Background:The prominent position of the chin makes it have a significant impact on one’s facial appearance. While most chin surgery involves implants for a small or horizontally short chin, a larger or more prominent chin is equally disturbing although less common. Because chin reductions are infrequently done, there is less information available on techniques and outcomes for it.
Compared to chin augmentation which is more common in men, chin reduction is more frequently requested in women. Even a slightly too prominent chin is less aesthetically tolerated in women as opposed to men. Long chins, pointy chins, and those that stick out too far are common chin complaints from women. A chin can be too long vertically, too far forward horizontally, have a too wide or too pointy shape, or some combination of several of these features. Diagnosing the exact dimensional problems with the chin is critical is determining the best way to shape it.
Case Study: This is a case of a 35 year-old female who has been bothered by her chin shape since she was a teenager. She felt that is was too long and pointy, particularly in a profile view. She despised her appearance in a picture from the side. She stated that the pointy nature of the chin became worse when she smiled.
In looking at her chin, its shape problems can be identified as largely horizontal (too far forward in profile), slightly long vertically (emphasis on slight), and with a mildly pointy shape. The pointy shape becomes more obvious when she smiles as the soft tissues around the mouth and face are pulled backwards against the hard outline of the chin bone.
Chin reductions always involve bone removal and reshaping. There are only two basic approaches, burring down the bone or cutting off the end of the chin bone and repositioning it. (chin osteotomy) Both of these chin reduction methods must always take into consideration how the surrounding soft tissue will adapt. One must remember that less enveloping soft tissue is needed afterwards. For this reason, horizontal chin reductions are best done by burring and excising and tightening the soft tissue envelope through an incision under the chin. Vertical chin reductions are best done by osteotomies which removes a wedge of bone. The soft tissues of the chin have less risk of excess and redundancy when reduced in vertical height.
Planning for this patient’s chin reshaping showed the desired movements of 7mm horizontal reduction, 2mms vertical reduction and flattening of the lower border to round out its shape. (get rid of the point) The chin reduction was done through a 3 cm long submental incision using a burr to do the reduction. Excess muscle was excised and plicated over the freshly burred lower border. Skin excess was then removed and the incision closed. A chin pressure dressing was used for just 24 hours.
Chin reductions do result in some discomfort, very similar to a chin augmentation with an implant. There are no restrictions after surgery and one can eat and drink unaffected. It takes several weeks for the major swelling to subside and the final result can be appreciated in 6 to 8 weeks. The chin will usually appear tight and look stiff for the first few weeks after surgery.
She was very pleased with her outcome and felt it made a very noticeable change in her chin appearance. She no longer felt that her chin was pointy. With her original chin problem (horizontal), the result is most noticeable in profile views.
Case Highlights:
1) Chin reductions is largely a female request with the desire to get rid of a prominent chin that is either too long, strong, or both.
2) Horizontal chin reductions are best done by burring and muscle and skin tightening to avoid soft tissue sag. A submental incision is used which results in a well-placed scar.
3) Reducing a prominent chin has about the same recovery time as a chin augmentation. However, it takes longer to see the final result as small amounts of swelling takes months to completely go away.
Dr. Barry Eppley
Indianapolis, Indiana