How to address recessed chin, excess fat in neck and jawline, and weird chin muscles when smiling? (Photos)

Question

I hate my recessed chin and lack of a jawline, but it looks even worse when I smile. Would a chin implant fix both the recessed chin and the weird way the muscles move downwards? All of this is expensive so I’m prioritizing the chin over the neck/jaw fat, although I was thinking about just getting the fat dealt with before I go in for a surgery to change my facial structure.

Larry S. Nichter, MD, MS, FACS · Answer

Without an exam your question cannot 
be answered.  You will need to see an Oral/Maxillofacial surgeon to see 
if othognathic surgery, genioplasty or using an implant is best for your
 specific case. It should be noted that patients with severely weak jaws
 or abnormally functioning jaws may be better treated with other facial 
surgery (orthognathic surgery), although a chin augmentation may be an 
option at a later time. These patients should seek the advice of a 
plastic surgeon to determine which course is right for them. Here is 
some information to help you make this decision: Candidates for Chin 
Augmentation - Patients whose chin profiles are weak but have normally 
functioning jaws are candidates for Chin Augmentation. Many of these 
candidates have used injectable fillers in the past to strengthen the 
protrusion of their chins, but are looking for a permanent solution. If 
you are one of these patients, then you are a likely candidate for chin 
augmentation
#weakchin #chinimplant

Michael P. Morrissette, DDS, FACS · Answer

You are a candidate for genioplasty or chin implant and since your degree of recession is mild I would recommend a chin implant. One advantage of a chin implant is that liposuction of the jawline can be performed through the same incision simultaneously. The muscle changes that you see when you smile can be made smooth with Botox. Good luck

Jonathan Kulbersh, MD · Answer

You have a few options to improve your chin and jawline. If you’re not sure you’re ready for surgery, but still want to improve and strengthen your chin and jaw, I’d suggest augmenting your chin with Sculptra and/or Voluma. If you like your new look, you can make it permanent with a chin implant. Liposuction can slim the jawline and neck. I hope that helps.

William Portuese, MD · Answer

The photographs demonstrate small amount of fatty deposits in the neck and a recessive chin profile. Placement of chin implant can augment the chin forward. The implant is simply are placed underneath the muscles of the chin directly over the bone to augment the deficient mandible itself. There is no way to improve the muscles when smiling. Chin implants offer a three-dimensional augmentation to the chin which includes forward projection, lateral  width, and a small amount of vertical height. Liposuction accomplishes  fatty deposit removal in the neck. Both procedures can be performed together and are complementary to each other. For many examples of both procedures and our current price list, please see the link and the video below

