Austin Texas Board Certified Plastic Surgeon

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Ears and Chin

Understand, Respect, Empower, Deliver

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Problem

Ears

Prominent ears are ears that stick out from the face. They draw unwanted attention and negative social scrutiny. Prominent ears also contribute to a perception of a lack of sophistication and the reduced level of intelligence. Prominent ears are generally noted when one is a child. An this condition can be treated surgically starting at the age of five. However many children do not undergo correction of prominent ears and this can result in significant negative social consequences and shyness. These experiences may persist into adulthood leading to less confidence and decreased satisfaction with social interactions. It is not infrequent that an adult who has managed with prominent ears from childhood and into adulthood ultimately decides to undergo correction of this anomaly.

At its heart, the problem of prominent ears is one of cartilage excess, cartilage shaped abnormality, and cartilage malposition. The cartilage excess exists in the central bowl-like structure known as the concha. The cartilage shape abnormalities are mostly confined to the folded structures known as the antihelical fold. Finally, the two preceding entities (excess and abnormal shape) contribute to cartilage position abnormalities where by the helical rim, the concha, and the lobule all project outward from the side of the head more than then the normal dimensions, thus resulting in noticeable prominence.

Solution

Ear Surgery – Otoplasty
Pinning back the ears is known as an otoplasty in scientific terms. Otoplasty is performed to reposition and reshape the ears so that they’re less prominent. There are many techniques utilized to accomplish satisfactory repositioning of the ears. In general, I like to simplify my explanation to patients by saying that the front part of the ear is weakened precisely and the back part of the ear is reciprocally strengthened so that the ear bends backwards in a guided manner so as to come to rest closer to the head.

The procedure is far more complex than that description. It involves placing little scratches on the front surface of the ear cartilage through a posterior incision. This promotes precise backward bending and folding of the cartilage. In addition, sutures are made on the back surface of the ear to carefully fixate the cartilage into the new desired position. Sometimes, when patients have excessive cartilage, usually confined to the concha, a small amount of it and even some skin needs to be removed. Scars on the ear are almost always confined to the back of the ear and thus are difficult to notice. In the rare occasions that incisions are required on the front of the ear, the resulting scars are difficult to see because the skin is very thin and because they are hidden in the shadows of the ear’s contours.

 

Problem

Chin

One of the most important features that contributes to the harmony and balance of the face is the chin. When the face is viewed from the front a weak chin contributes significantly to facial imbalance reducing the vertical height of the lower third of the face. A weak chin has an even more negative impact when the face is viewed in profile as it reduces the horizontal dimensions of the lower third of the face. Thus a small, withdrawn chin immediately draws attention when viewed from the side. While in a woman the effect may be subtle, in a man the small chin contributes to a perception of reduced masculinity and decreased strength. Furthermore, a weak chin worsens the overall appearance of the face by reducing the natural distinction that needs to exist between the face and the neck so as to highlight the attributes and character of the face.

While the diminutive chin degrades the masculine mystique in a man, an overly strong or overly projecting chin challenges notions and appearance of femininity in a woman. A female’s chin is more rounded, less projecting, and delicate in nature. Hence the chin is a very significant facial feature and, given its location in the lower face, can be thought of as the anchor of the overall appearance.

Solution

Chin Surgery – Genioplasty
Enlarging the Chin

Osteoplastic Genioplasty
Genioplasty is a process of reshaping the chin. This procedure is also known as a mentoplasty. It can be performed in two specific techniques. The osteoplastic genioplasty procedure involves making precise cuts through the chin bone and repositioning a segment of it more forward to make the chin appear more forward, larger, lower, or a combination of all three. This process generally helps people with small chins appear to have larger chins thus treating a condition known as micogenia. A very small metallic plate or screws is used to hold the bone segment in the appropriate location until it heals in place. Sometimes a small piece of bone graft is placed between the two pieces to help the bone heal.

Implant Genioplasty
The other method of genioplasty involves a chin implant. Technically, this method known as alloplastic genioplasty however recently in the media it has come to be known by the nickname “chinplant.” In the past chin implants procedures were plagued by complications including capsular contracture, distortion, malposition, and boney erosion. However, these problems are far rarer now with the use of newer designs and materials. The most common material I use for chin augmentation with the alloplastic genioplasty procedure is porous polyethylene material. This sterile, material has the form of a firm small cell plastic sponge. Human tissue is integrated into the open pores and helps keep it in place and reduces complications. This is my material choice when I perform a chin implant procedure. I do not used silicone chin implants because they can result in malposition, tissue contracture, and bone erosion. A chin implant can be used to make the chin stick out further adding a dimension when the face is viewed from the side and also can add dimension to the face in a vertical vector so as add length in the lower third of the face.

Chin Reduction
The description above pertained to procedures designed to increase the size of the chin or to bring the chin forward and/or down in order to augment the dimension of the lower face. However there are some patients who benefit from reducing the size of the chin or making the chin appear as if it is further back. There are two procedures intended to accomplish these goals of chin reduction. One procedure, selective chin burring, is well suited for subtle reductions of the chin and can also be used for slight adjustments in chin shape. Another procedure, reduction osteoplastic genioplasty, can accomplish more significant reductions in chin size and projection.

In selective chin burring a power bur is used to gently and precisely plane away small segments of the chin’s internal bony surface millimeters at time. This process can also be used to help shape the chin. In particular some women have a square appearance to the chin which has a more masculine appearance. Selective chin burring is used to gently sculpt the squared edges into a rounded surface so as to provide a more feminine appearance. Another example of reshaping the chin is removing a cleft or dimple in the chin. While this is an acceptable feature in men, most women are not happy with this feature and selective burring is a relatively minor procedure that can improve this condition.

Reduction osteoplastic genioplasty involves making precise cuts in the bone. When a reduction is required two parallel cuts are made and the intervening bony segment is removed. This creates a gap between the two segments. The anterior chin segments is moved backward to make contact with larger jaw segment resulting in a reduction in chin size and projection.

Some chin procedures can be enhanced by concomitant liposuction of the neck. The combination of these two procedures can improve the contour of the neck and the definition of the jaw-line. This approach is very helpful in the younger patient who believes they want a facelift or neck lift to improve the appearance of her neck but is otherwise too young for a face/neck lift.

Key points

  • Skilled at both osteoplastic and implant genioplasty thus able to offer true choices to patients based on their specific indications thus customizing approach.
  • Additional fellowship training with an emphasis on genioplasty.
  • Authorship of a chapter specific to genioplasty/chin surgery.
  • Published a scientific paper on otoplasty technique.
  • Staffs the ear surgery clinic Dell Children’s Medical Center of Central Texas.

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