Being one of the face’s most prominent features, an overly small or large chin can affect a person’s self-confidence. There are a number of surgical techniques which can improve the chin’s appearance depending on the specific concerns of the patient. In this detailed guide, Professor Andrew Sidebottom, a leading consultant oral and maxillofacial surgeon, gives specialist guidance on the different types of surgical procedures that can be performed to enhance the appearance of the chin.
Which procedures can be performed to improve the appearance of the chin?
Surgery for chin augmentation or reduction falls within the remit of maxillofacial surgery as the alternatives require a precise anatomical knowledge of the bone, nerves and muscles around the chin and the underlying teeth. Procedures of this type have the aim of enhancing or improving the appearance of the chin and are generally referred to as genioplasty.
Reduction or setting back of the chin can only realistically be done by cutting off the chin point and either removing a fragment of bone above the cut (to reduce vertical height) or pushing the separated fragment of bone backwards with the attached muscles such that the function is retained. This procedure is called a reduction genioplasty or a setback genioplasty.
I will go on to discuss the operative procedures below, but the cosmetic concerns with any procedure which reduces the amount of bone is that they tend to be “aging”. The additional concern with a setback genioplasty is that it can increase the risk of snoring and sleep apnoea (temporarily stopping breathing during sleep).
Advancement of the chin can be achieved either by cutting and moving the bone forwards (advancement genioplasty) or by placing an artificial graft over the chin point. It is important not to use silicone as this can slip and also over time causes bone loss under the implant. The materials used for this are commonly medpor (porous polyethylene) and PEEK (polyethylether ketone). They should be fixed in place with screws to help maintain stability.
The advantage of genioplasty is that it is host bone that is moved and therefore the risk of rejection is less and long-term stability is greater. However the surgery is more traumatic as the bone is cut and moved and there is a greater risk of damage both to the teeth and also the nerves which supply feeling to the lower lip and gums.
The advantage of artificial grafts are that they require less trauma and can be easily shaped to obtain the best contour. The disadvantage is that if they are not fixed they can slip and are more likely to become infected. Even if they are fixed in position there is a greater risk of infection than with genioplasty, although there is minimal risk of damage to the teeth and less risk of damage to the nerves which supply lower lip and gum feeling.
A rotated chin point is often a difficult procedure to fully correct, as whilst the centre-line can be corrected, there are frequently changes to the main body of the jaw due to bowing during growth. This may require more extensive augmentation techniques or specific 3D planned custom prostheses or surgical cutting guides. Further discussion is required for each individual case and is beyond this guide.
How are these procedures carried out?
This procedure is carried out under general anaesthesia to reposition your chin point. You will be admitted on the day of the operation and can usually go home the same day provided you have adequate home care support.
The operation takes about one hour and involves making a cut inside the mouth within the lower lip. The chin bone is separated from the rest of the lower jaw with bone saws and is repositioned into a predetermined place and held there with plates and screws. These stay in permanently (with less than five per cent risk of removal for infection) and will not set off the alarms at the airport! Your jaws will not need to be wired together.
It is unlikely that you will need a blood transfusion, as you will lose less than two-hundred millilitres of blood (which is less than after a blood donation). Your body will make this up within a few weeks, but you will feel slightly more tired.
This is also a procedure which is routinely carried out under general anaesthesia. You will be admitted into hospital on the day of the surgery and if you have appropriate support at home, you will probably be able to go home on the same day. The operation takes about one hour and involves making a cut inside the mouth within the lower lip.
The implant size will have been discussed and agreed beforehand and usually standard implants are adequate although some patients require a custom made implant which is designed from a CT scan of their jaw. The implant may require to be soaked in blood and antibiotic solution so the anaesthetist will take a small quantity of blood during the procedure to soak the implant in. This helps to reduce the risk of infection.
Once in the required position, the implant is held in place with two to four small screws. These stay in permanently, but there is a risk that either the screws alone or the implant may need removal due to infection in around five per cent of cases.
What is the recovery period like after these procedures?
The stitches placed to close the wound will dissolve within a few weeks. During the operation, you will be given antibiotics to reduce the risk of infection and steroids to reduce swelling. These will not need to continue after the operation. You will have a pressure dressing on your chin for two to three days to reduce swelling and help the skin to reattach to the jaw in the right place.
In genioplasty procedures, there is also a small risk of damage to the ends of the teeth. Usually this does not cause a problem, but there is a small chance of the tooth becoming infected and needing root canal filling or extraction. However, I have never seen this in any of my own patients.
Following the procedure, you will be swollen and sore. You will need to take regular pain-killers for up to two weeks. The pain should start to reduce after a few days. The swelling will be at its worst after two days then start to go down and is largely gone by two weeks, but persists slightly for up to six months. You will need up two weeks off work but occasionally more. You may also need a soft diet for a few weeks as chewing excessively may be uncomfortable and you should avoid contact sports for three months.
After surgery your lower lip and gum will be numb. The lower lip may take a few months to recover, but there is some degree of permanent numbness in about five to ten per cent of augmentation patients and ten to twenty percent of genioplasty patients. This does not usually involve the whole of the lower lip or the red margin. Most patients who get permanent numbness hardly notice it after a few years and it cannot be seen by other people.
I hope the above provides an overview of the surgical techniques aimed at enhancing the appearance of your chin and helps you to understand if one of these procedures may be right for you.
If you are considering surgery to the chin and wish to discuss your options further, you can schedule a face to face or remote consultation with Professor Sidebottom by visiting his Top Doctors profile.