What Are The Risks Of Chin Reduction/Narrowing?

Q: Dr. Eppley,  I am interested in getting my chin narrower as it is too wide from the front view. In addition, it is longer on one side than the other. I know that you can burr or shave down the chin to reshape it. I have some concerns and questions about the procedure.

1.  I want my chin to be narrower by at most 1/4 inch.  I want the same squared shape only narrower from the frontal point of view.  Is that easier to do by cutting out a long narrow vertical strip in the middle of the chin and pushing the sides together thus preserving squareness or is it just better to burr down tubercles of chin on outer edges?  I do NOT want a pointy chin nor an oval chin.  Slight square is better just like it is, but narrower. Don’t know how narrowing would change smile lines as they arise from chin though.  Nor am I clear of how the jawbone to chin transition would change in a burring.  May be difficult to preserve some squareness.  Don’t want too small a chin for my size. I also fear that a subsequent face lift will feature a prominent bony masculine chin.  

2.  I do NOT want my chin profile to be changed.  I think it is fine as is.  Would burring down of sides affect this?

3.  Also want the bottom of the chin to be evened out.  One side is longer than the other.  Hopefully the asymmetry in the rest of my face (the right side is fuller in the cheeks) won’t be accentuated by any chin narrowing.   

4.  Will intra-oral approach allow you to visualize the submental nerve adequately?  Will it increase chance of infection?

5.  Percent likelihood of numbness of chin?  Tongue?  Typical resolution time? Ever seen permanent numbness?

6.  What is most catastrophic thing that could go wrong with a chin reduction? Lower face paralysis or worsening of my already incompetent lower lip?

A: In answer to our questions:

1) It is better to simply burr down the side of the chin for such a small amount of chin narrowing. Technically I actually use a reciprocating saw to remove the bone. That stills keeps it square in the front view, just narrower by the amount removed. I don’t think this would have any great impact on the smile lines nor change the jawline-chin transition…it is just being made slightly smaller/narrower in the frontal view. Also, a facelift does not really pull and shift tissues in the chin area so I don’t think that it will accentuate or create more of a square chin appearance.

2) Taking down the sides of the chin will not affect its horizontal projection. (profile) The most projecting part of the chin bone is not being affected.

3) The longer vertical side of the chin can be reduced as well. The computer imaging done previously should show you what the impact the chin surgery has on the look of the rest of your face.

4) The intraoral approach will allow the mental nerves to be seen completely. Intraoral surgery does nto increase the risk of infection unless an implant is being placed. There is nothing wrong with going from beow the chin through a skin incision, it is just that it is not necessary. (no advantages in doing so)

5) There will always be some temporary numbness of the chin because the mental nerves have been exposed. I have not seen permanent numbness from an isolated chin reduction/burring procedure. No risk of tongue numbness, the tongue is innervated from the lingual on the floor of the mouth which is a long way away.

6) There are no catastrophic events that can happen from this procedure. It is just an issue of aesthetics, how close do we come to the desired aesthetic goal. Lower facial paralysis is an impossibility because the facial nerve the moves the face is back near the ear. If your lower lip is incompetent to some degree I will resposition the mentalis muscle and chin soft tissues to try and improve that problem at the same time.

Dr. Barry Eppley

Indianapolis, Indiana