Based on anatomy and an understanding of their interrelationships, the following are important aesthetic tenets about manipulations of the chin region: These particularly relevant to augmentation.
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Men will tolerate a larger chin than women
It is generally acceptable to augment the chin in a male to a vertical line dropped down from the lower lip. Men can tolerate more aggressive chin augmentation outcomes.
2. Always undercorrect a woman’s chin.
Unlike men don’t bring the chin as far forward as a vertical line dropped down from the lower lip in females . That will almost always be seen as too stong.
3. Bringing the chin forward, whether by osteotomy or implant, will make the chin look longer in most cases.
Because of the rollout of the soft tissue chin pad any form of chin augmentation will make the chin look a bit longer.
4.There are more effective options for advancing the chin than there are for reducing a prominent one.
Chin augmentation is always an ‘easier’ surgery because, no matter how it is done, it stretches out the soft tissue chin pad risking no soft tissue issues. Reducing the bony chin, however, will often create an excess soft tissue problem.
5. Bony chin reduction is the most challenging of all aesthetic chin surgeries.
Unlike chin augmentation, which stretches out the soft tissue chin pad and submental tissues, chin reduction often creates soft tissue excesses which can adversely affect the aesthetic outcome if not concurrently managed.
6. Soft tissue redundancies are aesthetically unpleasing and difficult to correct.
The chin pad is more unpredictable than reducing the chin bone itself. It does NOT have the ability to smoothly shrink down when the bony support is less.
7. Significant lower lip eversion may be a sign of an underlying malocclusion, not just an isolated retrogenia.
When the lower lip is everted think about total jaw advancement not just that of the chin. That is the only way to improve dental projection.
8. A deep labiomental fold in retrogenia correction will make the chin pad appear postoperatively large when augmented.
The labiomenral fold will always get deeper when the chin is augmented whether by implant or a sliding genioplasty.
9. A high labiomental fold (i.e., a high chin pad percentage) when augmented will produce a larger chin effect.
The more chin pad height that exists the greater the visible effect will be from chin augmentation.
10. A cleft chin is a function of central mentalis muscle deficiency not a groove in the bone.
Creating a vertical grrove in the bone or an inplant will rarely create much, if any, external chin cleft appearance.
11. Liposuction should never be performed on the chin pad for reduction. Irreversible skin irregularities and adherent scarring will ensue.
Never, and I repeat never, liposuction a chin pad. Only excision can reduce the size of the soft tissue chin pad.
Dr. Barry Eppley
Plastic Surgeon