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Dr. Barry Eppley

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Posts Tagged ‘narrowing chin osteotomy’

Narrowing The Width Of The Chin By Osteotomy

Tuesday, May 31st, 2011

Changes in the chin are traditionally perceived as the need for a horizontal increase or improved anterior projection. While many chin deficient patients need horizontal augmentation, there are other dimensions in which the chin may need to be changed. Vertical lengthening or shortening is the other most recognized alteration that can be done to the chin.

The least recognized and often overlooked chin change is in its width or transverse dimension. Increasing the width of the chin is done in male chin augmentation, usually using an implant to get a more square or wider masculine appearance. Narrowing the chin, however, can obviously not be done with an implant. Like vertical chin shortening, only a chin osteotomy can reliably make that change.

Burring of the sides of the chin from an intraoral approach can make for a more narrow or pointed chin but it has limits as to what can be achieved. This is best thought of some mild chin contouring. There is also the issue of extensive soft tissue release with a burring technique and there is no guarantee of good soft tissue readaptation afterwards. This is why a chin osteotomy may be preferred when a significant narrowing effect is aesthetically desired.

The chin osteotomy is done with a traditional intraoral vestibular incision. Once downfractured with an osteotomy cut below the mental foramen, the mobilized chin segment is brought forward for exposure. The amount of chin narrowing is then marked in the midline and bilateral sagittal osteotomies are made. A central bone segment is then removed based on the desired amount of chin narrowing. General 5mm to 7mms needs to be removed to make a visible external difference. The chin segments are then brought together and plated on their superior surface to hold them together. Plating superiorly is important so that the anterior surface is still available for plate fixation for an advancement or vertical lengthening which may still be done.

With a narrowing chin osteotomy, it is important to look for any palpable edges above or out laterally which may need to be burred to prevent any notching that can be felt through the skin. Good mentalis muscle resuspension/tightening is needed once the chin bone is stabilized even though the soft tissue has not been released from the inferior border of the mandible and chin.

While a chin osteotomy is needed when a significant narrowing effect is needed, there are other considerations for its use as well. Certain chin shapes when advanced by osteotomy may be still too wide in the frontal view. This can be seen with certain women’s chins. Changing the chin to one with less width can be aesthetically advantageous as it comes forward, resulting in more of a u-shape and creating the perception of some flare to the jaw angles as well.

Dr. Barry Eppley

Indianapolis, Indiana

A Narrowing Genioplasty for Making The Square Face More Slender

Monday, April 25th, 2011

The perception of a square face usually has much to do with the shape of the jaw. A square lower face is largely influenced by the width of the jaw from the chin back to the jaw angles. This may or may not be associated with a horizontally short jaw as well. While this is a common aesthetic facial concern in Orientals, it may also be seen in other ethnic groups as well. In those seeking a change from this appearance, their goal is a more narrow and slender appearing face which changes the shape from square to an oval.

The traditional approach to narrowing a wide or square lower face is jaw angle reduction surgery. An outer cortex ostectomy technique is preferred over complete angle amputation. While this can have a narrowing effect, the results are limited exclusively to the posterior part of the face where the jaw angles exist. This may not make a face appear slender as the chin and anterior jawline area unchanged. For some patients, this is an important area to combine with jaw angle reduction and is often overlooked in the surgical planning of facial slimming.

Chin osteotomies can have a significant influence in changing the frontal appearance of the lower face. The traditional forward movement of the downfractured chin segment gives a measureable narrowing effect as its u-shape is brought forward. When combined with some vertical elongation, this effect can be further maximized. But not every face needs visible horizontal or vertical movement of the chin and it may not be asesthetically advised.

Chin osteotomies can also be done just for narrowing its width. By removing a central bone segment (up to 1 cm) from the mobilized chin segment, it can be brought back together in the midline and secured together. This is a far more effective method of width reduction than burring. This is because the effect of burring is limited by the location of the mental nerves. Once the chin segment is narrowed, smoothing of the bone edges along the osteotomy lines is needed to prevent step-offs that can later be felt through the skin.

One caveat about bony chin narrowing is management of the attached soft tissues. When you have less bone support, soft tissue prolapsed and redundancies are possible. This can occur in the jowl areas as well as the floor of the mouth muscles. The genioglossus muscles must be resuspended to the chin as they are detached with central chin bone resection. The mentalis muscle should also be securely reattached to prevent any sagging of the jowls or chin pad. As it turns out, both muscles are sutured to the same place…the plate and screws used to secure the chin osteotomy in the midline.

The entire jaw contributes to a wide and square face for some patients. A narrowing sliding genioplasty can be a valuable addition to a jaw angle reduction in the goal of making a more slender jawline that has more of an oval appearance.

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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