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I am considering chin augmentation, but I don't know whether or not my complaint can...

Q:

I am considering chin augmentation, but I don't know whether or not my complaint can be fixed. My complaint is this: Not only do I have a small chin in profile, but from the bottom of my bottom lip to the indentation where my chin actually starts, there is a big space, about an inch. I actually want my chin to "start" right below my bottom lip, not an inch below it. I was wondering if this can be changed through surgery, and if it can, will there be massive scarring or an artificial look?

A:

I believe that your condition could be corrected with surgery. There are several techniques available, and selection depends on the individual's condition. If your chin is small but your bite (the way that your top and bottom teeth come together) is good, then you would be a candidate for augmentation with an implant or by advancing forward the bottom portion of your jaw around the chin area (advancement genioplasty). Both procedures can be performed from inside the mouth or through a small incision under your chin. If your bite is off and your lower teeth sit behind your upper teeth with your mouth closed, then you might be a candidate for an advancement of your entire lower jaw (sagittal split advancement osteotomy). This is a more complex procedure but is also done from inside the mouth, and there are no external scars. All these procedures can significantly improve the appearance and achieve facial balance.

A:

 

My preference is to use structural fat grafting, as much as possible, to enhance facial features. Fat grafting could likely be used to correct the space you are describing below your lower lip.  In many cases, the need for a solid implant can be eliminated by the careful and meticulous grafting of a patient's own fat. While the incidence of complications with facial implants is not high, certain problems may develop which require implant removal including infection and implant migration. Bone resorption (bone loss) has also been reported below solid facial implants. Neither of these problems are an issue with structural fat grafting.

The only setting in which I currently use a solid facial implant is for chin implant augmentation. Some patients with a 'weak' chin profile can be adequately improved by structural fat grafting alone. However, when the chin protrusion needs to be enhanced by a half centimeter or more, a chin implant is absolutely required. I prefer to use a soft, flexible, anatomic chin implant that conservatively enhances the anterior projection of the chin in profile. The chin implant is placed through an incision hidden underneath the chin, an area where many people already have a scar from a fall in childhood.

Moderate enhancement of chin projection in appropriate patients can dramatically enhance the profile, in a manner that is completely natural-appearing. It is remarkable how increasing chin prominence in some patients will reduce the apparent prominence of the nose, and restore an overall sense of harmony and balance to facial features.

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