Background
Chin implants for augmentation are available in a wide range of styles and sizes. However, this variety does not guarantee that every patient’s desired outcome can be achieved with standard, off-the-shelf options. One example is the request for a square chin shape in male patients.
While square chin implants exist, in practice they often fail to create the desired effect. Standard implants typically equate width with squareness, when in fact, sharp and defined corners—rather than excessive width—are what truly create a square appearance.
Achieving this effect generally requires a custom implant design. A key design principle is to create chin corners at approximately 110 degrees. In addition, the width of the implant should not extend beyond the natural jawline when traced from back to front—what I refer to as the “converging jawlines.” Most patients do not want a chin that appears wider than the jawline behind it.
Another important consideration is the increased implant volume that results from square designs. This becomes particularly relevant when horizontal projection exceeds 10 mm. A round chin implant primarily places tension centrally on the soft tissue chin pad, whereas a square implant distributes that tension across the full width of the chin. This broader stress can make wound closure more challenging and must be factored into the design and surgical plan.
Case Study
A young male patient presented with longstanding dissatisfaction about his short chin. In addition to augmentation, he specifically requested a square chin shape.
A custom chin implant was designed to provide 12 mm of horizontal projection with sharply defined square contours. To facilitate accurate intraoperative placement and stable fixation, screw holes were incorporated into the inferior border of the implant.
The procedure was performed under general anesthesia through a submental incision. The implant was secured to the bone using screws along the inferior border, with an additional 15 mm central screw providing three-point fixation for enhanced stability.
The patient’s results demonstrated both the anticipated chin projection and the desired square contour. Importantly, despite the sharp angles of the implant design, the external appearance was not overly harsh. This is due to the blunting effect of the thick overlying soft tissue chin pad, which softens the external contour. This same effect explains why standard square chin implants rarely achieve the desired aesthetic—implant designs must be exaggerated internally to produce a visible external improvement.
Key Points
- A male patient’s request for a square chin shape is a strong indication for a custom chin implant.
- Incorporating inferior border screw holes in the design enhances both centering and fixation of the implant.
- Custom implants with significant horizontal projection and a square design place greater stress on the soft tissue chin pad, which must be considered during closure.
Dr. Barry Eppley
World-Renowned Plastic Surgeon