Although chin augmentation is a technique that’s been used for decades, it’s a procedure that a lot of people aren’t aware of. Here is some information about what goes into a successful chin implant.
There is a widespread belief that the profile of a person’s chin, particularly in men, is associated with success. Naturally, there is some interest in this type of operation to enhance such an appearance, particularly for those who have what may be considered “weak” chins. It’s a matter of proportion of the chin to the rest of the face, and there are some basic measurements that can be made to inform this kind of augmentation. In a classically proportioned face, three facial zones are generally considered to be equal in length: the hairline to the brow, the brow to just below the nose and just below the nose to the chin. There are also proportions within the lower face that need to be considered: from the crease of the lip to the chin as well as the relationship between the chin and the neck. These relationships must be adjusted appropriately to provide the desired outcome.
Not all people with weak chins are necessarily good candidates for chin implants. For example, some people have a large space from nose to lip with a weak chin, and the lower face is already an appropriate length. Placing an implant in this type of candidate may appear to enlarge the entire lower face. The chin itself is made more proportional, but the entire lower face can become too long, giving an unattractive result. We also need to consider how thick the tissue is over the chin. If the tissue is thick and we attempt to reduce this thickness, then we may get irregularity in contour. We need to evaluate how the chin changes when someone smiles, because if there is a natural drooping of the chin when smiling, an implant may make it worse. Sometimes the whole jawline needs to be increased. This is particularly true in males, where its not desirable to only extend the very tip of the chin. Females typically should have very small implants, because we don’t want to masculinize the chin by making it too wide.
We also need to consider the lips. Some people, when in repose or not moving, hold their lips slightly apart. If we put an implant in such a candidate, the tissues move down a bit and the mouth is left more open—not a desirable result. An excellent plastic surgeon will examine the proportions and musculature of the entire face, at rest and in motion, to determine how sound the candidate is, and what kind of procedure would be best.
We need to be sure that the function of the jaw and teeth are normal. A very high percentage of patients who ask for chin implants actually have a malocclusion (an imperfect positioning of the teeth when the jaws are closed). Eighty-four percent have what’s called a “Class 2 occlusion,” where the jaw itself is too small, not simply the chin. This type of patient may need orthodontics to improve the relationship of the teeth and even surgery on the jaw itself to move it forward. In some candidates, operations on the jaw should be considered before a chin implant, because a functional problem may require a more surgical solution. If a person does have a normal functioning of the upper and lower jaws and a weak chin, then certainly a chin implant is something to be considered.
Hard silicone is the most frequently used implant material. There are several profiles to choose from, the basic difference is their range in size, from small ones that fit right at the chin, to wide implants that enhance the whole jawline. A chin implant is a straightforward procedure to perform, either through the mouth or through the skin. It’s a relatively short operation that will give the desired result.
Osteotomy (Cutting the Bone)
Augmentations and changes in the chin itself can be made by making cuts in the actual bone of the mandible (jawbone). By cutting the mandible, you can change the angle and/or make the chin longer. You can step it forward and anchor it with surgical screws so that it heals in a new position. Osteotomy is a much bigger procedure and is utilized when a simple implant is not going to solve the problem. Osteotomy is appropriate when you need to change the length of the jaw, move the chin forward, adjust an asymmetry from side to side or simply bring it out more than you could with an implant alone. This procedure is particularly good for women that have a weak chin if we’re also doing a procedure to rejuvenate their face, because a little more volume in the chin tightens things up and gives a longer profile to the mandible. It can be a nice adjunct to a tightening procedure. For someone that has asymmetry, a failed implant or has had other operations, osteotomy is going to be a better procedure for them. Osteotomy is good for reducing an overly large chin. If a person has a small chin but a long face that we don’t want to make longer, osteotomy can be utilized to bring the chin forward, making it more pronounced, without increasing the length of the lower face.
With any surgery there’s always a risk of infection and bleeding. With chin implants, the biggest risk is malpositioning, or if the implant fails to stay securely in place, both resulting in asymmetry. You could have tightening and hardening of scar tissue around the implant. The implant could be the wrong shape or size. Also of concern are the many nerves that pass through this area that could be damaged, resulting in permanent numbness, but that is not typical. The best way to mitigate these risks is to select a well-qualified and certified plastic surgeon, especially one with cranial-facial training and extensive knowledge and experience with facial anatomy.