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CHIN
WHAT IS NORMAL?
1. The chin should extend almost four finger widths below the lower lip.
2. From the side view, the chin should extend out to the lower lip and reach a line drawn through the forehead, base of nose, and mouth.
3. A strong jaw line.
COMMENT: Again, the three dimensional character of the chin is difficult to describe. The male chin tends to be boxier than the female, which tends to be more slender.
SELF-EVALUATION:
- A profile photo is very helpful. Does the chin line up with the lower lip?
Is it too long or short?
- Is the chin too blunt or is the definition adequate?
- Do you have an overbite? Do you have a bad occlusion?
HOW MUCH CAN BE IMPROVED?
- Patients with weak chins may have poor development of the entire jaw bone. If they have a bite problem that they also wish corrected, they may benefit from a large operation in which the jaw bone is divided and slid forward.
- Patients with only a cosmetic concern, may be easily treated by a chin implant.
- Chin implants come in all shapes and sizes BUT they must rest on the bone. Chin enhancement is only possible where there is bone underneath! A chin implant will not push out the lower lip. Feel the gutter behind your lower lip. That's where the implant starts and even there it is thinnest.
- Extended implants are available that can enhance the jaw line, somewhat. They do not replace a facelift.
THE OPTIONS: CHIN
The chin needs to be in harmony with the face and once again the question tends to be too much or too little. Leonard da Vinci divided the face up into thirds: one third the forehead, one third the mid-face and one third the lower face, essentially comprised of the chin.
IMPLANT VERSUS BREAKING THE JAW
There are two main categories of surgeries that are done for the chin, depending on whether the person has a bite problem or not. If it is simply a cosmetic problem, a chin implant or reduction can work adequately. If someone is having a problem with their bite, a malocclusion of the teeth (TMJ syndrome) may be present, and these need active treatment as well. In the process of repairing the dental alignment, the chin will be rotated into the proper position as well. This is the preferred procedure under those circumstances.
If these problems are occurring but are not significant at this time in a patient's life, then a chin implant may be placed and even removed at a later date when other procedures are done.
INSIDE VERSUS OUTSIDE INCISION
The implant can be introduced either from inside the mouth or from outside the mouth. I generally place implants through the mouth even though there is a slightly higher risk of infection. For the larger implants, particularly if they add more bulk to the side of the jaw, they must be placed through a skin incision underneath the chin or else the nerves that bring sensation to the chin area can be damaged.
LARGE VERSUS SMALL IMPLANTS
Once again, when it comes to implants, patients are encouraged to accept a small or medium size implant. This is not just because they are easier to place, but also because natural harmony is ruined if one area of the face becomes too large.
Again all of these chin implants are made of solid plastic and sit on the bone of the jaw. They come in a large variety of sizes and shapes.
If you desire a large implant, the scar underneath the chin is usually placed directly in the crease and heals favorably.
WHAT CAN BE ACCOMPLISHED WITH A CHIN IMPLANT?
Patients sometimes are confused about what a chin implant can accomplish, in terms of contouring the area around the chin and lip. One thing I constantly have to remind patients is that all of these implants need to sit on a base of bone. Therefore, the chin implant needs to sit on a ridge of bone at the edge of the chin, which tends to prescribe the direction of the implant and the amount of extension that can be expected.
For instance, in the lower lip area, the crease cannot be fixed by a chin implant nor can a fullness around the lips be achieved by a chin implant. On the other hand, there are "jowl" or "extended" implants with long ends that can fill in the spaces along the jaw line. Most of these implants only involve modest improvements, keep in mind, so even though the implant may extend into the areas around the jaw, they are not adding a large amount of volume to the region. Once again when looking at the pictures in a doctor's office, find out how long after the surgery the follow up surgery picture was taken. Some of the fullness and contour changes may just be the result of swelling which can be present even several months after the surgery.
CHIN COMPLICATIONS
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IMPLANT INFECTION
Uncommon, even if the implant is placed through the mouth. If it happens, the implant must be removed and replaced at some later date.
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IMPLANT DISPLACEMENT- Since the implant is placed in a soft tissue pocket and cannot be attached to the bone, it is frequently displaced a small amount. The patient may notice this but often the average observer would not. The surgeon may try to adjust it but there is a good chance it may not end up straight. Sometimes, the underlying chin itself is not straight either. Again, perfect is the enemy of good and so these are often left alone.
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