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Posts Tagged ‘submental chin reduction’

Case Study – Submental Chin Reduction

Sunday, May 1st, 2016

 

Background:  Chin augmentation is one of the most common facial reshaping procedures both historically and to the present day. While augmenting the chin is a straightforward procedure using a variety of implant shapes, management of the large chin (macrotia) is a completely different story. Not only is it less commonly needed  but the procedure to do it are not well understood.

The traditional and often chosen procedures for macrogenia are intraoral approaches either shaving or cutting the bone and moving it back. Shaving the chin bone intraorally is a simple procedure and seems like it would work…but it doesn’t. It consistently leads to soft tissue chin ptosis as the degloving of the soft tissues and the soft tissue excess creates a soft tissue sag off of the bone. A bony genioplasty has a role in vertical and width reduction of the chin. (V line jaw surgery) But doing a sliding genioplasty and moving it backwards for too much horizontal projection create sa relative soft tissue excess. This  results in the excessive soft tissue being relocated to a bulge under the chin.

The submental chin reduction is a technique that addresses both the bone and soft tissue aspects of a large chin. Using an incision below the chin, the bony chin can be reduced by  shaving or burring the chin in all three dimensions. Once the bone is reduced, the excess soft tissue created can be managed by a submental tuck which redrapes the soft tissue over the remodeled chin bone.

Case Study: This 25 year-old female had a prior history of a vertical reduction boy genioplasty done to reshape a large chin. It failed to achieve its desired aesthetic goals and actually made the chin wider as it vertically shortened it, exaggerating the patient’s original aesthetic chin concerns.

Submental Chin Reduction incision Dr Barry Eppley IndianapolisUnder general anesthesia, a submental incisional approach was used to expose the bony chin. The incisional length was  4 cms and stayed well within vertical lines dropped down from the corners of the mouth. The bony was burred down horizontally and in width. The sides of the chin was taken down back behind the mental nerves removing the stepoffs from the prior chin osteotomy.

Submental Chin Reduction Reshaping result front view Dr Barry Eppley IndianapolisSubmental Chin Reduction Reshaping result oblique view Dr Barry Eppley IndianapolisSubmental Chin Reduction Reshaping result side view Dr Barry Eppley IndianapolisHer submental chin reduction results after three months showed improvement in the shape of the chin being smaller in horizontal projection and in its width.

Highlights:

1) Chin reduction is a challenging procedure because of the need to manage the excess soft tissue as well as that of the bone.

2) A submental chin reduction allows for reduction of both the bone and the soft tissue chin pad.

3)  A submental chin reduction allows for 3D reshaping of the chin bone including length, projection and width.

Dr. Barry Eppley

Indianapolis, Indiana

The Submental Chin Reduction Technique

Friday, December 25th, 2015

 

The treatment of macrogenia (large chin) is much different than that of microgenia (small chin) and is also more challenging. Expanding the chin (chin augmentation) can done very reliably and in a straightforward manner through an implant or sliding genioplasty as it pushes out the overlying skin and soft tissue. While a prominent chin bone can be reduced, the success of any chin reduction procedure usually depends on what happens to the resultant excess soft tissue that will result from loss of bone support.

While a few limited chin reductions can be done from an intraoral approach, significant chin reductions require a different approach for two reasons. First, significant chin reduction requires a multi-dimensional approach to the bone reduction. This often includes horizontal, vertical and width bone removals. If the surgeon is skilled in bony genioplasty techniques and the patient is young, an intraoral vertical and midline wedge bone removals can reshape a large chin. But the best access to doing every dimension of bony chin change is from a submental approach from below. Secondly, any successful management of excess chin soft tissue involves excision which can only be done from below. Resuspension or ‘tightening’ of chin tissues done intraorally is not really an effective method making the chin soft tissues less in volume.

A submental chin reduction has several key technical steps to be successful. These include the location and extent of the incision, the method of bone removal and tye closure method which includes a submental tuck-up procedure,

Incision for Submental Chin Reduction Dr Barry Eppley IndianapolisThe submental incision needs to precisely placed and put back a few millimeters further that the standard submental skin crease (many young people do not have such a crease) The curve of the inferior border of the jawline is marked out and the submental incision placed 5 to 10mms behind it. Its length is no greater than 3.5 cms and is curved to follow the curve of the jawline.

Submental Chiun Reduction bone removal Dr Barry Eppley IndianapolisThe submental skin incision allows direct access to the entire bottom of the chin which is done through wide subperiosteal undermining. A reciprocating saw is the most reliable way to make horizontal, vertical and width bone reduction with little risk of damaging the skin edges of the relatively small access incision. Burring can be done to smooth out all reduced bone edges. The bone should only be reduced until the marrow spaces are encountered where some bleeding will occur. That can easily be controlled by bone wax.

Submental Chin Reduction immediate result Dr Barry Eppley IndianapolisAfter chin reduction and reshaping the soft tissue chin pad is pulled over the reduced bone and its mentalis muscle edges sewn to either the bone edges (through drilled bone holes or to the muscle and periosteam on the underside of the bone edge. This fixes the anterior edge of the submental incision. The excess submental tissues behind the incision are advanced forward and the ‘excess tissues’ are trimmed and the incision closed. Rather than removing the redundant chin soft tissue pad, they are redraped over the reduced chin bone. This ensures that the submental incision is moved behind the new inferior border of the chin and the now ‘fuller’ neck tissues are removed and brought forward.

The technique for submental chin reduction is not well described or frequently performed. But careful attention to detail can create a submental scar that is both very aesthetically acceptable and not overly long.

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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