It is often necessary to recommend surgery for a receding chin, either in connection with a rhinoplasty, a facelift, or liposuction, or as an isolated procedure. The chin is an important feature in creating comprehensive facial harmony.
When facial plastic surgeons examine a patient’s profile, they look to see if the chin projection approaches a line dropped vertically from the lower lip, as Renaissance genius Leonardo da Vinci concluded it should (Fig. 13.1).
A small chin is a feminine characteristic. A strong chin is a masculine characteristic. In women, I generally choose an implant that slightly undercorrects a receding chin. In a man, an implant that brings the chin into alignment with the vertical line extending from the lower lip is preferred.
Too much recession of the chin, particularly when accompanied by a slanting forehead, will cause the features to taper to a point in the midface, rather than give the vertical alignment described by da Vinci.
A discerning facial surgeon may actually advise against other facial procedures unless the projection of the chin can be brought into balance.
Fig. 13.1 From the profile, the chin alignment should approximate a line extended vertically from the lower lip.
Of course there are patients who desire chin augmentation alone. Many patients who choose to undergo face and neck lifts (and who have a receding chin accompanied by excess fatty tissue underneath) can achieve a more aesthetically pleasing profile by having a chin implant and submental liposuction performed in conjunction with their face and neck lifts (Fig. 13.2).
While I have performed chin augmentation through a variety of methods, I generally prefer an intraoral approach. The procedure is performed through an incision several millimeters superior to the crease between the lower lip and gum. A fatal error is to make the incision directly into the gingival-labial sulcus. Doing so makes creating a liquid-proof closure virtually impossible and increases the risk of postoperative infection.
Absorbable sutures are used to close the intraoral wound—first the muscular layers, then mucous membranes. When the scar in the mucous membrane “matures,” it is well camouflaged. Most patients may resume their preoperative activities within about 1 week.
“Twilight” anesthesia (conscious sedation) is used for chin augmentation.
For more than 4 decades, a condition-specific, individually created, medical-grade mesh has been my implant of choice. It is placed beneath the periosteum and increases chin projection by supporting the soft tissues overlying the gonion of the mandible, or jawbone.
Chin augmentation is based upon the same concept as breast augmentation (mammoplasty), wherein an implant is placed under the soft tissue. In the chin operation, the implant is placed (subperiosteally) on top of the mandible so that the soft tissues (skin, fat, and muscles) rest upon the implant, rather than on the bone (Fig. 13.3).
In 4 decades of using soft, medical-grade mesh implants, I am not aware of a single case of bone absorption deep to the implant—a sequela often seen with hard silastic implants.
Medical-grade materials are sometimes employed to make artificial heart components or arteries, for reconstruction about the eye and nose, to repair hernias, and for many other purposes in various parts of the body. The material has been used in hundreds of cases and has a high record of safety and satisfaction. After a short time has elapsed, a mesh implant becomes practically the same consistency as the surrounding tissues and becomes incorporated into them. As is sometimes recommended for patients who have been diagnosed with mitral valve prolapse, I recommend that patients in whom any alloplastic implant has been placed, be placed on prophylactic antibiotic therapy.
Fig. 13.2 When the chin recedes behind an imaginary line dropped vertically from the lower lip, an augmentation mentoplasty (chin implant) can correct the deficiency and provide facial harmony. This patient also had a cheek/neck facelift with liposuction at the jowls and neck.
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