Background: Chin augmentation in females is uniquely different than in men. This is particularly relevant in the horizontal and width dimensions. Women do not need as much horizontal chin augmentation as men. The classic vertical line dropped down from the lip as the advancement goal for the chin is frequently too much, less horizontal augmentation is almost always better in women. The width of the chin is rarely considered in female chin augmentation but is the most frequent source of dissatisfaction in many chin augmentations when it ends up too wide or looks too bulky due to the use of extended anatomic implant styles.
Of the three potential dimensions of chin change, the vertical component is the most frequently under diagnosed. When a standard horizontal chin implant is used in the vertically short chin, the lack of height becomes magnified particularly if it becomes too wide as well Adequate horizontal augmentation still makes the chin appear ‘off’ or disproportionate.
Vertical lengthening of the chin can be done by a bony genioplasty or an implant. Both have their roles in vertical lengthening but the bony genioplasty has the benefit of also making the chin a bit more narrow as well. This narrowing effect can be enhanced by the addition of an implant on the very end of the lengthened chin.
Case Study: This female had a prior chin implant placed which still left her chin vertically short as well as wider. Under general anesthesia through an intraoral approach her chin implant was removed which was seen to be of an extended anatomic style.
A horizontal osteotomy was done and the chin lengthened by 6mms and brought forward 4mms by plate fixation. A small 2mm piece of ePTFE was added to the end of the chin bone to help with the tapering effect.
Her long-term results show an improved chin shape that was vertically longer with a distinct taper.
Case Highlights:
1) Undesired chin shape effects can occur in females with the use of standard extended chin implants.
2) The need for vertical lengthening is the most frequently misdiagnosed/untreated aesthetic chin deficiency.
3) Replacement of an undesired chin implant with bony vertical lengthening genioplasty and a small implant on the tip of the lengthened chin bone can create a more desired v-shaped chin.
Dr. Barry Eppley
Indianapolis, Indiana