I had Rhinoplasty last year, but the doctor recommended that I get a chin implant as well. I opted not to. I do love the outcome of my new nose, but I am now considering chin augmentation to help balance out my face. I have seen the profile computer image, but I am having a hard time understanding how I will look from the front, and when I smile and my facial expressions. Also, I am trying to decide between the implant or sliding genioplasty (since I don't love the idea of an implant being in my body. Any thoughts?
Cosmetic Chin Surgery - What Are my Options?
Doctor Answers 21
Chin Augmentation: Implant vs. Sliding Genioplasty
Chin implants and sliding genioplasty are both excellent options for changing the shape of the chin. There are a few things I would like to share about my own personal experience with chin implants. First of all, one of the advantages is that the surgery can be easily and comfortably done under local anesthesia (we typically give light sedation for comfort). Another key thing to keep in mind is that the implant can be removed or changed just as easily if we don't like the change in size. Also, a multitude of different shapes and sizes of implants can be used, depending on the degree of projection needed and the need for a vertical component to the implant. The risk of infection is extremely low and the implant can be placed with a very small, inconspicuous incision under the chin or with an incision inside the mouth, behind the lower lip. It's a surgery for which I find computer imaging quite helpful. In general there is not much of a change on the front view so the profile and 3/4 views are the more important to consider.
Sliding genioplasty is a more involved approach in which the mandible (jawbone) is cut and screws are placed to secure the bone in a new position. It is a procedure with a long track record of safety and effectiveness, however, due to the more invasive nature of the procedure, I would typically recommend a chin implant to the vast majority of patients seeking augmentation.
Umang Mehta, MD
Chin implant or sliding genioplasty
Chin augmentation can be done any of a number of ways. The timing should not be an issue for you--it can be done after or before a rhinoplasty. As you mention, it is often done at the time of rhinoplasty.
The advantages of an implant are that it probably is a lower risk operation, and can be done under local anesthesia. The implant augmentation is somewhat predictable. The downside is that it does not reduce the vertical chin height (as is desirable in some cases). It can increase chin height (the distance from the lower lip border to the bottom of the chin) if placed lower on the mandible (jawbone). Also, any implant can carry risks of migration or infection. The ePTFE-coated silastic implants probably have a lower risk of this, though no study has been done to show it specifically.
The sliding genioplasty is a technically more difficult procedure, probably requiring general anesthesia. There is an implant used--small titanium screws/plates. It has the advantage of no 'large' implants. Also, the vertical height of the chin can be reduced if necessary. The swelling takes much longer to subside in most cases.
Both procedures carry risks of injury to the nerve(s) that give sensation to the chin/lower lip.
In general, most patients opt for the chin implant, as the benefits outweigh the risks, especially in comparison to sliding genioplasty. In some situations, the sliding genioplasty may be preferable.
Hope this helps.
Chin Augmentation Options
Each individual patient requires a thorough preoperative assessment to determine the best treatment plan. This assessment includes evaluation of the soft tissue and bony relationship of the lip and chin in the sagittal (profile) plane.
Advantages to an implant. It has a good track record for safety. Although infection and malposition are possible, complication rates have been reported to be as low 1-3%.
Advantages to Osseous Genioplasty. It can be used for more complicated facial skeletal deformities. It can also allow for better control over the vertical height of the chin, if that is needed. Its disadvantage is that it is more involved and requires bone to be cut. This results in more swelling and usually more pain.
Although you can see changes in the frontal view, these changes are usually more subtle when compared to the profile view. One can appreciate these changes better using 3D imaging versus conventional photography. A good way to test how you would look, other than using computer simulation, would be to try using fillers. Fillers will augment the chin and provide you with a temporary result.
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Combination rhinoplasty and chin implant
Chin augmentation is an excellent procedure...
