About Chin Implant Surgery
Video transcript: A recessive chin is such that the chin sits further back than ideal. The ideal chin is really lined up with the forehead. So on a profile view we’d like to see the chin projecting as far forward as the forehead. Now in this situation this patient has a chin that is probably has a chin that sits back 7 to 8 millimeters than it should be ideally. With the ideal chin, the angle between the horizontal neck and vertical face is between 80 to 90 degrees. In a patient who has a restrative displaced or small chin, often that angle is often more obtuse, or in this case it might be as high as 120 to 130 degrees.
Let’s do an assessment of this patient. She does have a recessive chin, but other wise she does not have extra skin or fat, the skin is not lax, she does not have any jowls, and her skin is thick enough that it’s going to camouflage any of the surgical work we do underneath. The recommendations for her would be to advance her chin. Now this can be done in several ways. The safest and most effective is to use a chin implant. A chin implant is a solid material, it’s made out of solid silicone, and it has enough density and strength to actually physically move the soft tissues of the neck forward. So this is an example of a chin implant. It’s also very safe. This is something that gets incorporated into the tissues and lasts permanently and I think that is a very attractive benefit to a traditional chin implant.
Now I’ll discuss the recessive chin augmentation. Of course the patients are sedated for this procedure. Local anesthetic is used so there is no discomfort. A small incision is placed in the submental crease; that’s an area right about here on me. That area is facing the floor so it’s not something people can see and it’s very common for people to naturally have a crease in that area anyways, so it doesn’t really look like a scar. Once the incision is made, a pocket is created in the midline of the chin, so just about this area right here, and it’s made big enough so it can accept the anterior augmentation that we’re going to get with the chin implant. Once that’s performed, small incisions are place into the periosteal, the surface layer of the chin. A little pocket is created to accept the tail of the implant on each side and the tails are inserted into those pockets and that allows the implant to sit in the midline and sutured in place with stitches. Once that is all set in place then the skin is closed with dissolvable stitches.
After the surgery most people will have a little bit of discomfort and we often will give the patients some pain medications for that. It’s usually short-lived. There are some tapes and dressings that go onto the chin that stay for a week, but once those are off people look quite normal. I think the augmentation that they see initially is probably a little bit more than what they’re going to see long term, just because they have some tissue swelling as a result of the surgery. Usually at the 3 or 4 week mark things have settled and the chin looks just the way it will look permanently.
So what are the medial risks? Very similar to any surgical procedure it’s always possible to get an infection or to have some bleeding from the incision line. Sometimes the wound will not heal as quickly as we’d like. All of our patients are placed on antibiotics prior to the surgery, during the surgery, and afterwards.
In terms of recovery, most patients go back to work after a week. There is always a bit of swelling and bruising at that time, so they may need to wear camouflage makeup initially but that resolves quite quickly. We don’t generally use a compression garment, but often there are some tapes that are applied to the outside skin, just to make sure that the implant stays where I’ve placed it for the first week. And those are removed at the one week post operative visit.
So again, when thinking about the risk/reward trade off with chin implant surgery the surgery is performed in a very small area, very little skin is actually elevated to insert the implant, the procedure is fairly quick, and the risk of infection is very low. The reward is that there is a substantial augmentation that can be achieved with a chin implant, it feels extremely natural, it’s sitting under many layers of skin and muscle so it’s not palpable, but because it’s firm, it’s able to substantially augment the chin in ways that wouldn’t be possible with injectable fillers or other alternatives.
On the spectrum of face and neck procedures, chin implant would be fairly low in terms of recovery period; so very short recovery, very low risk, and not a particularly invasive procedure with excellent long-term results and very substantial changes to the shape and appearance of the chin.
Here is an example of a patient that required a chin implant. She has a slightly recessive chin, and you’ll notice it doesn’t line up well with her forehead, it’s sitting a little bit further back. So these are her results. We’ve advanced her chin through a small submental incision, we’ve put in a medium sized chin implant so that brings the chin forward slightly in line with her forehead. We always want to be very cautious with not to advance the chin too much. It’s always good to be conservative with augmentation in women. You’ll notice as well we’ve performed a rhinoplasty for her, it’s quite a common combination.