Chin Surgery

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Chin Surgery

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GPL	Chin Surgery
Procedure	The chin can be enhanced or reduced by cutting and fixing the chin bone with metalwork in a new position, using an incision inside the lower lip (=sliding genioplasty or mentoplasty). Enhancement can also be achieved with a chin implant using an incision under the chin. A minor chin prominence can be rasped using an incision under the chin. Dynamic chin ptosis, where the chin pad moves downwards when smiling, can be addressed by excising skin and soft tissue using an incision under the chin. If the bite is affected (=malocclusion) or if the whole lower jaw is small, a dental opinion should be sought prior to aesthetic correction. Malocclusion should be corrected with orthodontic treatment or orthognathic surgery before the chin is changed surgically. A too ambitious attempt of bringing the chin into the "ideal" position increases the risk of other aesthetic imperfections and should be avoided. E.g., advancement can lead to an elongated, narrow and aged chin ("Pharaoh deformity") with a deep chin fold, and setting back the chin can cause a boxy contour with neck laxity and a flat chin fold. Advancing, setting back, elongating and reducing chin height can also affect the depth of the chin fold adversely (by deepening or effacement). This operation is sometimes combined with a rhinoplasty to achieve more balance. I do not use drains routinely. The wounds are repaired with sutures under the skin which do not require removal and dissolve within four months. Soft food and mouth wash are advisable for one week after sliding genioplasty.
Scars	Inner lower lip for sliding genioplasty. Underneath the chin for implants, rasping of localised prominences and correction of dynamic chin ptosis.
Operation time	3 hours for sliding genioplasty 1.5 hours for chin implant, burring of localised prominence 1 hour for correction of dynamic chin ptosis
Anaesthesia	General for sliding genioplasty and reduction of localised prominences. Local for implants and for correction of dynamic chin ptosis.
Hospital Stay	Day Surgery > (Overnight)
Benefits	Aesthetic, Psychological
Risks	Bleeding, Infection, Scar problems (stretched, thick, abnormal pigmentation, red, retracted etc.), Skin discoloration, Wound separation, Slough, Necrosis (bone, skin, tissues), Pain, Nerve injury (Numbness, weakness, paralysis), abnormal chin & lip muscle movements, Cold insensitivity, Tooth injury, Bruising, Swelling, Overcorrection, Undercorrection, Asymmetry, Chin ptosis, Contour irregularities, Lower lip retraction, Aesthetic imperfections, Seroma, Need for further surgery (including implant removal), Allergic reaction, Chest infection, Heart attack, Stroke, Blood clots in legs & lungs Sliding genioplasty: Non-union, Malunion, Fixation failure, Palpable metal / bone edge, Metalwork extrusion, Neck laxity Implant Surgery: Implant extrusion / displacement, Capsular contracture, Bone erosion, Palpable implant, Chin ptosis and abnormal chin & lip muscle movements after implant removal Bone burring: Bone irregularity, Chin ptosis, Remaining asymmetry Correction of dynamic chin ptosis: Less curvature
Risk factors	Smoking / contraception / flights within 6 weeks of surgery, overweight, high blood pressure, bleeding tendency (Stop herbal products or supplements for two weeks before surgery), diabetes, poor oral hygiene
Optimising factors	Diet rich in Vitamin C and protein, plenty of fluids, fresh air, scar massage, sun protection
Discomfort	1 - 2 weeks
Bruising	2 - 3 weeks
Recovery	Light activities 2 weeks, Driving 3 weeks, Physical work & sports 6 weeks
Acceptable appearance	2 - 4 weeks for most patients (This is subjective)
Final result	6 - 18 months
Alternatives	No Surgery, Make-up, Fillers, Fat transfer, dental or maxillofacial treatment if the bite is affected; an alternative to sliding genioplasty is burring through a cut under the chin. However, this can flatten the chin and make it droopy (chin ptosis).