Chin Enhancement Specialist
Dr. Barry Eppley has years of experience helping his chin augmentation and chin reduction surgery patients with their aesthetic needs. Please visit the chin surgery before and after photos page to view patients who have undergone this procedure.
The chin serves at the leading point of the face for most people. As a result, it has a major influence on how the face appears and the image of how it is perceived. Whether it is too small, too big, too narrow, too wide, there are many options for changing one’s chin. One very important consideration in any chin surgery is an understanding of the differences between a male and a female chin. Its size and shape and how it fits with the rest of the face to create a gender identity is very important when doing any form of chin reshaping surgery.
The position and shape of the chin is traditionally perceived and surgically changed when the chin is small or recessed. This makes the face overall appear smaller with the neck looking short and full, the jaw line ill-defined, and the nose may even seem large. Changing the position of the chin (i.e., bringing it forward) has one of the most dramatic effects of all of the facial procedures.
The chin may be brought forward by one of two techniques; adding a synthetic implant to the bone (chin implant) or bringing the chin bone forward by cutting and moving it (sliding genioplasty). Each chin augmentation technique has its advantages and indications which differ for each patient. As a general guideline, chin implants are used when small to moderate amounts of chin augmentation are needed. There are a large number of styles and sizes of chin implants today and this allows a great number of changes to be made. These include the amount of horizontal projection, some vertical lengthening and increasing or narrowing the chin width (squareness vs. round vs. narrow triangular shape when viewed from the front). Chin implants can be inserted from either under the chin (submental) or from inside the mouth. (intraoral) There are advantages and disadvantages to either chin implant insertion approach.
When the amount of chin augmentation needed is significant or need a significant vertical lengthening as part of the augmentation, it is usually better to move the chin bone forward. Known as a sliding genioplasty, the chin bone below the front teeth roots and the mental nerve is cut and can be brought forward with the neck muscle attached to it. This chin bone segment can undergo a variety of dimensional changes including bringing it forward, bringing it forward and down (lengthening chin height), bringing it forward and up (shortening chin height), only lengthening or shortening as well as either make the chin wider (by expansion) or more narrow. (by wedge narrowing) As can be seen, the bony genioplasty has a lot of dimensional change possibilities. Once the chin bone is moved/changed, it is held in position by very small titanium metal plates and screws. All sliding genioplasty procedures are done from inside of the mouth.
The opposite of chin augmentation and less frequently done is chin reduction. For those patients whose chin sticks out too far, is too vertically long or is too wide, there are a variety of chin reduction procedures for correction. Chin reduction can be done through either an intraoral or submental incisional approach depending on the chin excess problem. An intraoral genioplasty can be done to vertically shorten the chin by removing a wedge of bone. From inside the mouth the chin can be narrowed by lateral ostectomies which are commonly done for reshaping Asian jawlines and in facial feminization surgery. When there is soft tissue excess or sag from a long or protrusive chin, the submental approach offers the ability to remove bone and soft tissue and tighten the tissues over the reduced chin.
The shape of the chin in the front view is affected by both its width and vertical length. While men may want a more broad or square chin, women often want a more narrow one. Female chins are often considered more attractive if it has a more narrow or V-shape to it. This can be done through isolated lateral ostectomies (tubercle reduction) or as part of a sliding genioplasty procedure through a central wedge resection technique.
CHIN PTOSIS REPAIR
An uncommon and difficult chin problem is that of soft tissue sagging or ptosis. Soft tissue that hangs off the chin is usually the result of prior chin surgery, often after implant removal or poorly executed or planned chin reduction surgery. Chin ptosis can be repair with intraoral muscle resuspension in minor to moderate ptosis but needs a sub mental approach with excision for more significant chin ptosis.
SLIDING GENIOPLASTY IN ORTHOGNATHIC SURGERY
Chin augmentation through sliding genioplasty is often done as part of orthognathic surgery where the jaw bones are already being cut and moved. Because it is a ‘bone operation’, concomitant chin enhancement is done by moving the bone also. This can help tremendously in improving a patient’s profile where the entire jaw is short and the limit to how much the jaw is brought forward is controlled by how the teeth fit together.
SLIDING GENIOPLASTY IN OBSTRUCTIVE SLEEP APNEA
A sliding genioplasty can also be one type of surgical treatment for obstructive sleep apnea (OSA). Because the genioglossus muscle is attached to the back part of the chin, a sliding genioplasty is one technique for genioglossus muscle advancement if the aesthetics of the chin is favorable to a large horizontal chin movement. By moving the chin bone forward with the genioglossus muscle, there will also be some forward movement of the base of the tongue if the bony chin movement is significant enough (10mms or greater).
When obstructive sleep apnea is severe, maxillomandibular advancement is the most effective method of enlarging the nasopharyngeal airway. Often these forward bone movements need to 7mm to 10mms of both jaws coming forward. If the entire lower jaw is initially short enough, a sliding genioplasty can be combined with a maxillomandibular advancement to open up one’s airway as much as is surgically possible.
In addition to helping chin augmentation / chin implant patients, Dr. Barry Eppley also offers a variety of surgical and non-surgical treatments for the face. He helps face lift, rhinoplasty and Botox patients achieve their desired facial contour. He is also a trusted cheek implants and custom implants provider.
Chin Augmentation – Before Surgery
The origin of the chin shortness is determined by looking at the face and neck as well as the position of the teeth. In the younger patient with a severe overbite (lower teeth behind the upper teeth), the chin position may be a reflection of an overall shorter jaw. In these patients, other treatment options may be considered (jaw surgery). Computer imaging in the profile view is extremely helpful in determining the value of chin advancement and how much advancement would be beneficial. In some cases, an x-ray in profile may be useful to look at the bone and the facial profile for treatment planning.
Chin Augmentation – Operation
Most chin implants are placed under IV sedation or general anesthesia as an outpatient. They are commonly placed through a very small skin incision under the chin where the bone is easily reached. Placing the implant through a small incision inside the mouth behind the lower lip can also be done. Chin bone advancement is always through an incision in the mouth where the bone is cut, brought forward, and fixed into its new position with a small plate and screws. Often times, chin procedures are part of other facial procedures including nose surgery and facelifts.
Chin Augmentation – After Surgery
A chin strap is usually used after surgery to control swelling and help the overlying tissues adapt to the implant or bone. Bruising is rarely seen but swelling is common. Sutures inside the mouth are dissolvable and do not need to be removed. Sutures in the skin under the chin are removed in one week.
Chin implants are extremely well tolerated and infection is very rare. When the chin bone is moved, there is usually a short period of lower lip numbness which completely resolves by one month after surgery.