Background: The primary objective of chin implants historically is to provide horizontal projection as this is the most requested dimensional change. They secondarily provide width, intended or unintended, due to the wings or lateral extensions that most chin implants have. The dimensions that most chin implants can not change is adding vertical length. They simply are not designed to do so. Surgeons often try to make the implant create vertical length by tilting it downward on the edge of the bone. But this is an ill-conceived approach most of the time as it creates other issues such as a high wing position as well as implant instability by using it in a way that it it not designed.
The one standard chin implant that is specifically designed to make the chin longer is the vertical lengthening chin implant. (VLC) Angling down at 45 degrees in proper position on the bone provides a combined horizontal and vertical elongation of the chin. It is a first generation type implant meaning that it is noir a perfect design and improvements in its shape are still needed. It is a bit too wide for most patients and intraoperative modifications are often needed to avoid too large or wide of a result. But short of making a custom chin implant design, the VLC implant can be effectively used in the properly selected patient.
Case Study: This female desired to improve the shape of her chin. She wanted a chin that had both more horizontal and vertical projection.The amount of change in each dimension was roughly equal by preoperative imaging.
Under general anesthesia and through a submental skin crease a medium VLC implant was modified in its width (narrowed) and placed on the end of the chin bone. It was secured with a secured with a single screw on its superior ledge to the bone.
When seen four years later she had always been happy with her chin augmentation result but now sought to improve it even further with a custom chin implant design. She wanted and even longer chin (nor more horizontal projection and to keep its width.
As often happens the initial result of a facial implant can lead to another implant for even further improvement. When the dimensional changes that are desired are unique, in this case more vertical chin lengthening, it is time to graduate to a custom implant design.
1) Vertical lengthening of the chin is not a dimensional change that most standard chin implant can effectively provide.
2) The vertical lengthening chin implant (VLC) is designed to do so but often has to undergo some intraoperatve width modifications for the optimal desired 3D aesthetic effect.
3) Screw fixation is essential in the VLC implant to maintain its edge position on the bone.
Dr. Barry Eppley
World-Renowned Plastic Surgeon