Chin augmentation is an excellent way to balance your facial features. It is an easy procedure that can be done under local anesthesia, while a sliding genioplasty is more involved and slightly more risky. The chin implant should only minimally change your front view unless you are trying to lengthen the vertical height of the chin, which the genioplasty can do a little more effectively. Niether procedure should affect your facial motion. Most people simply need more projection and the implant is definitely my preferred procedure for that. It is normal to have concerns about implants, but infection is rare and they essentially become part of the body after they become encased in collagen. The implant is placed over your existing bone structure of your lower jaw to increase dimensions and will produce an excellent result. If you are still having concerns about the procedure, please speak with your surgeon, and he/she will help you resolve any questions.
Chin surgery considerations
There are several options for improving your chin projection. Temporary fillers would allow you to test the look out. Computer imaging would allow you and your surgeon to get an accurate idea of what result to plan for. The frontal view doesn't change much after a chin augmentation, especially when done conservatively. You may notice a little more fullness to the area on either side of the chin itself (prejowl area). Patients with an under-developed chin often have some underdevelopment here as well and can benefit from this fullness. Those that wouldn't benefit from this prejowl component can have the augmentation customized accordingly.
Either a chin implant or sliding genioplasty are permanent options. The sliding genioplasty involves making an incision on the inside of the mouth just above the chin. Then the bone is separated from the rest of the jawbone and advanced forward (the teeth are not advanced). The chin bone is secured in place with a small titanium plate. Not all surgeons have experience with sliding genioplasty in which case they would prefer an implant. A side benefit of advancing the chin bone itself is that it can help advance the tongue forward which may help lessen snoring.
Either method can provide excellent results. Sliding genioplasty can allow for more powerful 3-dimensional changes such as angling the end of the chin downward (to lengthen the lower third of the face) if needed. Most patients don't require this, however, so an implant can also work well in most situations.
Chin augmentation often complements rhinoplasty. When both procedures are necessary, performing one without the other may result in facial disharmony. The options for chin augmentation include (1) sliding osseous genioplasty in which the bony chin is osteotomized (cut) and advanced/repositioned, and (2) the use of a chin implant.
Plastic surgeons trained as craniofacial surgeons are most comfortable performing the sliding genioplasty as it is a relatively simple procedure with a permanent result once the bone heals. The titanium plate used to secure the bony segments in almost never a problem and rarely requires removal. However, problematic chin implants, which are much more prone to infection and malposition, can result in a "witch's chin deformity" should they need to be removed as the soft tissue envelope has been expanded by the implant and now droops. Such a deformity is difficult to correct and must be kept in mind every time an implant is used. Furthermore, such implants often result in bony erosion of the chin itself due to the constant pressure on the bone; this diminishes the effect of the augmentation.
Chin augmentation is an overdone operation.
I think if you like the result of the video imaging you will like the operation. The front view does not change much in vido imaging as well as real life. I see too many patients, particularly women, who have had a chin implant which masculinizes the face. I think video imaging is the best way to inform the patient. The procedure, itself, is simple.
Considering a chin implant? Try fillers as a non-surgical option.
Chin augmentation can be a powerful procedure that really improves your look. Having a strong chin is like having nice breasts, almost anyone can benefit from having a little boost. And in some of us, we really need a little more chin.
The computer imaging program is a great way to see the possible effects on profile, but you are correct, it's not so great at predicting the changes on frontal view.
A nice solution is to try fillers. The fillers are placed in under 10 minutes. Some will like the procedure so much they stay with fillers every 6 months, while others, may now feel comfortable having a surgical procedure performed.
Click on the link below to review before and after photos of a patient of mine who has received a Non-Surgical Chin Augmentation.
Chin Implant Vs Sliding Genioplasty
Most commonly, a chin implant is the preferred treatment of choice in treating the underprojected chin. A chin implant is well tolerated, biologically compatible implant which can safely and effectively balance out a chin. While there are specific instances when a sliding genioplasty is clearly the better modality (long underprojected chins), most of the time the invasiveness of the procedure is not justified. Sliding genioplasty breaks a segment of bone from your chin and suspends it with metal plates (a foreign body).
These answers are for educational purposes and should not be relied upon as a substitute for medical advice you may receive from your physician. If you have a medical emergency, please call 911. These answers do not constitute or initiate a patient/doctor relationship.