Medicine / Plastic Surgery
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On Chin Augmentation: A Basic Primer

July 7, 2018

Jeffrey Francis MD




Disclosure: Opinions reflect neither employer nor affiliated institutions, soley those of the author(s).


Brief History:

Basic surgical procedures have been around for thousands of years. This is sort of scary to think about because numbing medications and anesthesia only came into the medical field in the late 1800s. That means a lot of screaming.

There are several books on the subject, but it appears that plastic surgery has been occurring for thousands of years. One of the earliest rhinoplasty’s (read nose enhancement) occurred in the 1600s in Italy. The surgeon used a flap of skin and tissue from the bicep of the patient to replace a nose that was destroyed by syphilis. The blood supply from the arm had to remain in place while a new blood supply from the face formed into the tissue. That meant the patient literally held the bicep to the face for about 6 weeks. So much fun.

Plastic surgery became popularized after surgical technique, anesthesia, and sterile technique were improved. Around the end of WWI plastic surgery to repair war wounds became more commonplace. Today techniques are revolutionary and indeed an entire face can be reconstructed (look it up for an interesting story).

A Few Thoughts from an Emergency Medicine Resident Physician:

I just want to mention a few thoughts here on whether or not to proceed with surgical alteration of a fully functional body. It is one thing to repair deformities from birth or injury or illness. Making a person whole again can improve someone’s life and make them feel normal. This is a wonderful gift that the field of surgery has given us.

That said, to alter a body or face with surgery when it is fully functional is a bit different. To me, beauty represents a sound mind in a sound body. It represents general care and concern and a decent set of genes. To alter those things with surgery rather than exercise, diet, and hygiene is to make yourself represent something other than what you are. If you alter yourself, you are creating changes that cannot be passed on to progeny. Sexual attraction at its core is based largely on the ability to create and maintain progeny. It is at least worth a conversation with your partner.

When considering plastic surgery, remember that every surgery is relatively safe, but none of them are without risks. Be sure you have put serious thought into what is important in your life before you get augmentation. While some procedures are reversible, some are not. I won’t sugar coat it and say that everyone is beautiful and perfect just the way they are. However, everyone has flaws, and someone out there may find your flaws to be beautiful.

Let's Begin:

So you have a weak chin and a few bucks in your pocket and you want to fix the former by spending the latter. Perhaps your parents, who really don’t know how to type with more than their index fingers or search the web, are considering an operation and have asked you, their millennial child, to explain literally everything to them. Or maybe your significant other has a landslide chin and you are tired of kissing Jabba the Hutt. In any case, you just want to find out a little more reasonable information on chin augmentation.

Before you start dreaming of how good that chin will look, first consider a few principles you should understand about these procedures. Today, operations in general are very safe. This includes anything from an appendectomy (read removal of the appendix, a small part of the colon) to a total hip arthroplasty (read removal and replacement of the hip with synthetic parts). Genioplasty (read reshaping of the chin) is no exception. Most surgeons have a post-operative infection rate of less than 1% for this procedure.

The procedures themselves are relatively simple. Don’t read that and think that you should just go get the cheapest surgeon you can find. As a consumer, you should find a good surgeon. Specifically, you want one who creates good aesthetic results and one who has a low rate of surgical complications. Statistics on these qualities are not easily found anywhere and finding a good surgeon is as much an art as it is a science.

In fact, if you ask surgeons (as I have done) how they would go about finding a good surgeon, they will tell you that the only way is to have insider information from people who work in the business. It has nothing to do with how many papers they have published or even their pedigree, as these can often be misleading when it comes to surgical skill. With that in mind, it is best to search for a reputable surgeon online who has performed the procedure many times and with success. Online reviews and your personal opinion of the surgeon when you speak with him or her are the only real avenues, unless you work in medicine. I won’t bore you with more, but I do want to emphasize the importance of finding a good surgeon. You only have one face.

Chin augmentation is essentially a reshaping of the chin. This can be achieved in a few different ways. They can be broken up into two basic groups: Non-Surgical and Surgical.

Non- surgical

This is essentially an injection of a filler material. Injectable fillers tend to not last as long as the surgical options, but these procedures are less invasive. A skilled surgeon can reshape your soft tissue (read fat and muscle over the bone of your chin) using filler material. As we age, subcutaneous soft tissue flattens. The idea behind these fillers is to put back what aging took away. Currently, there is no absolute consensus as to what filler is best. The ideal filler should be safe, predictable, easily shapeable, and long lasting.

Autologous fat is a good filler option because it is natural. It is from your own body and so it will not create an immune response. Your body will recognize it as your own tissue and will leave it alone. Also, the majority of facial volume loss is from fat loss. Thus you are putting back exactly what your face has lost. The downside is that these injections typically maintain their shape for only a couple of years. The research on this subject is varying, but 2 years is a good rule of thumb.

