Background: While the surgical technique for chin implant augmentation for men and women are the same the selection of the implant and it’s size can be quite different. Man can tolerate larger amounts of chin augmentation and want a broader or more square chin. In contrast, females often can only tolerate lesser amounts of horizontal advancement and almost never want a broader or wider chin appearance. In fact most women prefer a less wide and more narrow shaped chin from the frontal view.
The problem in a female chin implants is that most of the standard implant styles create a broader chin shape with their longer extended wings. This failure to recognize the width dimension of the implant in females is a frequent source of many patient’s postoperative dissatisfactions. While this is a problem that could easily be remedied in surgery, or at least improved by wing removal, this alone may still not create the tapered chin shape that females may desire. Even with removal of the wings the shape of the standard chin implant is still fairly round. This by itself can still create undesired width.
A tapered or more narrow chin implant shape to create that desired effect must almost look like a V. This may seem an excessive or strange shape to some but with the thickness of the overlying soft tissue pad the effect is never the same externally as that of the implant shape on the bone. Verse many implant designs, the female chin implant included, must have an exaggerated shape to have any portion of it seen externally. This could be done by carving of standard implants intraoperatively but is most ideally done by a custom implant design.
Case Study: This female had a history of two prior standard chin implants which added undesired chin width. This was replaced by a custom chin implant design by another surgeon which, while not as wide as the standard implants used, did little to give it a more tapered chin shape. While she was happy with the horizontal projection the wide shape remained the problem.
In looking at this custom design the following changes were needed to make a real difference.
A new radically different chin implant design was made with a very short tapered shape. This was like a cap that fit over the end of the chin bone. Same horizontal projection as before with a different shape.
Because of the small chin shape and the need to secure it with screws fixation holes were designed on an extension that fit over the inferior border.
During the exchange surgery through her existing submental scar the removed implant vs the replacement implant were compared.
The new custom chin implant was secured with two microscrews at the inferior border extension.The intraoperative improvement in the shape of her chin could be immediately seen with a more tapered chin shape.
More relevantly when seen three months later when all the swelling had resolved and the soft tissue shrink wrap effect had occurred the tapered chin shape was clearly visible.
Key Points:
1) The challenge in female chin implant is to get the desired horizontal augmentation but without making the chin too wide.
2) All standard chin implants have wings which are not appropriate for most women.
3) Either standard chin implants have to be modified or a custom chin implant design is needed for narrow shaped chin augmentation effect.
Dr. Barry Eppley
World-Renowned Plastic Surgeon