Q: Dr. Eppley, I am interested in chin reduction surgery. Unfortunately it seems that there are not that many Doctors in the US who do chin reduction. I even consulted two hospitals in Korea but I think I’ll skip. I don’t need anything major. Maybe just shorten and chisel it like 5 mm? Also I am 42 years old so I will need a facelift after? 🙁should we do the external approach to avoid the loose skin? I feel like there’s already too much tissue on my chin right now.
A: Thank you for sending all of your pictures and detailing your chin objectives. As you may know there are two methods to chin reduction, intraoral osteotomies and extra oral submental osteotomies. Because there are two methods it is not a surprise that there are some differences between them.
The intraoral approach uses bone cuts (osteotomies) where the a T-shaped pattern is done with both vertical and width bone reduction. It is then put back together with a small plate and screws. The soft tissues remain intact on the bottom and back side of the bone segments so there is not any resultant skin sag. (if there is too much soft tissue initially this won’t change) Its advantages are that it is scarless as everything is done from the inside. Its disadvantage is that the amount of bone reduction is usually a little more limited to protect the mental nerves and tooth roots since the actual vertical and transverse bone removal is done in the middle of the chin bone. There will be some temporary lower lip numbness as the mental nerve gets stretched with retractors to protect it during the bone cuts.
The submental approach uses a skin incision under the chin where the bone is shaved from the bottom up. The chin can be vertically reduced as well as the side bone cut down for reshaping. Because the bone removal is done from the ‘bottom up’ more bone reduction can be safely down particularly in regards to the mental nerve as well as the more direct linear access to the bone removal. There usually is little to no temporary lip numbness from this bottom up approach. Also any soft tissue redundancies can be addressed as most submental chin reductions get some form of a submentoplasty as a result. Its disadvantage is the fine line scar under the chin. This is why it is not popular in Asian countries where their skin types are more prone to adverse scarrring.
Having done a lot of each chin reduction approach, you have to choose which technique is most appropriate for the patient’s anatomy and aesthetic chin reshaping goals. It is not really a question of one being better than the other, they are just different with each one having their own distinct advantage and disadvantages.
Dr. Barry Eppley