Would a chin/jaw implant fix my ptosis? (Photos)

Question

I have always suffered from a fatty chin pad. It pulls down when I smile which causes me anxiety when I smile. I have tried Botox and filler but have been unsatisfied with results (filler has made my chin even more fleshy and the Botox affected my lower lip movement!) the rest of my jawline is bony and slim. Would a chin or jaw implant help to correct this and give me a more sculpted and defined jawline/chin? I would prefer a permanent surgical option rather than a non-surgical option.

Michael P. Morrissette, DDS, FACS · Answer

It appears that you have dynamic ptosis which usually responds well to Botox. Well placed botox should not affect your lower lip movement. definitely not a candidate for fillers. I would recommend a reduction genioplasty (height and projection) through a submental incision with a soft tissue "chin tuck" in order to decrease the size of the soft tissue chin pad. I usually perform this procedure with a reduction a bur to minimize the effect on the mentalis muscle.

Jonathan Kulbersh, MD · Answer

Thank you for your question and for providing photos. Since your chin doesn’t appear to be recessed, a chin implant is unlikely to provide the improvement you’re looking for. When properly administered, Botox is a reliable solution for treating chin ptosis and should affect lip movement. Since you’re interested in an alternative, long-term solution, you may want to consider a chin surgery known as genioplasty to address the placement of the jawbone or excise tissue in this area. Determining the best approach depends on the underlying cause of the chin ptosis you’re referring to. I recommend scheduling an in-person consultation with an experienced, board-certified facial plastic or maxillofacial surgeon. They will be able to conduct a thorough physical examination and determine the best treatment to help you achieve your aesthetic goals.

Mats Hagstrom, MD (license on probation) · Answer

Facial assessments are always done without facial expression. I recognize that the area of concern happens while you’re smiling but that is not how we make an assessment.
It’s fine to include pictures including when muscles or facial expression are contracted but the baseline assessment pictures should always be without facial expression with a neutral look. likewise, lateral pictures should be taken using the timer on your camera or having someone else take the picture. You should not be turning your neck instead look forward and have the photographer take the picture at a right angle.
Think of how mug shots are taken.
Straightforward and straight profiles showing both sides without facial expression.
Each individual persons facial appearance is primarily based on bone structure. Your mandible is large compared to your maxilla so augmenting your chin it’s probably not the way to go. From the limited pictures it appears that your chin has excessive vertical height.
I suggest having a few in person consultations with oral surgeons or plastic surgeons who have done craniofacial fellowship training.
Facial assessments are by their own hair nature complex and require being able to see relationships between areas of the face and how they relate to each other.
You may very well be a good candidate for surgical intervention but getting the diagnosis made accurately and getting the right procedure is paramount and getting a quality outcome.
To get a good understanding of facial dynamics you need a comprehensive facial assessment most likely including x-rays.
Appropriate surgical procedures may or may not be to your liking once you have a clear understanding of what the true problem is.
Simplistic solutions to complex problems typically leads to unsatisfactory results like your attempts of treating this with Botox and fillers.
I’m afraid a chin implant is also a simplistic way of seeing the problem or rather the solution. 
Working with surgeons who take on the most complex facial reconstructive surgery‘s will put you in the hands of someone who has the best understanding and will give you the most comprehensive assessment and treatment options.
You can then do what you want with the information. it’s up to you but at least you’ll have a good understanding of why your face looks the way you do it does and what the different treatment options would entail.
I think if you consult with run-of-the-mill plastic surgeons who do mostly soft tissue manipulation you’ll get a simplistic approach or very ill-defined explanations.
Best,
Mats Hagstrom MD

Would a chin/jaw implant fix my ptosis? (Photos)

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