Francis R. Palmer, III, MD (retired) · Answer

Hi, I have performed many facial shaping procedures, including Chin Augmentation with dermal fillers or silastic chin implants, for over 30 years.  Looking at your photos, your chin is very weak, there is a very "slight" amount of excess fat under the chin and evidence of chin "ptosis" when you smile.  Ptosis means that the chin muscle (mentalis muscle) points downward.  This is made worse by the lack of bony volume under the chin muscle. 
 When the chin is weak, this creates an imbalance making the nose appear larger, the mid face top heavy, the lower face looks short, de-emphasizes the lips and allows early formation of a "double chin".  
 Proper placement of a silastic chin implant adds forward projection to the chin thereby creating harmony and balance to the lower face.  Using the same incision, liposuction can be performed to reduce the fat and further shape the neck.  Excess skin, from below the chin, can also be removed through the same incision.  
 I have found that placement of a silastic chin implant, through a small curved incision under the chin (also allows excess skin removal) to be very safe, quick, highly effective and far less invasive than a sliding genioplasty (requires extensive tissue dissection, bone cuts and placement of metal screws and plates to secure the cut segments of bone).  I perform chin implant surgery in 30 minutes or less, often using a local anesthetic alone.  In my opinion, you are a good candidate for chin implant surgery.  
 In contrast, since there's only a very slight amount of fat under the chin....removal of that slight amount of fat by liposuction or "any" method by itself will only provide minimal results because it will "not" correct the weak chin.  Correction of the weak chin will require adding forward facing volume to the chin...which will also help reduce the chin muscle ptosis.
 When consulting with surgeons perhaps ask not only is your chin weak but do they have experience performing chin augmentation?  The attached video shows how I determine whether the chin is weak.  The second part of what that surgeon said is absolutely correct.  The selection of the proper size, shape and thickness as well as the proper placement of the silastic chin implant are all "key" elements in creating a naturally looking chin.  If too large of an implant is used in a woman, the chin can look relatively masculine.  That's where experience, performing chin implant surgery, comes into play.
 In my opinion and experience there is no need to secure a silastic chin implants with sutures and screws when the following conditions are met:
 * Select a silastic chin implant ( I prefer the EAC) that doesn't have too much projection (thickness) as this becomes a problem stabilizing the implant under the periosteum when the implant is too thick.
 * Place the implant through a small curved incision under the chin which allows direct access to the periosteum (under the mentalis muscle) while preserving the muscle attachments.  This prevents upward migration of the implant which can occur when the intra-oral approach is used that severs the muscle attachments.
 * While the center or body of the chin implant should be placed at a perpendicular angle the chin bone in order to provide the proper forward projection to the chin, the "wings" of the implant should be at a lower level and follow the inferior (bottom) edge of the jaw line on either side of the chin.  When properly dissected and placed, this will be below the mental nerve foramen and be just wide enough of a dissection to accommodate the tapering wing.  There isn't enough room in this technique to allow the wings to migrate upward and contact the mental nerve.  In contrast if the dissection, along the sides of the chin (jaw line) are performed too high...this will place the mental nerve in danger and if the side dissection is too wide, the wings will have a space within which to migrate upward.
 * We have all of our chin implant patients avoid touching and feeling their chin implant for 1 month post op.  We also ask that they sleep on a U-shaped airline pillow for the same time.
  Our experience when following the technique described above is that the silastic chin implant does not need to be secured with sutures or screws and does not move.  I have placed silastic chin implants in military, SWAT, LE, professional fighters, as well as actors and many regular people who are active.  In addition, I have had the opportunity on numerous occasions to replace silastic chin implants (placed by others) that had been screwed into the bone.  During the replacement it was evident that the metal screws pushed right through the soft silastic implant as it was tightened down on the hard chin bone.  Which makes perfect sense.  So in the long run, these fixation methods alone are no guarantee that the implant won't move.  Proper placement, proper implant pocket creation and meticulous closure of all the tissues layers is what is required in my humble opinion.
I prefer placement of a  silastic chin implant through a small, curved incision under the chin (submental) instead of through the mouth for the following reasons:
*The submental approach is sterile while the intra-oral approach is not.
*The submental approach requires limited dissection as it is much closer to where the chin implant needs to be placed along the center (front) and lower most sections of the chin on each side (where the wings are placed).  The intra-oral approach by contrast requires dissection all the way down the entire section of the chin in order to reach the same areas for chin implant placement.  This leads to several issues in my humble opinion.  The attachment of the chin muscle to the bone must be cut during the tissue dissection, the sensory nerves (mental) and motor nerves (marginal mandibular nerve) that move the muscles of the lips and mouth) are all in much greater jeopardy of injury because of the added dissection required.
*The added areas of dissection with the intra oral approach allows upward migration of the implant as well as an increased risk of nerve injury.   There are numerous shapes and sizes of silastic chin implants, some of which are rather old shapes that do not yield the desired "natural" aesthetic results.  The Curvilinear shape is an example that is similar to the old "button" implants (had no wings or lateral tapering elements of the newer EAC design) that created a "pharaoh" shaped chin.  The EAC or extended anatomical chin implant style offers, in my experience and humble opinion, the most natural, aesthetic result when augmenting the chin.  The EAC in a size small is the most common implants that I use in women ( size medium in men ).  Proper placement and the appropriate approach (placing the incision under the chin and not inside the mouth) are also key to obtaining the best aesthetic result.
Looking at your face it has equal vertical segments = upper, mid and lower face.  In my experience this is typically the case.  When the chin is weak, this causes the lower vertical segment of the face to appear weak creating the "illusion" of a shortened vertical dimension.  Take a look at the attached video "before" and "after" placement of silastic chin implants illustrating that point.
 Which is better, chin implant or sliding genioplasty.  We place silastic chin implants through a small, curved incision under the chin using local anesthetic in 30 minutes or less.  This is "far" less invasive than a sliding genioplasty that requires cuts in the bone with plates or screws.  For that reason and because the aesthetic results are so good with a properly placed silastic chin implant of the correct shape and size...in my humble opinion there's no comparison.  The chin implant is quicker, easier, with far less surgery and healing, less unwanted side effects with results that are highly effective and reliable.
 Hope this helps.

Ronald V. DeMars, MD (Retired) · Answer

I think the chin augmentation would do a lot to bring aesthetic balance to your lower face. It probably would not create much change in the smile, but if not then botox could help. The chin augment often makes the area under the chin look thinner but a little very conservative liposuction done at the time of the chin augment should help contour that area. It is less expensive in the long run to do procedures at the same time.

Gerald Wittenberg, MSc, DMD (retired) · Answer

You have a small lower jaw; which means the distance under the chin towards the neck is short, which makes it appear as if you have a 'double chin' which is not valid. If you do a genioplasty and extend that distance, you will 'appear' to have lost that fullness. As well, you have a steeper growth pattern to the lower jaw so that an implant is not a good choice. Further, consider the 'sides of the chin width' when you have a procedure to ensure the 'look' is good frontally as well.

How to address recessed chin, excess fat in neck and jawline, and weird chin muscles when smiling? (Photos)

Answers (7)

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