Background: Standard chin implants works well for the vast majority of modest to moderate chin augmentation needs. While the chin is a projecting facial structure that has a three dimensional shape, it is most commonly evaluated in only the side or profile view both before and after surgery. While the profile assessment is an important facial view the frontal and oblique views are also critical views and often the ones the patients see the most.
The frontal view of the chin has very gender specific traits. Women prefer a rounder or more tapered chin appearance while men often prefer a broader or even square chin appearance. For men getting a more square chin shape may be able to be achieved with standard chin implants although the most common chin implant used, extended anatomic style, has a round shape. There are square chin implant styles but they don’t achieve a good square chin shape in my experience.
A custom chin implant design can be made to have any shape, including a square one. But besides creating a square chin shape it also allows the design to extend back along the inferior border with extended wings for a more natural shape. When the chin gets wider it also needs to extend far back along the jawline to ‘look like it belongs there’.
Case Study: This male had a prior extended chin implant placed, which while providing improvement and had good positioning on the bone, left him desiring some additional augmentation enhancements. A little more horizontal projection, a more square shape and some vertical lengthening were the desired improvements.
A custom chin implant was designed from his 3D CT scan that incorporated these desired shape improvements.
The changes in the custom implant can be best appreciated by overlaying the new design over the existing chin implant. (standard implant in green color, custom implant in teal color)
An important finding on the 3D CT scan was the identification of the areas of bony overgrowths (green color) along the edges of the indwelling chin implant. Such bony overgrowths will need to be removed for proper fit of the new custom chin implant.
Through his existing submental scar, the indwelling chin implant was explanted, the bony overgrowths removed by osteotomes, inferior capsulotomies performed and the new chin implant placed. It was secured by a single midline screw.
The immediate effects of the standard round chin implant vs the custom square chin implant were immediately observed.
The custom square chin implant has a better aesthetic effect because it extends the chin, not just horizontally, but a bit vertically as well. This creates a 3D effect along the inferolateral border of the chin back along the jawline that is greater than if it just pushed out the existing border of the bone.
Case Highlights:
1) The standard extended anatomic chin implant mimics the natural shape of the bone which is usually round.
2) For the male who desires an assured more square chin shape a custom chin implant design is needed.
3) Replacing a standard chin implant with a custom chin implant often requires bony overgrowth removals and capsulotomies for proper implant positioning.
Dr. Barry Eppley
Indianapolis, Indiana