Background: A female chin shape has a more rounded or a tapered look. The male chin can be also be rounded but a square shape is more gender specific and often desired. In facial feminization surgery changing the shape of the lower third of the face can be done by chin reshaping alone or combined with jawline reshaping as well. Reduction to a more narrow and less angular shape is the facial feminizing goal.
In reshaping of the square chin it can be done by either an intraoral osteotomy or corner osteotomy. The well known osteotomy narrows the chin by making a combined horizontal and midline osteotomies, hence the T shape. The midline osteotomy also removes a central segment of bone which, when out back together, narrows the chin. The horizontal osteotomy permits other dimensional changes such as horizontal advancement or setback as well as vertical length reduction.
The. corner ostectomy is a simpler approach to reshaping of the square chin. Through an intraoral approach, or can be done through a submental skin incision, the square corners of the chin are removed to make a more rounded chin shape. The qualifications for this chin reshaping technique are that every other dimension of the chin is adequate and does not need to be changed.
Case Study: This young transgender male to female patient was undergoing multiple facial reshaping procedures, one of which was the chin.The chin had adequate projection and length that would be acceptable for a female chin but had distinct square corners.
Under general anesthesia and through an intraoral approach, the chin tissues were degloved along the sides but preserving its central soft tissue attachments. A reciprocating saw was used to remove the square corners and further back along the jawline behind the level of the mental nerve.
The chin corner osteotomy can be an effective reshaping procedure in the properly selected patient. What differentiates it from an overall intraoral chin reshaping procedure, which can be associated with poor soft tissue reattachment and subsequent ptosis, is that the central soft tissue attachments are left intact.
1) Chin reshaping is a common facial feminization procedure to soften the lower third of the face.
2) Desquaring the chin can be done by either an intraoral ostectomy or osteotomy techniques.
3) If the chin has adequate horizontal projection and vertical length, it can be reshaped by a corner ostectomy technique.
Dr. Barry Eppley