Although the chin is an important part of an attractive face, aesthetic problems with the chin are generally not put on the agenda by patients and demands for plastic surgical interventions are usually intended for the correction of nose deformities or sagging skins on the face and neck areas.
On the other hand, noticing and evaluating the aesthetic problems about the chin and solving them with appropriate approaches create very important positive effects on facial appearance.
In all faces considered to be attractive, there is a structural symmetry and balance between the elements constituting the facial skeleton. A well-balanced facial skeleton can be possible with the availability of three dimensional harmony and right aesthetic ratios between the bones that constitute the face.
Accordingly, the chin should be evaluated based on its neighboring anatomical structures such as the lips, teeth and nose. Correction of aesthetic problems in the chin structure provides harmony between the structures constituting the face, and also makes a positive contribution to the appearance of the mouth, lips and nose. Therefore, evaluation of the chin structure and solving also aesthetic problems about the chin for better aesthetic results are recommended to all patients, who request aesthetic surgical intervention in their facial regions.
Surgical treatment of chin deformities is administered as implant procedures or advancement or setback of the bone structures that constituting the tip of the bony chin, with various methods.
Implants with different structures placed at the tip of the chin successfully augment the chin in the lower facial area in front-rear plane. However, they may remain incapable for augmentations in the upper-lower and left-right planes and therefore different surgical interventions may need to be made on the jaw bones for these purposes.
Evaluation of Patients
In patients, whose chin deformities are planned to be corrected, the neighboring bone and soft tissue structures such as the lips, teeth and neck should be carefully analyzed. Patients with upper-lower jaw closure problems first need to be evaluated by a dentist, and before any aesthetic intervention. It is required to be determined if orthodontic treatment or surgical intervention on the jaw bones is needed for ensuring a normal jaw closure.
The structure and tightness of the soft tissues in the chin and lower lip regions should be evaluated in terms of tissue sagging or excessive muscle activity that may occur in these regions due to different reasons.
Evaluation of the side view is made on a profile photo intended for evaluation, or on a lateral cephalometric X-ray film showing bone and soft tissue structures. In this regard, there are different evaluation methods. In the most widely accepted procedure, a full vertical line is drawn in such a way as to pass through the line between the front ear cartilage and the lower margin of the eye socket (Frankfort horizontal line) and the transition line between the lower lip skin - mucosa connection (vermilion line). Accordingly, if the front most point of the lower jaw tissues (Pogonion) is on this line in men, and just behind this line in women, it is considered as a normal aesthetic appearance. If the front most point of the lower jaw is ahead of this line, the chin is considered as a big chin (macrognathia) and if that point is behind the line, the chin is considered as a small chin (micrognathia).
There are different methods for the evaluation of the lower jaw's size in the upper-lower plane, i.e. its height. Among them, the most practical approach is to divide the lower facial area into two equal sections that should be aesthetically equal and then evaluate the height of the lower jaw. In this evaluation, in a face considered to be aesthetically acceptable, the transition line between the lower lip skin - mucosa connection (vermilion line) is expected to be positioned in the middle of the distance between the lowest point of the nose (subnasale) and the lowest point of the lower jaw (Menton). If the distance between the vermilion and menton is shorter, the height of the chin can be planned to be increased, or vice versa if it is longer.
Especially in patients with congenital anomalies involving the facial bones, asymmetries may be observed to exist in different planes of the lower jaw at the same time.
How Is a Cosmetic Chin Surgery Performed?
Approaches to be chosen in cosmetic chin surgeries are determined based on the content and extent of the problem. In case of limited degree of inabilities in the side view plane, i.e. in cases where the lower jaw is small and behind, using a chin implant for providing augmentation is the easiest and more effective method.
In these surgeries that can be performed under local or general anesthesia, a chin implant in dimensions appropriate for the patient's need is placed in the pocket prepared in a suitable location and plane on the jaw bone, by accessing there through a small incision made under the chin or inside the mouth.
After this surgery that takes less than an hour, daily bandage application for a few days is adequate, and the favorable effects of surgery on the aesthetic appearance of the face appear immediately.
Implant is selected in accordance with the needs of the patient and the preference of the surgeon. Among implants with different structures, shapes and dimensions used for this purpose in some cases, bone or cartilage tissues taken from the patient can be used for this purpose, as well
In severe and complex deformities concerning several planes, it is possible to augment or reduce the chin or correct its asymmetries, by means of incisions and dislocations in the bone structures that constitute the lower jaw tip.
