A well-balanced chin is important for the overall harmony of one’s facial features for a number of reasons. An appropriately shaped and sized chin helps to contribute toward a youthful and clean jawline and neckline. A small or underprojecting chin can also cause the nose to appear larger. Finally, on the front view of the face, a chin that is small in vertical height causes the entire lower third of the face to appear disproportionately small in comparison to the upper and middle thirds. Particularly in men, this effect can make the face look immature or boyish.
Options for modifying the shape of the chin include placement of a chin implant, injection of fillers, and use of Botox. An expert in facial plastic surgery, Dr. Mehta is experienced and skilled in chin augmentation and will explain all of your surgical and nonsurgical options during the consultation.
Augmentation of the chin with an implant (chinplasty) can be comfortably done under light intravenous (IV) twilight sedation. It can be done as a stand-alone procedure or combined with others such as liposuction of the neck (submental liposuction), rhinoplasty, platysmal plication, or buccal fat removal. The chin implant is made of solid silicone rubber and comes in a variety of shapes and sizes, uniquely chosen for the patient’s anatomical needs. The implant is inserted into a small pocket along the front of the jawbone (mandible) through a small incision, underneath the chin.
Another nice feature of chin augmentation using an implant is the straightforward reversibility of this surgery. The implant can be removed or replaced with a different sized implant, if needed, through the same approach used for the initial surgery.
The Consultation
During your chin augmentation consultation with Dr. Mehta, he will begin by discussing exactly what is bothering you about the appearance of your chin and neck. Dr. Mehta will then obtain a careful medical history, to determine your candidacy for this procedure and any precautions which would need to be taken prior to, during, or after surgery. If there are issues related to the alignment of your teeth, Dr. Mehta may refer you to a maxillofacial surgeon for evaluation, to determine if a procedure such as orthographic surgery/genioplasty may be appropriate for you.
This discussion is followed by a thorough examination of your face, chin, and neck. Dr. Mehta or our Medical Assistant, Kelli, will photograph your face from several different angles. He will then display your photos on a flat-screen TV in his office and perform computer imaging, to illustrate the appearance of your chin and neck before and after chin augmentation. These images are saved to your electronic file and used during surgery as a guide or template, to help ensure that you and Dr. Mehta are on the same page in terms of the desired aesthetic goals.
After your consultation, Jill, our Office Coordinator, will assist you with scheduling your surgery, pre- and postoperative appointments.
Preoperative Visit
After this initial consultation, you would return for a preoperative visit, two or three weeks before your surgery. At this visit, Dr. Mehta and Shannon will again go over your list of medications and supplements, as it is usually necessary at this time to discontinue any products that can increase the risk of bleeding during or after the surgery. These include, but are not limited to, aspirin, ibuprofen, heparin, warfarin (Coumadin), Plavix, vitamin E, fish oil and numerous other supplements. The decision to stop any of these prescription or over-the-counter products is made in conjunction with your primary physician.
Dr. Mehta will give you prescriptions for your pain medication (or call your pharmacy) at this visit as well. This allows you to pick up these important medications prior to your surgery, so that postoperatively, you and your caretakers can rest and concentrate on your recovery. Dr. Mehta will advise you to pick up Arnica Montana and Bromelain, two homeopathic products that help to reduce bruising after surgery. These are taken as directed, beginning immediately after surgery. You will be detailed preoperative and postoperative instructions, to read prior to your surgery. It is important to avoid alcohol for three days leading up to your surgery.
Lastly, you will have the opportunity to spend time with Jill, our office coordinator, to answer any logistical questions related to your surgery. Your final surgical fees are settled at this visit as well.
Surgery
On the day of surgery, you will arrive at the surgical center with a friend or family member who will drive you home and care for you after your surgery. It is imperative to come in on an empty stomach, not eating or drinking anything for at least 8 hours prior to your surgery. This includes water and chewing gum. You should wear loose and comfortable clothing, including a shirt that buttons in the front to avoid having to pull anything over your head after surgery.
The operating room nurse will meet with you first to go over your instructions in detail. The procedure is generally done under local anesthesia with twilight sedation, with medications given through an IV. If additional procedures are being performed requiring deeper anesthesia, you would meet your anesthesiologist, who will have carefully reviewed your medical and surgical history. You will have the opportunity to ask the anesthesiologist any questions you may have at this time. Finally, Dr. Mehta will meet you and your friends/family to answer any last minute questions as well.
