Chin Augmentation
Other associated terms: chin implants, mandibular augmentation, mentoplasty, genioplasty.
Overview:
Chin augmentation, using implants, can significantly change the underlying structure of the face. The goal is to provide a better overall balance to the facial features and can be performed along with other procedures such as a rhinoplasty (nose job) to achieve this balance. A reason for this, for example, can be that a change in chin size would magnify or minimize the perceived size of the nose. Chin implants are additionally used to correct congenital facial deficiencies and facial trauma.
Chin augmentation may involve the use of hard implants made from silicon or other synthetic materials, bone or fat from the patient’s body, harvested cadaver tissue or other biological implants. Chin augmentation can also be achieved by manipulating the main bone of the jaw (mandible).
A more dramatic result is usually achieved with this type of correction than with implants. This type of augmentation surgery can be performed by an oral and maxillofacial surgeon, cosmetic surgeon, plastic surgeon or an otolaryngologist (ear, nose and throat physician).
Benefits:
For those who would like to change the appearance of a “weak chin” can benefit from chin augmentation. The same holds true for women who are unhappy with an overly “mannish” look that a strong, protruding chin can present. In this case, a chin reduction may be the key to a more feminine appearance.
Types of Augmentation:
The type of chin augmentation that will be performed is dependent on the material used for the implant, or whether manipulation of the bone is key to the procedure. This is either an augmentation with the use of an implant or reduction surgery on the bone.
Reduction surgery is a procedure that re-shapes the contour of the bone at the chin area in which the bone height and width is altered to suit the patient’s facial profile and to obtain balance of the facial structures. The surgeon will accomplish this by shaving a portion of the bone with an osteotomy (bone cutting) machine (oscillating saw). A thorough X-Ray assessment of the patient’s facial skeletal structure is needed prior to surgery and this will provide information regarding the amount of bone that will need to be removed.
Patient Characteristics:
A good candidate for augmentation is a person in good physical and mental health, with no pre-existing medical conditions (especially bone disorders) and who wishes to balance their facial features. They should have reasonable expectations regarding the results and the recovery time, as well.
This is important because the final results may not be evident for 3-4 months after the surgery. This may make an emotionally unstable patient susceptible to depression. Also, the patient should not have been taking Isotretinoin (Accutane®, which is no longer sold as of 6/25/09 – but the generic drug, Isotretinoin, is still available) for the last six months or more.
Procedures and Materials:
Note: patients who are planning to undergo chin augmentation are prepared and advised prior to the scheduled surgery. Patients should avoid the following for 2 - 3 weeks prior to surgery; smoking, alcohol, steroids, NSAIDs (Non-steroidal anti-inflammatory drugs – like aspirin, ibuprofen, naproxen, mefenamic acids, etc.), herbal tea, herbal medications, Vitamin E, blood thinning medications like heparin and Coumadin® (warfarin sodium), regulated drugs like Valium® (diazepam), oral contraceptive pills, diet pills and prohibited drugs like methamphetamines.
These may delay healing, prolong bleeding during surgery and may interact with anesthesia. It is advised that patients discuss this further with their surgeon to minimize possible risk and complications. This holds true with all surgical procedures.
Chin Implant Materials:
Typical types of chin implants include silicone implants (in different degrees of softness), silicone “elastomers” (various polymers having similar properties to natural rubber) and porous polyethylene. Other common implant materials include Supramid® (a suture material) and Mersiline® (a mesh-like material) that can be used as “bone scaffolding”.
Gore-tex® is another common material used and is known by an abbreviation of its chemical name, ePTFE (expanded polytetrafluoroethylene) or Gore S.A.M. (gore subcutaneous augmentation material). This material popular because it is biocompatible (compatible with living tissue) and because ePTFE is flexible, soft but very strong, it can easily be molded and secured to the bone by titanium screws. The material is also porous – so what really holds the implant in place is the actual soft tissue and bone growing through the implant.
Another chin augmentation implant material is commercially known as AlloDerm®. AlloDerm® comes from deceased tissue donors. Just subsequent to death, a thin layer of skin tissue is removed and antibiotics and other substances are used to remove the cells and DNA that may result in rejection. The material that has been processed is then used to cover a chin implant.
Also, bone and fat may be harvested from the patient’s own body. This, of course, requires an additional procedure whereby fat may be taken and processed before injection (see: Liposuction) or, in the case of bone, the material is usually taken from the patient’s pelvis (ilium) or from the ribs.
Chin Augmentation Procedure (with Implant):
Chin augmentation procedures, that involve implants, are usually performed on an outpatient basis. The location of the surgery can be in a surgery suite at your surgeon’s office, in a dedicated surgery center/clinic or a local hospital.
The chin implant procedure can be performed either under local or general anesthesia, depending on patient preference or the surgeon’s recommendation
The chin implant surgery, itself, usually takes just under an hour but if you are having other procedures done (such as a rhinoplasty) at the same time, the duration of the surgery may be longer.
