Protruding chin when I smile. Am I a good candidate for chin implant or would botox give me a more balanced look? (photos)

Question

I feel as though my chin protrudes when I smile and as I’ve gotten older I’ve noticed it more and more. Would I be a good candidate for a chin implant or would botox fix it? I initially wanted a rhinoplasty but I now (after some googling) think it’s not my nose that’s the issue, my bottom half of the face is imbalanced?!

Alejandro Nogueira, MD · Answer

Firstly the chin: it seems a tad strong for a feminine woman, I'd not say it is a bad one, maybe we are being over critical with it, you can just do the nose and see how you feel, because the chin itself is not a problem for your beauty. However, if you decide to go for the chin, never ever chin implants, they are very very problematic and lead, sooner or later, to their removal. You'd be a case for a slight reduction genioplasty, but never shaving, at all! only with well planned reductive osteotomies allowing reassembling the natural dome of the chin and preserving the mentalis muscle attachments.

Nose: I recommend you get it done, would be a great plus for you, however you have to be aware the risks and complexities of your case, should you be operated by a surgeon unaware or unexperienced on the challenges your nose presents, which otherwise are routinary in the hands of a talented and experienced structure rhinoplasty surgeon. Bear on me, this is your technical diagnosis and technical indication:
-verticalized or malpositioned lateral cruras (MLC) aka parenthesis tip deformity: this si essential to be diagnosed and treated, without its correct treatment you'd get a mayor deformity, you are NOT a case for simple reductive maneuvers. Essential this problem happens when the lateral leg (lateral crura) of the horseshoe shaped alar cartilages is too vertical, leading to series of chain events described below
-boxy tip: the MLC always create a typical square shape of the tip, a quich research of images may tell you this
-overly high tip: also derived from severe degrees of MLC, like in your case; you do not have a piggy nose or an upturned tip, that's a different condition, just your tip is located overlapping the caudal dorsum, this differentiation is essential technical regarding how to approach to its treatment
-retracted nostrils or overly high lateral alar rim: the MLC makes the cartilages ectopic (out of the place they should be), hence they fail to push down the nostrils and the alar rim, leading to their elevation which increases the size of the nostrils (fake increase) and the annoying visibility of the vibrissae
-nasa valve collapse: the MLC make the cartilages supporting the functional breathing of the nasal valve fail to carry out their function, therefore the easy collapse with air intake at breathing, normal or sports
-pinched nose/tip: the aesthetic side of a nasal valve collaps is the typical look of a nose like having a peg pinching the sides of the tip, again because the MLC do not play their functional and aesthetic role
-infratip lobule protrusion: that's not actual, but a indirect effect of the overly high tip and alar rims, derived from the MLC
-"hanging columella": this condition ONLY happens in very old people, it is a legend running on the Internet that less than 70 yr old people have hanging columella, all these cases are only patients with overly high alar rims or nostril/alar rim retraction, derived from MLC too

This kind of compex tips and alae are rarely treated properly, actually they are often ignored by surgeons who, even performing a irreproachable basic rhinoplasty, get in surprise and shock when they see the calamitous, if not catastrophic, results they obtain even "acting correctly" but insufficiently; it is a MUST applying invasive and complex modern structure rhinoplasty grafting and maneuvers, keep this concept clear: no way you should accept a "mini procedure", a conservative technique, a minimally invassive rhino, etc, run as fast as your legs allow, you are born with a very difficult type of nose, well known and perfectly described in textbooks, it is not your problem, fault or responsibility but the surgeon's.

The management of these noses cover these essential principles:
-open approach
-graft harvesting, either septal (most of the times) or ear concha, no need for rib at all
-repositioning maneuvers of the MLC
-grafting at alar rim (batten, tutor, articulated, etc several choices here)
-tip grafting
-columellar grafting (strut, shield, etc)
-eventually a septal extension graft

Adding a plus of exigency, you have thin skin, so... any small error or defect is going to be noticed by you, therefore the surgeon has to be of excellency.

Finally, your brige needs work too, lowering it a tiny bit and probably correcting the pinched middle vault with spacer grafting.

Do research well.

Jonathan Kulbersh, MD · Answer

Thank you for your question and photos. Chin implants are ideal for patients who would like to strengthen a weak or recessed chin, so this approach is unlikely to alleviate the protrusion you’re referring to. 
Botox injections are regularly used to slenderize the appearance of a wide jawline and may help deproject your chin to create the desired effect. I recommend scheduling an in-person consultation with an experienced, board-certified facial plastic surgeon or injector. They will be able to discuss your aesthetic goals with you and suggest the best treatment option.

J. Jason Wendel, MD, FACS · Answer

Thank you for your question regarding a chin implant and for including photos. The side profile is especially helpful!

From the photos that you shared, it appears that you would make a great candidate for a chin implant. The implant would give you more facial balance.

To be sure, see two or more experienced, licensed and board-certified providers in your area for a complete evaluation to make sure you are a good candidate and that it is safe for you to have treatment.

I hope this helps.

Mats Hagstrom, MD (license on probation) · Answer

We do not make facial assessments with patients having facial expressions.
Assessment pictures need to be expression less without showing strong emotions.
If you create a treatment based on how you look when you’re smiling then what is that going to do when you’re not smiling.
Look at plastic surgeons and how they take before and after pictures and try to emulate those.
Sideways pictures should be with you looking straight forward with someone else taking the picture or using the timer on your camera.
Don’t use mirrors or try to hold your own phone.
We can’t really make a good assessment without quality pictures. Consider consulting with local oral surgeons or plastic surgeons. Both specialties contribute to surgical treatments of this part of the face. Oral surgeons tend to see things more from a skeletal perspective.
Patients should probably refrain from making their own assessment or deciding what is the correct procedure.
Best,
Mats Hagstrom, MD

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