Chin Widening

Q: Dr. Eppley,  I am iunhappy with the appearance and shape of my chin. My bite was corrected with braces, and my chin isn’t receding or over-projected, but it is admittedly quite narrow and pointy from the front view. 

I have a tapered heart-shaped jawline/face which only serves to exacerbate my self-consciousness about my narrow and pointy chin.

I have consulted with a local surgeon, but I found out you are the go-to expert on facial bone surgeries and chin surgeries through RealSelf. I really hope you could provide some insight onto the options I was provided so that we can have some foundation to go off of during the video consultation. 

My surgeon, who is a plastic surgeon with a craniofacial background, assessed my chin at a consult and gave me three options. I would really appreciate your opinion on the suggestions as a medical expert so that I can have the best surgical plan to achieve what I desire.

(1) A laterally widening genioplasty. I was advised this would be an option as only a minor widening effect was needed. 

Would this bone widening make my lower facial shape more rounded and less angular, or would it just make my chin flat and square? Would I still have a natural curve to the chin? I’m a little worried it will make my chin more masculine looking.

(2) Hydroxyapatite on the sides of the chin. As a craniofacial surgeon, he mentioned he had quite a bit of experience with this material and that it could be placed on the sides of the chin and shaped.

However, from looking through your blog, this material seems to be quite unforgiving for augmentation purposes. I’m worried about potential asymmetry and not being able to remove the material if the shape is bumpy or doesn’t achieve what I want.

With your experience of the material, should we even entertain this option? It does seem less invasive than a bone-cutting surgery but there seems to be so much more that could go wrong (eg. asymmetry, not the right shape.) Can this material get infected?

(3) Lastly, the surgeon mentioned an implant but he did mention that off-the-shelf implants wouldn’t be suitable for my case, considering that no other dimensions of her chin need any augmentation. 

A custom implant was possible but it added on thousands financially, and for such a minor augmentation it just didn’t seem worth it. 

I am not sure what is the best option out of what I was advised. I would really appreciate your insight and I thank you for your time.

A: Thank you for your inquiry. Since I have no idea what the chin/face in question looks like nor have any knowledge as to what the aesthetic chin change goal is (I assume computer imaging has been done to determine the exact amount and extent of the chin/jawline widening effect), I can only make the following general comments:

1) Widening of the chin is accomplished by creating more width from the center of the chin back a certain distance along the jawline. That posterior widening extension will need to be longer than one would think and its shape as to be fairly precise to end up with the desired effect that is both a adequate and symmetric.

2) There is little question as to what is the best treatment option to create the desired chin widening effect…computer designed implants based on the bone on which it is intended to augment. Having precise control of their design simply can not be beaten, that is not the actual question you are asking. Because of cost considerations the actual question is what else can she done that costs less that may come close. to their effects. From that perspective I will address your current options.

3) The use of hydroxyapatite granules is very prone to irregularities and asymmetries, it is just not a precisely controllable contouring material in the unforgiving projection of the chin.

4) A widening genioplasty will make the sides of the chin wider…to a point. But there may be step offs along the back ends of the wings of the bony genioplasty when the bone flares out at its back ends when the center of the chin is widened, creating  a contour deformity along the jawline without a smooth transition. You are also correct in that it may have more a chin squaring effect than a rounding one and it does seem to a ‘solution that is bigger than the actual problem’.

5) There are standard prejowl implants that add some width to the side of the chin without increasing its horizontal projection. Whether this should be adequate I cannot say since I don’t know the exact aesthetic chin widening goal based on computer imaging. These can also be made by a special design process for whatever the desired width increases are needed.

6) There are also ePTFE (Gortex) blocks and sheets that can be handmade and carved to create one’s own intraoperatively fashioned ‘custom chin widening implants’. 

In conclusion, trying to cut and move the bone to create the exact chin widening effect one wants is harder than it seems. The chin bone can be cut and centrally widened but precise control of the resultant shape is not assured. Placing granules into a. subperiosteal tunnel and them molding them from the outside is not an assured method of bone contouring with both symmetrym, smoothness and an exact shape is desired. The best method for such minor chin widening, in my opinion, is to get a preformed implant shape to do it. As discussed there are various implant options in that regard.

Dr. Barry Eppley