In terms of volume augmentation (read filling the space in that flat chin and making it jut out like Hercules’ biceps), fat is thought by most to be the best filler. It lasts longer than the others. These other fillers include hyaluronic acid, collagen, and bioceramic microspheres. They tend to last for months rather than years. The details behind these can be discussed in more detail with your surgeon.

Surgical

These options are more invasive but last much longer. They also give you more control over the shape of the chin. The general idea here is to reshape the bone or supplement the bone with biocompatible material (read substances that won’t disrupt your natural tissue or cause inflammation) in order to produce a more aesthetic appearance. A surgeon can correct asymmetry, increase or decrease facial length, and improve chin volume.

Before looking at the different surgical options, I’d like to touch on some basics of chin malformations. The roof of your mouth and upper jaw and some other structures are attached to a bone, called the maxilla. You can search this bone on Google Images to get an idea if you are curious. Sometimes apparent problems with the chin are actually problems with the maxilla. A large, protruding maxilla can make the chin look small. Alternatively, a small, recessed maxilla can make the chin look huge. Be sure you ask to have an evaluation of the maxilla before blaming the mandible (read chin bone). There are surgical options for the maxilla, which are beyond the scope of this article. Ask your surgeon.

Once you have addressed the maxilla and you decide that the mandible is the culprit, then you can consider different options:

Sliding genioplasty can be translated to “slice the jaw bone and scoot it forward”. This procedure involves a small incision inside of the mouth, just in front of your lower incisors. After dissecting tissue and protecting nerves within your chin, the surgeon makes an osteotomy (read a cut through your bone, in this case the jaw bone) and then slides the cut bone from your lower jaw forward. He or she will then reattach the soft tissue and close up the wound inside of your mouth. Eventually, this bone will heal in its new position and you will have a chin that is, for all practical purposes, permanently reshaped. Sometimes this procedure causes numbness to part of the chin. This is because the mental nerve is moved during the procedure and sometimes displaced from its original position. The numbness occurs more often in this procedure than the others listed below. That said, once a genioplasty heals, it is the most durable form of chin augmentation.

Alloplastic Implant can be translated to “adding a custom shaped implant in front of the jaw bone”. Essentially this operation adds material to pre-existing bone to act as a scaffold for the overlying tissue. This is essentially an extension of the function of naturally occurring bone. Implants are made of various materials including polymers, metals, and ceramics. Silicone based implants are a commonly used polymer and are very stable once in position against bone. There are gel based implants and some made of porous material. The porous materials allow bone and tissue to grow into them. This means more stability, but it also means that reoperation to remove it is almost impossible. The advantage to using an alloplastic implant for chin augmentation when compared to genioplasty is that there is a shorter operating time and less blood loss. The disadvantages include a slightly increased risk of infection and a risk of the implant becoming displaced. Incisions can be made outside of the mouth. This reduces infection because there is no oral flora (read naturally occurring bacteria in the mouth) introduced.

Before the procedure it is best to avoid things that will impair hemostasis (read make you bleed more easily) for about a week. This includes excessive alcohol, vitamin E, aspirin, naproxen, and other non-steroidal anti-inflammatory drugs. Your surgeon will go over this in great detail after reviewing your personal medical history.

After the procedure most surgeons ask you to limit activities in order to allow the implant or injection or moved bone to settle. It is common to have you not touch your chin for several hours, sleep with your head elevated for a night or two in order to allow the tissue to drain inflammation, and to not chew for a day or two. It is also advisable to avoid activities in which you may receive trauma to the face, such as football or skiing.

From a patient perspective, your job is to first find a good surgeon. Once you feel comfortable with the surgeon, he or she can discuss the best option for you and should always discuss possible side effects or bad outcomes. This is not to scare you. It is to explain what can happen. No surgeon is above these possibilities.

From there, it is your job to listen to the pre-operative and post-operative instructions and do these things religiously. It is in a surgeon’s best interest financially, morally, and professionally to minimize complications and so he or she will give you the best advice for after care and proper hygiene. All you have to do is to follow it.

With all of the above in mind, I want to mention a few take home points:

* As a patient, it is your job to find a good surgeon and then to follow his/her instructions.

* There are many ways to change the shape of your chin. Briefly and from least to most invasive, these include injection of filler, alloplastic implant, and genioplasty. The genioplasty is the most durable form because it uses naturally occurring bone and allows it to regrow into itself.

I hope this article helps to outline a few basics of chin augmentation and can help you to make a more informed decision moving forward.

References:

Greer, S. (Ed.), Benhaim, P. (Ed.), Longaker, M. (Ed.), Lorenz, H. (Ed.), Chang, J. (Ed.), Hedrick, M. (Ed.). (2004). Handbook of Plastic Surgery. Boca Raton: CRC Press.



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