EXPLORE
Plastic Surgery
Dr. Barry Eppley

Explore the worlds of cosmetic
and plastic surgery with Indianapolis
Double Board-Certified Plastic
Surgeon Dr. Barry Eppley

Posts Tagged ‘chin narrowing’

Case Study: Chin Narrowing Surgery By Lateral Ostectomies

Saturday, June 7th, 2014

 

Background: The chin has a major impact on the appearance of the lower face. While most think of it as only from a horizontal projection perspective, its frontal shape has a major influence on the gender identification to whom it is attached. Men often have strong more square chin shapes in the front view while it is usually perceived as more feminine to have a narrow and or heart-shaped chin.

It is not rare for either a women or in male to female facial feminization surgery to make an effort to narrow the chin. There are a variety of methods to accomplish the bone removal needed, either by direct lateral bone reduction (ostectomies) or by an osseous genioplasty technique. (wedge reduction) Each has their own advantages and disadvantages but the more extensive genioplasty approach is usually indicated when there are other dimensional changes needed in the chin as well. (vertical and horizontal)

Case Study: This 31 year-old male to female patient was having a variety of facial feminization procedures from brow bone reduction to rhinoplasty. One of the changes that was requested was a narrowing of the jawline to reduce a square chin to a more narrow and softer one.

Chin Narrowing Technique Dr Barry Eppley IndianapolisUnder general anesthesia, an intraoral high vestibular incision was made and the chin bone exposed by muscle and periosteal elevation. A vertical bone cut of 4 to 5mms was made from the mid-body of the mandible to a point just lateral to the center of the chin, protecting the mental nerve on both sides. This removed along strip of bone along the sides of the chin and anterior jawline. Some additional bone smoothing was done with a burr to smooth out any rough edges. The narrowing effect was immediately apparent when the the first side of chin was done.

Chin Narrowing result front viewRecovery from chin narrowing surgery does involve a fair amount of swelling that takes a full four to six weeks to completely resolve. One can tell when all swelling is gone when the feeling in the chin is norma again and it feels soft and supple again.

Chin Narrowing result oblique viewNarrowing of the wide chin or the desire to have a more narrow chin can be done by a by lateral ostectomy technique if no horizontal or vertical changes are needed. This type of ‘bony’ chin procedure is different from the sliding genioplasty as bone is removed rather than cut and relocated. It can be remarkable how a small amount of bone removal can change the shape of the chin in this narrowing technique.

Case Highlights:

1) The wide chin can be narrowed for either a softer jawline or to help feminize a face.

2) The width of the chin can be narrowed without a genioplasty by lateral tubercle ostectomies.

3) The intraoral approach for chin narrowing ostectomies leaves no scar but takes a while to see the final result due to prolonged swelling.

Dr. Barry Eppley

Indianapolis, Indiana

Chin Narrowing and Lengthening for Slenderizing the Wide Lower Face

Thursday, August 15th, 2013

 

Jaw angle reduction, also known as angoplasty, is one of the most commonly performed procedures for lower facial width reduction particularly in Asians. While it has been touted for years as a mainstay facial bone reduction procedure, it is not as effective as many believe. And when done aggressively through an amputation technique, it can destroy the shape of the jaw angle and lead to a very unnatural slope of the jaw. Even when done well with a more shape-sparing angle reduction by burring or corticotomy, the result may still not be sufficient to make a wide face look significantly more narrow.

When viewed from the frontal view, the width of the jawline (lower face) is more than just the jaw angles but includes all the way front to the chin. Good bigonial angle reduction at the jaw angles will not make a big overall change if the chin is also wide. (which it frequently is) This to slenderize some faces, it is necessary to include chin width reduction and reshaping as well. Chin width reduction and even vertical chin lengthening may be necessary to maximize a facial slendering effect.

In the August 2013 issue of the journal Plastic and Reconstructive Surgery, an article was published on this concept entitled ‘Angloplasty Revision: Importance of Genioplasty for Narrowing of the Lower Face’. Over a two year period, the authors performed over 50 procedures on women who had unsatisfactory jaw angle reduction with a narrowing genioplasty and contouring of the lower border of the mandible back to the jaw angles. All patients had improved aesthetics with a more narrow jawline. No complications were reported other than two patients who had increased submental fullness afterwards. No permanent lip numbness occurred.

A wide lower face is usually caused by increased width of the entire mandible. Thus when considering attempting to change a wide lower face into a more slender one, changes to the entire mandible need to be considered. Jaw angle reduction by corticotomy, body narrowing by burring, a narrowing genioplasty and an inferior border resection reshaping are all elements that can be considered. Changes in the chin for many patients, however, may have the greatest yield because of the effect of its shape on the frontal view. (which is how most people actually see themselves)

Besides narrowing the chin, it frequently is beneficial to length it as well. Because a wide lower face usually has a disproportionate width to height relationship, lengthening the chin as it is narrowed changes that and makes the lower face appear more narrow. Lengthening the chin also creates a more triangular shape which is also beneficial for female facial aesthetics.

