Chin implant `augmentation is typically viewed as a ‘simple’ operation that has a low complication rate. And for many types of modest chin augmentations needs this may be true. But I have seen hundreds of ‘simple’ chin implant patients that have become complicated through improper implant selection and placements. Many of these patients never went back to their original surgeon, or even told them of their unhappiness, as they had lost confidence. To the implant surgeon this patient understandably was viewed as a success. But today’s easy access to 3D imaging allows the exact position of the chin implant to be determined unequivocally and can be a humbling experience to what the surgeon views as its location from the outside.
There is merit, therefore, in reviewing the most common types of chin deficiencies and how to avoid choosing the wrong chin augmentation procedure.
By far the most common dimension needed is a straight horizontal projection of the chin. This generally works well in the typical range of up to 10mms using standard implants. It is important to remember that standard implants are made for average or modest deficiency problems.
When the chin is more severely recessed, greater than 10mms, the slope of the chin bone often becomes more angulated backward. Trying to place a standard chin implant in the typical location may create an unintentional vertical elongation as some of the projection is heading more inferior rather than completely horizontal.
Severe chin recessions for this and other reasons may be better served by a bony genioplasty to prevent over lengthening or to be able to actually vertically shorten the chin as well as bring it forward. At the least the implant may be able to be positioned higher on the bone, and this makes theoretical sense, but often creates a disruption of the mandibular plane angle line and can result in an unnatural chin appearance.
The single greatest aesthetic problem I see in standard horizontal chin augmentation is in females. The popular use of extended or winged anatomic chin implant designs, while providing the desired horizontal augmentation, often ends up making the chin too wide in the front view. This can be very disturbing for many women. Either trim down/remove the side wings or choose a more central implant style to avoid this adverse effect in female chin augmentations.
Dr. Barry Eppley
Indianapolis, Indiana