After local anesthesia and sedation are administered, the surgery is begun by numbing the neck and chin with local anesthesia. The skin is thoroughly prepped with Betadine, to sterilize the surgical field. If liposuction is needed, this is performed first. Then, a 1-2 cm incision is made underneath the chin. Using careful dissection, a pocket is made along the front of the jawbone, underneath the muscle layer and periosteum, the tight layer overlying the bone.
Next, various size templates are inserted, to determine what size implant is needed (Small, Medium, Large, or X-Large). This also helps to determine if the pocket is large enough for the implant. Care is taken to avoid the nerves that provide sensation to the lower lip and innervation to the muscles of the corners of the mouth. The chin implant is then irrigated with antibiotic solution and placed in the pocket. It is commonly stitched in place to make sure it is sitting precisely on the middle of the chin. The surgical site is then irrigated and closed in layers, with dissolvable sutures. Either removable or dissolvable stitches are used to close the incision, depending on whether the incision is made under the chin or inside the mouth.
Dr. Mehta can also create a chin dimple or cleft in a couple of different ways. For subtle dimples, the implant can be carved with an indentation in the center of it, such that the skin indents slightly over this portion. A stitch can be used to further indent the skin should the patient desire a deeper dimple.
A compressive head and neck dressing is then applied, to hold pressure on the neck and chin during the recovery process. After surgery, you will awaken in the recovery room, where your vital signs are carefully monitored by the anesthesiologist and recovery room nurse.
After Surgery
After approximately 1 hour in the recovery room, you will be discharged home, in the care of a responsible adult for the first night. Your friend or family member will help ice your chin/neck, assist with your pain medications, and help you with your normal daily activities. You will sleep with your head elevated on two pillows. At this time, you will begin taking your prescribed medications as well as the Arnica Montana and bromelain. Eating fruits such as pineapple and papaya are encouraged as well, as they are thought to help minimize bruising.
You will return to the office the following morning to be seen by Dr. Mehta. He will remove your compressive dressing wrap, check your chin and neck and go over your instructions in detail. The compressive wrap is reapplied, to be worn as much as possible over the subsequent week. Over the first 48-72 hours some patients develop mild bruising and swelling around the chin and neck, though pain and discomfort are usually mild. Patients are up and around the same day as their surgery and the pain is well controlled with Tylenol or prescription pain medication such as oxycodone. Often patients will work from home though most avoid work or social situations for around a week.
To minimize swelling and the risk of complications, you should avoid any vigorous activity or heavy lifting for the first 10-12 days after surgery. A lower salt diet may help the swelling clear faster.
Your next visit will be 6-7 days after surgery, to check your progress and remove stitches. Your chin may be mildly swollen and bruised at this time, though most patients look quite good. The majority of the swelling and bruising disappears over the subsequent few days. On average, patients return to work at 8-10 days after surgery though this certainly varies depending on one’s degree of bruising/swelling and comfort level.
The next visit will be at 3-6 weeks, followed by every 3 months until the one-year mark. The final “after” photographs are taken at this one year follow-up visit.
Nonsurgical Options
During your consultation, Dr. Mehta can also explain the nonsurgical options for changing the shape of the chin. The first of these is with the use of injectable fillers, such as Radiesse, Voluma, Restylane Lyft, and Sculptra. These products typically last around 12-18 months and take just a few minutes to inject in the office. The degree to which the chin can be augmented is smaller than what can be achieved with implants, but filler can be a great option for patients who need just a small amount of augmentation and do not want to undergo a surgical procedure.
The other interesting technique for changing the shape of the chin is the injection of Botox. In certain patients, the chin appears “balled up” due to a hyperactive mentalis muscle. This can cause the bulk of the chin to appear higher or closer to the lip rather than along the jawline. Injection of a few units of Botox can drop this muscle slightly towards the jawline, causing the chin to take a more normal shape. Dr. Mehta will examine your chin carefully to let you know if you would be a good candidate for this procedure.
Conclusion
Chin augmentation is an excellent procedure for improving the appearance of the lower face and jawline for patients with weak or small chins. This surgery can make a profound difference in the shape of the face. The procedure has a brief recovery period with mild discomfort and can be done very comfortably under twilight sedation.
If you have any additional questions or would like to schedule a consultation, please contact us.