Once the anesthesia has taken effect, the surgeon makes an incision at one of two places. The incision may be made inside your mouth (along the lower lip), or it may be made in the skin just beneath your chin. Your surgeon will then create a pocket over the front of your jawbone.
A chin implant (that has been pre-selected for the size and shape to provide desirable results) will then be inserted into that pocket (under the muscle of the chin and above the bone).
If the implant has been inserted through an incision in your mouth, dissolving stitches will probably be used (these will dissolve in 10 days or less).
If an incision was made in your chin, regular (non-dissolvable) stitches will be used and will be removed during a follow-up visit (about a week after surgery). Also, after surgery, the chin is usually taped up to provide support and to limit swelling and discomfort. A cold compress may also be applied after surgery to reduce swelling.
After surgery, you will be taken to a recovery room and your vital signs will be monitored until you are released to go home. You should someone to drive you home (due to the effects of the anesthesia). You may also want to arrange to have someone look after you for a day or two after surgery.
Recovery:
You will experience some discomfort, bruising and swelling in your chin and jaw area for several days after the surgery. Talking may also present some discomfort. This should lessen considerably within a few days. You will be given specific instructions from your surgeon regarding eating limitations and tooth brushing procedures.
If the chin implant was placed using a mouth incision, there will probably be restrictions on the types of foods that you can eat for the few days after surgery. Soft foods and food supplement shakes will likely be recommended. This way, you can get the nutrients needed for proper healing without damaging the surgery area.
Since activity will be limited, immediately following surgery, you may wish to set up a recovery area in your bedroom or normal sleep area (prior to surgery) that will allow you to get the rest that you need. Items you may wish to place in close proximity are:
- Ice packs/cold packs. Some suggest frozen peas in a freezer bag. These remain cold for an extended period of time, won’t leak like liquids, and mold to the shape of your face.
- Soft foods to eat when you get hungry.
- Prescribed and suggested medications (pain medications, mouth rinses, etc.)
- A thermometer, so you can check your temperature regularly in order to spot an elevation that may indicate an infection.
- Gauze rolls to absorb any additional discharge or bleeding.
- A telephone with a list of your doctor’s contact numbers should be placed within easy reach. Placing the contact numbers on speed-dial is also a good idea - but make sure to test them, first.
Risks Associated With Chin Augmentation Surgery:
As with all cosmetic surgeries, there are standard risks that you should discuss with your doctor. In addition to the standard surgical risks there are procedure-specific risks, as well. Risks can include:
There is a standard risk of infection inherent in all surgeries. This can usually be treated successfully with antibiotics prescribed by your physician. However, if the infection occurs around the chin implant itself and cannot be controlled by antibiotics, additional surgery may be needed to temporarily remove the implant until the infection clears up.
Swelling, bruising and discomfort after surgery - This is typical of many kinds of operations and should be temporary. If pain persists beyond what is expected, you should immediately call your surgeon or the on-call medical support team.
Implant-specific risks - Chin implants can be made of a variety of different materials. Specific risks may be associated with the material that is used in your surgery. You should discuss this with your surgeon. Your chin implant could shift out of alignment, creating an imbalanced look. This may necessitate additional surgery to correct the problem.
Procedure Costs:
Like most cosmetic surgeries, the costs can be broken down into three major fees: the surgeon’s fee, anesthesia and the facility fee. Costs are variable and are dependent on the experience of the surgeon and the complexity of the procedure. For example, complicated procedures may take quite a few hours; which is a factor that increases surgical costs, like anesthesia, and facility time, which increase the total cost of the procedure.
When general anesthesia is required, an overnight hospital stay is will also be required and the costs will be higher than if local anesthesia is used and no hospital stay is needed. The facility in which the procedure is performed also influences costs. More than one procedure may be required but if multiple procedures can be performed at the same time, then certain fees may be combined.
Average fees for the mentoplasty or genioplasty procedures can range from $2,000 to $3,000. Benefits will vary among insurance carriers and some may pay for a percentage or the whole procedure if it is deemed medically necessary due to a traumatic injury or a birth defect. Aside from medical insurance, your surgeon will also offer financing options that can make your procedure(s) affordable. Consult your medical insurance carrier and/or your surgeon for details.
10 Things to Discuss with Your Surgeon During Your Consultation:
1. What are the realistic expectations for the procedural results?
2. What is the surgeon’s level of experience in performing chin implants? How many procedures, of this type, have been performed?
3. Are multiple before and after photos available for viewing?
4. What percentage of this practice’s patients experience complications with the implants? What are the most common complications?
5. Where is the chin implant performed (facility) and how long will it take? Is the facility accredited?
6. In my case, what technique and/or which implant type and material is most appropriate?
7. What are my anesthesia options?
8. What is the total cost of the procedure (including follow up, surgeon’s fee, anesthesia, facility fees and incidental costs)?
9. What is the surgeon’s policy in regards to correcting or repeating the procedure if the implant does not meet agreed upon goals or if a complication arises?
10. What should I expect, regarding recovery (discomfort, job downtime, activity level, etc.)?