An important part of any rhinoplasty evaluation is that of the chin. Patients who pursue rhinoplasty to make their nose smaller should not be surprised that they may have a comparatively smaller chin by facial proportion assessment. This is because a ‘weak’ chin can make a nose appear more prominent. In patients that come in because they feel that their nose is too big, I ask them close to the end of the consult to take a close look atyour chin. It is simply a question of facial balance. A small or receding chin can make the nose appear bigger than what it really is. This is similar to the influence of the forehead on the appearance of the nose. A sloping or recessed forehead can make nasal projection seem bigger than what it really is.
The balance of the chin to the nose is almost always done in a profile view. A vertical line is mentally (or physically done on a picture) drawn down from the edge of the lower lip and the horizontal chin position is assessed by where it is in reference to this line. If the tip of the chin falls behind this line, chin augmentation will usually be aesthetically helpful. Conversely, if the tip of the chin is beyond this vertical line, chin reduction may be needed. Classic cephalometric analysis and tracings use the glabella, or lower portion of the forehead between the eyebrows, as the place to drop this vertical line to determine proper chin position. But the lower lip is easier and a more accurate reference.
But chin assessment in rhinoplasty should not be limited to just the profile view. This is an overly simplistic approach. Like the nose, chin assessment must be evaluated in the frontal view as well. The width and shape of the chin is also important. A more narrowed nose with a wide chin is not aesthetically ideal, particularly in a female. Conversely, too narrow a chin in a male even if brought ideally forward is similarly mismatched to many results of a male rhinoplasty.
The width of the chin is not as established an ideal as that of horizontal chin projection. But there are some guidelines to go by. The width of the chin should not usually be wider than a vertical line drawn down from the inner aspect of the iris in females or from the center of the pupils in males. There is a central pad of the chin that is discernible in most patients and it is usually close to the same width as that of the outside edge of the nostrils, known as alar width. The central pad chin width is not really changeable but the outside or lateral width of the chin is. A chin implant, based on the style chosen, can help widen or narrow the chin’s width. A chin osteotomy can do the same. Most chin osteotomy advancements will actually narrow the chin as it comes forward, unless midline expansion via a separate bone cut is made.
Rhinoplasty and chin augmentation are close cousins that impact each other’s appearance. Like the nose, the chin must also be assessed in three dimensions as well.
Dr. Barry Eppley
Indianapolis Indiana