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Background: A chin implant is the most common facial augmentation procedure. This is evidenced by the large number of chin implant styles and sizes that exist from which the surgeon can choose. Such standard implants will work for the vast majority of chin augmentation needs.

But when certain chin dimensional needs exist standard implants may be inadequate and a custom implant approach may be better. Such circumstances may be chin bone asymmetry, the need for substantative vertical lengthening, the desire to achieve a specific chin shape, replacement of an indwelling aesthetically ‘failed’ chin implant or the reassurance of knowing exactly what the chin implant dimensions are and how they fit the patient’s specific chin bone. While many think a custom chin implant is extraordinary in size, they are often no bigger than standard implants in volume.

A synergistic approach with chin augmentation is to try and thin out the face above it. By bringing the lower facial chin projection forward, even slightly, with a little thinning out of the lower cheek area by buccal lipectomies, the more rounder facial shape can be favorably changed to a more slimmer one..

Case Study: This young female desired to have a chin augmentation but wanted a very specific effect. She had chin asymmetry and wanted this corrected with a modest horizontal chin augmentation effect.

Using a CBCT scan of her chin an implant was designed that centered the chin and created a small horizontal augmentation of 4mms with no vertical increase. The implant design had a tapered shape with no posterior extensions.

Under general anesthesia and through an intraoral approach behind the lower lip the custom chin implant was placed with double micro screw fixation. Through an intraoral posterior vestibular incision opposite the maxillary 2nd molar, the buccal fat pads were extracted and removed.

The diametric effect of volume addition (chin implant) and volume subtraction (buccal lipectomies) helps make for a facial shape change. Pulling the anterior projection of the lower face forward with the middle of the face more inward makes for a facial slimming effect that is greater than the effect of either one alone.

Case Highlights:

1) Custom chin implants can have a role even in modest amounts of chin augmentation when specific aesthetic goals are desired.

2) Custom chin implants can be placed from an intraoral approach which often may be desired in females.

3) Buccal lipectomies are often done with various types of chin augmentation to help achieve an overall slimmer facial effect.

Dr. Barry Eppley

Indianapolis, Indiana

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