Facelift pointy chin. How do surgeons avoid this?

How do so many women end up with the 'Witche's' chin look after facelifts? I have seen some outstanding natural results but also some where the person looks really bizarre afterwards in chin area - extremely pointy crafted and unnatural 45degree vertical slant angle between neck and chin. How do surgeons do this is it an aggressive necklift that causes it? I really don't want to have this when I get my op - how do surgeons avoid this?

Doctor Answers 13

Facial Plastic Surgeons Can Help Avoid “Witch's Chin”

Although having plastic surgery to the face does not create the phenomenon known as “witch's chin,” by not taking time to understand each patient's unique bone structure and musculature, some surgeons mistakenly accentuate disharmonies that are already present in the face. My training in facial aesthetics by some of the top plastic surgeons in the country means that I examine each patient's face thoroughly and develop a plan that works with their unique features and natural beauty. When it comes to facial plastic surgery, there is no “cookie-cutter” method. Decisions about where to lift and how much tension should be applied to each portion of the skin and muscle must come from thoroughly understanding that particular patient's anatomy. A witches chin can occur if the chin region is not properly undermined and a step off forms in the area.   I hope this helps

Sagging Skin Is to Blame

A "witch's chin" deformity is generally related to sagging skin, fat, and other tissue that descends with age and accumulates around the chin. Facelift surgery doesn't cause a witch's chin if it wasn't present to begin with, but it can make an existing one look worse if it isn't properly addressed during the procedure. A chin implant, which is usually placed through an incision in the lower lip, can help lessen the appearance of a lax chin and smooth the jawline. Other options exist, as well, such as chin liposuction. If you're considering facelift surgery, ask your surgeon about it — specifically, ask to see before-and-after photos of patients with a similar condition.

Witch's chin not related to a facelift

A facelift will not cause a witch's chin, but the improvement to the jawline can make a pre-existing witch's chin look worse. There are a variety of causes and treatments for a witch's chin. See a surgeon that specializes in aging face surgery.

Andrew Campbell, M.D.
Facial Plastic Specialist
Quintessa Aesthetic Centers

Andrew Campbell, MD
Milwaukee Facial Plastic Surgeon
4.7 out of 5 stars 26 reviews

Facelift

Thank you for your question. Witche's chin is a concern oftentimes voiced by patients. It occurs when there is laxity in chin and can be addressed with an implant procedure. Always consult with a board certified facial plastic surgeon.

Best wishes,

Ross A. Clevens, MD
Melbourne Facial Plastic Surgeon
4.7 out of 5 stars 97 reviews

Witch's chin

 A witch's chin can be accentuated by placing the incision in the chin crease. By placing the chin incision behind the crease, and releasing the chin crease, can minimize the appearance of a witch's chin.

Steven Wallach, MD
New York Plastic Surgeon
4.1 out of 5 stars 24 reviews

Witch's chin following Facelift

Hello.  Thank you for your question.  A Facelift procedure does not change the structure of the chin.  Chin ptosis (witch's chin) results from laxity of the soft tissues overlying an inadequately projected chin.  If someone has a witch's chin after a facelift, then they had a witch's chin prior to the facelift.  Tightening of the neck and jawline may just make it seem more apparent.  Placing a chin implant to improve the projection of the chin can provide improvement in this area.  This can be done at the same time as the Facelift or as an independent procedure.  I hope this information is helpful.  I would suggest that you seek a consultation with a board-certified facial plastic surgeon and allow them to assess your individual anatomy, concerns, and goals, in order to determine the best treatment plan for you.  Best of luck to you in achieving your aesthetic goals.

Michael Boggess, MD
Nashville Facial Plastic Surgeon
4.8 out of 5 stars 33 reviews

Witch's Chin after Facelift

A facelift will not cause a Witch's Chin. It did exist before the operation and can be accentuated by lifting the surrounding loose tissue at the time of facial rejuvenation. It can be treated with a chin implant or lifting the relaxed chin muscles during the facelift procedure.

Richard W. Fleming, MD
Beverly Hills Facial Plastic Surgeon
4.9 out of 5 stars 38 reviews

How do so many women end up with the 'Witche's' chin look after facelifts?

 Hi, I have performed and taught facelifts for many years. Chin ptosis, described as a sagging mentalis chin muscle that's oriented at a 45 degree angle wouldn't be caused by a facelift or Neck Lift. Chin ptosis would have already existed pre-facelift and perhaps was not diagnosed and treated. If the chin is weak, chin augmentation with a chin implant can allow upward rotation of the sagging chin muscle placing it in the proper forward projection and position. If the chin is not weak, the ptotic muscle can be pulled under the chin to obtain similar results using a curved incision under the chin. As I describe below, facelifts in and of themselves are designed to reduce sagging facial tissues, "not" shape the face. Additional techniques must be applied in order to make the face more feminine or masculine whichever is gender appropriate.

Hi, I have performed facelifts for over 30 years and have performed many minimally, invasive type facelifts. Following the beauty principles outlined in my book on face and body beauty, 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. Cheek augmentation with a dermal filler or using cheek implants for a permanent enhancement will create full, round cheeks that will feminize the entire face. Conversely, men look chiseled and handsome with angularity in the cheeks, chin and mandibular angles.

If the chin is weak, this creates an imbalance making the nose appear larger, the mid face top heavy and the lower face look short that de-emphasizes the lips and allows early formation of a double chin. Chin augmentation using a chin implant will add projection to the chin creating harmony and balance to the lower face. 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 and highly effective.

If you have "jowls” these are sagging facial tissues and an 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 facelift is the minimally invasive, short incision 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
  • minimal tissue dissection = less bruising and swelling = rapid recovery
  • can be performed in 90 minutes or less, with or without general anesthesia
  • no incisions within the hair = no hair loss
  • excess fat can be removed
  • excess skin removed
  • 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.

Hope this helps.

Francis R. Palmer, III, MD
Beverly Hills Facial Plastic Surgeon
4.6 out of 5 stars 24 reviews

Chin ptosis

milliemils9, chin ptosis or witches chin is a multifactorial problem that by definition has several causes and different fixes depending upon the cause. In general it can be fixed in a virgin patient and in a post op patient where this is an end result of the surgery typically that is due to a misjudgment by the surgeon in either approach or execution. To minimize your chances see an experienced surgeon that does "only faces" and has a lot of photos to review on their web site. Also review the video. Good luck!

M. Sean Freeman, MD
Charlotte Facial Plastic Surgeon
4.7 out of 5 stars 46 reviews

Face lift - why the witches chin afterwards?

Thank you for your question about your face and neck lift.
  • The face and neck lift does not alter the chin 
  • The 'witches chin' is unrelated to surgery but appears with age in some women -
  • The chin tissues loosen and move down.
  • This may require a small chin implant or other procedure to correct.
  • If you are seeing it as the result of a face lift, it is not from the surgery but from the surgery revealing another problem.
Always see a Board Certified Plastic Surgeon.
Best wishes. Elizabeth Morgan MD PHD FACS

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.