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 Thus a small, withdrawn chin immediately draws attention when viewed from the side.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.
Chin Surgery – Genioplasty
Enlarging the Chin
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.
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.
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.
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