Dr. Barry Eppley

Indianapolis, Indiana

Chin Narrowing by Lateral Tubercle Reduction

Sunday, November 13th, 2011

A square chin and jawline is considered desireable in a male but not so in a female. It is also deemed unattractive in certain ethnicities such as in the Asian face as well as in the male to female transgender face. Reduction of a square jawline is often perceived as that of the jaw angles. While jaw angle reduction surgery has a role to play in facial contouring, it only provides some narrowing in the posterior mandible or back part of the jaw. It has no slimming effect in the front part of the jawline in the chin area.

 

Narrowing of the chin or front part of the lower face can be done by several methods, all of which require bone reduction. If a chin osteotomy (osteoplastic genioplasty) is being done, the width of the chin will naturally narrow when the chin bone is brought forward and/or vertically lengthened. But not everyone needs horizontal or vertical chin lengthening so an osteotomy can be ineffective. The other approach is direct burring reduction of the chin or mandibular tubercles. By reducing the bony sides of the chin it can be narrowed in the frontal view.

 

When doing an osteotomy to create a chin narrowing effect, it is important to realize that the bone will not narrow behind the osteotomy cut. This also is where a step-off can be created at this junction which is most evident when horizontal advancements are done. As the bone edge of the downfractured chin segment moves forward, this step-off can be created. It can be a difficult area to reach for smoothing out this step-off and there is risk to the mental nerve which is very close by. This is why it is helpful to make that osteotomy cut back as far as possible to extend the natural narrowing effect of the advancing osteotomy and avoid a prominent step-off.

 

Reducing the sides of the chin can be done by either burring or saw reduction. Using a saw always removes more bone quickly with less risk of injury to the mental nerve. The more relevant question is whether it is done through an incision inside the mouth or from an external submental incision from below. Most of the time an intraoral approach is used if only the sides of the chin need to be reduced. But when an overall chin reduction is being done reducing height and/or projection, a submental approach is used so that the extra soft tissues can be managed by excision and redraping to prevent postoperative sagging or ptosis.

 

To achieve a more slim feminine lower face, reduction of the jawline must be considered as a whole. Changing the width of the chin from a more square to a tapered shape creates an essential change in the frontal view. Barring the need for horizontal or vertical lengthening of the chin, burring or saw reduction of the sides of the chin can be done from either an intraoral or submental approach.

 

Dr. Barry Eppley

Indianapolis, Indiana

Lateral Chin Ostectomies – Narrowing the Broad or Wide Chin

Wednesday, April 29th, 2009

The chin is the most dominant feature of the lower face. It has significant influence on the perception of facial balance and how the neck looks as well. While the chin may only be thought of as being too small or too big, there are other dimensions to the chin that also play a role in how it looks. Its horizontal position relative to the rest of the face can be an overly simplistic view of its aesthetics. The width of the chin is also important. Men often want a wider chin, women usually desire a chin that is more narrow.

 

When it comes to building out a chin, whether it be for horizontal length or width, the use of an implant is a simple and very effective method. Reducing chins, however, require manipulation of the bone…specifically removing parts of the chin to change its shape. Subtraction is a slightly more complex maneuver than addition for all facial areas.

 

Broad chins can be reduced through a technique known as an oblique chin ostectomy. This is a method where bone from the side of the chin along its undersurface is removed. This can be done by burring it down, or more effectively, by sawing away the widest part of the chin and making it blend into the jawline. It can be done from either inside the mouth or from a small incision under the chin. As the bone is removed in a front to back direction, how much bone to remove and how it affects the narrowing of the chin can be seen quite easily. This procedure can be done alone or with any other chin operation, including implants. For a wide and short chin, for example, a central chin implant style can be placed with lateral narrowing to make for a slender narrower chin. This operation does cause some significant swelling, as bone manipulations will do, and some temporary numbness of the chin and lower lip as well.

 

Narrowing of the chin adds another method of cosmetic jaw enhancement including chin implants, chin, osteotomies, mandibular angle implants, and mandibular angle reduction. Chin narrowing can be done alone or in combination of any other chin/jaw method to create an overall lower jaw shape change. These changes are particularly visible through computer prediction imaging and, in my Indianapolis plastic surgery practice, I make sure that all such patients go through such imaging before surgery.

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.

Read More


Free Plastic Surgery Consultation

*required fields


Military Discount

We offer discounts on plastic surgery to our United States Armed Forces.

Find Out Your Benefits


Categories