Why Modify Your Chin Appearance

Not all patients are blessed with a perfect chin. Some are too small, some are highly asymmetrical, some are too short, some are too long, and some are too wide! When we think about beauty ideals, we envision balance and proportion. Facial features that are not balanced or proportionate draw the eye and can often be a source of discomfort or insecurity. Facial contour modification can be achieved either by moving the facial bones, i.e., by maxillofacial surgery, or by adding facial implants. Which is the best option for you?

 

Genioplasty

What is Genioplasty?

Literally, the term genioplasty means "to change the shape of the chin." It is a more invasive procedure compared to inserting a chin implant. Genioplasty can be performed under local anesthesia with intravenous sedation, although most of the time, general anesthesia is used. The incision is made inside the lower lip down to the bone. The chin is then exposed, and the chin nerves on either side of the jaw bone are identified. The chin bone is then cut. The muscles that are attached to the detached chin are maintained to ensure blood supply. This segment is then repositioned in a more advanced position and fixed using a titanium plate and screws. The incision is then closed with sutures, and a compressive dressing is applied for two days.

 

Advantages of Genioplasty

One advantage of genioplasty is that the simulation of facial changes can be performed pre-operatively using computer software. The degree and direction of movement of the chin segment can be predicted to help the patient visualize the likely outcome. Another advantage is that the result is stable as the bone heals very well and after remodeling, there is usually almost no visible sign of the operation, except for the fixation plate, which can be removed if the patient wishes. Furthermore, the shape of the chin can be modified in all directions. It can be reduced vertically and advanced horizontally, or vice-versa. It can also be reduced in width.

 

Disadvantages of Genioplasty

However, the main disadvantage of genioplasty is that it is quite invasive and can result in significant bleeding. There is also a higher incidence of numbness of the lower lip and teeth due to the proximity of the cut bone to the chin nerves, which supplied sensation to the lip. Post-operatively, swelling can be significantly more than that from a chin implant.

 

Chin Implant

What is a Chin Implant?

The insertion of a chin implant is identical to genioplasty up to the point where the gum is retracted from the bone. Then, instead of cutting the chin bone, the implant is fitted onto the surface of the chin bone and fixed with titanium screws. The incision is sutured in the same way, and a compressive dressing is applied.

 

What Types of Implants Are Available?

Chin implants can be made of a porous material such as polyethylene, which integrates with the bone, or silicone, which remains separate from the bone. Chin implants that integrate into the bone are permanent implants as they are extremely difficult to remove. This is considered an advantage by some surgeons as it becomes like a part of the native bone. However, in the event of complications such as infection, implant removal is difficult. Silicone implants, on the other hand, do not integrate with the bone and can be removed easily if the patient wishes. However, as it only rests on the surface of the bone, it tends to sink into the bone as long-term pressure exerted on the chin surface causes bone resorption. As the implant sinks, it loses its projection, and the chin may again appear deficient. The implant can be removed easily and a new, larger implant can be placed.

 

How Does a Patient Decide on the Approach to Take?

Chin implants can only be used for augmentation, i.e., increasing the volume of the chin. If the chin needs to be reduced, the chin implant has no role to play. As such, it is very much dependent on the treatment goal. Even in cases of chin augmentation, what may be required is an augmentation in the horizontal direction which the implant can achieve, and a reduction in width and/or height, which the implant cannot do. In cases where either approach is feasible, age may play a role in preference. Younger patients generally opt for genioplasty as it does not involve leaving a foreign body in the body for the rest of their lives. Older patients may opt for a chin implant due to the less invasive nature of the operation and shorter downtime.

 

Is Surgeon Choice Important for Genioplasty?

As with all operations, the surgeon’s experience plays an important role in the outcome. Maxillofacial surgeons are very familiar with bone surgery, and consequently, genioplasty is generally the preferred choice. Plastic surgeons are generally more comfortable with soft tissue surgery and may achieve better outcomes with implants. Ultimately, the patient needs to understand what the different approaches entail and choose a surgeon they are comfortable with. Chin surgery is mainly cosmetic in nature, except in the case of sleep apnea surgery where chin advancement is medically indicated. Due to the subjectivity of aesthetics, thorough discussion between patient and surgeon is of utmost importance to achieve the aesthetic ideal the patient has in mind.

 

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