Q: Dr. Eppley, I am interested in chin cleft reduction. How is it done and what is the best method? What is the cost of chin cleft reduction? Is it done under local or general anesthesia?
A: A chin cleft reduction can be done by several method depending on the etiology of the problem. For many patients the external chin cleft is the result of a mentalis muscle (soft tissue) deficiency. This is treated by injectable fillers for a temporary effect or by fat injections in the hope of a more permanent result. In a few patients the external chin cleft is the result of an actual cleft in the mandibular symphysis. (chin bone) In these cases the bony chin cleft is filled in with the use of a small implant placed intraorally or from under the chin. Only a physical exam examination can make that distinction between a bony versus a soft tissue chin cleft.
Since there are different methods used for chin cleft reduction, it would first be important to determine the exact treatment method. From fat injection to the use of an implant, the costs could range from $2000 to $3500. The procedure is usually performed under a combined IV sedation and local anesthesia.
Dr. Barry Eppley
Q: Dr. Eppley, I am interested in chin cleft removal surgery. The deepest part of my cleft is at the very top. Ironically, the deepest part at the top goes down to the bone, which is not a valley but a peak at this part of the cleft. So the top is strictly due to the positioning of the attached muscle. The bone is grooved at the bottom of the chin with a 1/8th inch deep notch in the bone. This is basically the deepest possible cleft chin possible.
From what I’ve read, entering through the mouth to avoid scarring this is the best that can be done and will most likely not fully remove the cleft but dampen it. I would like to know how many cleft chin removals using subcutaneous fat as a filler with smoothing of the chin bone have you done?
A: When it comes to chin cleft removal (or more accurately for many patients a chin cleft reduction), it is important to classify the type/depth of chin cleft. I classify chin clefts into four types based on the clefting seen in the skin, fat, muscle and bone levels. By your description and the example you have shown which corollates to your chin cleft, that would be a type IV chin cleft. When the chin cleft is this deep and the skin edges are deeply inverted, placing a filler material in the cleft is really not the best treatment. The tissues are so deeply indented that it will resist any ‘soft’ push from any underlying augmentation in the soft tissue layer. Augmentation of the bone, although reasonable to do, has the less effect on Type III and IV chin clefts. The most effective treatment in Type IV chin clefts is external excision and multiple layer reapproximation to level out the clefted tissues all the way down to bone. While this is the best approach in very deep chin clefts, this creates an external scar which is rarely aesthetically acceptable. Thus one has to accept an internal intraoral approach with a much reduced result. If done intraorally, the bony cleft would be augmented, the skin released from the muscle and a dermal-fat graft placed underneath the released skin. I would expect maybe a 1/3 to 1/2 reduction in the Type IV chin cleft with this approach.
One simple test to determine how much a chin cleft can be reduced, a saline or synthetic injectable filler treatment can be done in the office. If reasonably successful that would indicate that soft tissue filling would be reasonable to do. One could then proceed with either fat injections or a longer lasting more robust filler like Juvederm Voluma for treatment. If unsuccessful, then one knows that a more invasive procedure as I have described above would be needed.
Dr. Barry Eppley
Q: Dr. Eppley, I have a very deep cleft on my chin. A surgeon suggested dermal filler, saying that a chin implant would move because (he said) the dimple was too small. But my cleft chin is very deep and I am very unhappy with it. A doctor injected a syringe of hyaluronic acid into last year but with no visible improvement. I have placed a link to an image of my chin cleft here.
A: Very deep chin clefts in men are not usually the result of any underlying bone deficiency but are rooted in the soft tissue with a lack of tissue between the skin and the underlying muscle. Often the mentalis muscle is clefted as well. In addition the skin is very indented almost like a scar band. Thus a chin implant on the bone is likely to be of little benefit as pushing out from the bone will make little change in the depth of the cleft. Injectable fillers, as has been demonstrated by your experience, do not have enough stiffness and volumetric push to change the cleft. The viable treatment options would be either fat injections done with a subcision release of the vertical skin indentation or an open approach using a dermal-fat graft. In some cases the placement of a small implant in a midline bony groove can be of adjunctive benefit if it exists.
When it comes to chin cleft surgery, it is best to think of it as a reduction rather than a complete removal.
Dr. Barry Eppley