Hi, I have performed many facial shaping procedures, including Chin Augmentation with dermal fillers or silastic chin implants, for over 30 years. 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 pre-jowl type implants offer very little forward chin projection (this is required to correct a weak chin) and have wings that are quite thick (tends to widen and broaden the chin and nearby jaw line which masculinizes a female 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. 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. Non smiling resting photos of your face from the front and side would help in the evaluation. 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. 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. 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. In my experience, "jowls" are best treated with some form of a facelifts as described below. Masculinizing the chin and jaw with a pre-sulcus chin implant that won't correct a weak chin seems counterintuitive. I have performed many SMAS facelifts for over 30 years and have performed many minimally, invasive SMAS facelifts. If you have "jowls” these are sagging facial tissues and the main indication for some form of a SMAS facelift. The underlying SMAS layer, of the face, must be dissected, lifted, trimmed and re-sutured (not merely folded or suspended with threads or sutures that will not last). The excess skin is then removed and the facelift incisions closed. My most popular SMAS facelift is the minimally invasive, short incision SMAS facelift that has all the benefits of more invasive facelifts (traditional, mid-face, deep plane, cheek lift and subperiosteal facelifts) but with these added benefits: very small incisions and no incisions extend or are placed within the hair. minimal tissue dissection = less bruising and swelling = rapid recovery ( several days instead of weeks or months with the more invasive type facelifts mentioned) can be performed in 90 minutes or less, with or without general anesthesia proper SMAS Imbrication technique no incisions within the hair = no hair loss excess fat can be removed from the face and neck excess skin removed from the face and neck cheeks, chin and jaw line can be augmented with dermal fillers (I prefer Restylane Lyft) or facial implants most patients fly back home to parts all over the world in as little as 3 days post-op I combine facial shaping with every facelift procedure. When jowls are present, these should be done in concert and not alone or separately in order to create a naturally, more attractive face. Following my beauty principles, women look the most feminine, youthful and attractive with heart shaped faces. Heart shaped faces have cheeks that are full and round in the front. When the cheeks are flat or concave in the front, cheek augmentation with a dermal filler or using cheek implants for a permanent enhancement can create full, round cheeks that will feminize the entire face. Hope this helps.