at improving his chin shape. He had a prior history of two chin augmentation procedures using implants. He originally had an original 7mm anatomic silicone chin implant that was subsequently replaced by a 9mm Medpor two-piece chin implant that had been separated in the middle to give more of a square chin look. While he was improved with each procedure, he felt his chin was still too short. In addition, his chin felt tight and mildly uncomfortable even years after the second procedure.

Under general anesthesia, an intraoral anterior mandibular incision was made. The indwelling Medpor implant was exposed, unscrewed and removed. Contrary to popular perception the Medpor material did not have any bone ingrowth and, although the surrounding tissues were adherent, was not unduly difficult to remove. A horizontal chin osteotomy (sliding genioplasty) was done with the back end just beyond where the tails of the removed implant were. The downfractured chin segment was brought forward 12mms and secured into placed with a titanium step plate and two screws above and below the osteotomy line. To make the chin have more width, a small square silicone chin implant was placed in front of the chin segment and secured to it with screws. The mentalis muscle was then resuspended over the implant and advanced bone in layers.

His recovery showed the typical swelling and bruising down into the neck that commonly occurs with sliding genioplasties. It took almost three weeks until all swelling and bruising had resolved.

Significant chin deficiencies that do not achieve good results with implants may achieve better results with a sliding genioplasty, particularly when a vertical chin deficiency exists. Contrary to common perception, an implant can be used in front of a sliding genioplasty if more horizontal projection or greater width is needed.

Case Highlights:

1) Once a horizontal chin deficiency exceeds 10mms, standard chin implants will not produce an ideal result.

2) A sliding genioplasty can almost always extend the chin further forward than an implant.

3) To overcome the round chin shape that will occur from a sliding genioplasty, a square chin implant can be overlaid in front of the advanced chin segment.

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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