Chin Surgery
Chin Surgery can be one of the most striking cosmetic facial procedures. Many individuals have very recessive profiles due to the fact that their lower face and jaw have not developed properly. This is frequently a genetic situation and other family members may exhibit similar traits.
In addition to complimenting the profile, chin surgery can also tighten and enhance the sagging or fatty tissues in the neck. Many chin surgery patients also require minor liposuction which enhances the chin and addresses fatty or sagging neck skin.
The simplest approach to chin augmentation is the placement of a chin implant. This minor operation is performed in the office with IV sedation. The procedure takes about 30 minutes and requires a 5-10 day recovery. New technology in biomaterials has shown silicone implants to be very successful and extremely well tolerated by the body. The new chin implants are natural feeling and follow the contours of the normal jaw line. These new type of implants are known as anatomic implants which means they come in many shapes and sizes to personalize the esthetics of each patient.
When chin implants are properly inserted and fixation is used, the result is permanent. It takes about 25 minutes for the procedure and if for some reason the patient wants it removed or replaced, this can be done in 10 minutes with local anesthesia. Not many cosmetic procedures are both permanent but reversible!
Contemporary chin implants come in a vast array of sizes and shapes to allow the surgeon and the patient many options in facial enhancement.
The implants can be placed through an incision inside the mouth to avoid a scar on the face or under the chin in the natural skin crease. After chin surgery, the patient will experience minor swelling, bruising and temporary numbness of the lower lip. These conditions usually resolve over 1-2 weeks.
Implantech Silicone Chin Implant
The photograph above shows a contemporary anatomical implant. The implant is anchored to the jaw with a single microscrew which keeps it in place and prevents migration. Many surgeons do not use screw fixation and this can result in movement of the implant and an unnatural result. In addition, a lose implant can cause the underlying bone to dissolve. This is something I have not experienced due to the fact that we secure all implants.
Sliding Genioplasty
An additional way of moving a chin forward or backward is called a SLIDING GENIOPLASTY. This procedure is performed from an incision inside the mouth below the lower lip. The sliding genioplasty is used in more severe cases or in cases where the chin needs to be lengthened or moved backward. Dr. Niamtu makes an incision in the front portion of the jaw and advances or moves back the bony chin segment. This segment is then secured with a micro bone plate. The photograph below shows a model of a sliding genioplasty. The SLIDING GENIOPLASTY advances the patient's actual chin by moving the lower portion of the Jaw. This procedure will not only advance the chin forward, but it will also increase the lower 1/3 facial height.
The above photographs shows a model of the sliding genioplasty where the patient's actual chin bone is advanced.
We commonly see out of town patients for cosmetic facial surgery including chin and neck liposuction procedures. Generally they can come to Richmond the day before their surgery, have surgery the following day and return home the next. This patient is shown the morning after chin implant and neck liposuction.
Changing Lower Facial Height
While many patients need more chin in the horizontal direction (back to front) some patients need an increase in the vertical dimension of their chin (bottom to top). Patients with a shortened lower facial height lack the proper esthetics for a natural chin and lip support. Their lower lip looks folded over and unnatural.
Before and After Chin Advancement and Lengthening
Implants may be used in minor cases to slightly increase the lower facial height, but in more severe cases a lengthening genioplasty is the proper procedure. This procedure not only advances the chin, but also makes it longer. The chin is lengthened and secured with a micro bone plate. A gap is left from the lengthening and this is sometimes filled with an artificial graft material.
The jaw model at left shows a lengthening genioplasty with graft spacers in place to maintain the lengthening.
In some instances, vertical chin length can also be added with properly positioned chin implants. Although not as controllable as the sliding genioplasty, the vertical height can still be improved.
The patient shown here was treated with an ImplanTech silicone chin implant that was positioned in a manner to improve her profile while also adding vertical height to the lower 1/3 of the face.
This 7 year old young man has a congenital facial growth disorder where his lower jaw has stopped growing. Additionally, Paul had severe sleep apnea where his oxygen levels dropped to dangerous levels at night.It was also difficult for him to eat. In April of 2005, Dr. Niamtu and his partner Dr. Metzger performed a transplant of 2 of Paul's ribs to replace the defective temporomandibular joints. To improve his profile and self confidence, Dr. Niamtu also added a Chin implant. Paul is very happy with the results. Click on image to enlarge.
Although facelift surgery is the preferred surgical procedure for patients with excess neck skin, the placement of a chin implant and neck liposuction can improve some laxity of the neck skin. This patient underwent placement of a chin implant with neck liposuction. Along with the chin improvement, it has moderately improved the neck skin laxity. This is a variable improvement and is significant in younger patients and less dramatic in older patients. Click on image to enlarge.
Chin Asymmetry
Some patients have crooked chins that are not lined up with the normal facial structures. The chin may be off yo the side giving the face an asymmetric appearance. This can be corrected or improved by moving the chin tip to the left or right. The image shows a patient with jaw asymmetry with her chin off to the right. This has been corrected with chin surgery and was realigned by moving the chin back to the midline as shown in the photo on the right side of the image. Click on the image to enlarge.
Mandibular Angle Implants
Many patients are deficient in the lateral (side) portion of the jaw. This gives them weak facial form. Mandibular angle implants can provide a more square, contoured or chiseled appearance for the lower face.
Custom Computer Generated Implants
Dr. Niamtu has extensive experience with computer generated facial implants and was one of the first surgeons in Virginia to use them in the early 1980's. At left, Dr. Niamtu shows some of the advanced reconstructive cases he has performed with computer generated implants.
Custom implants are specifically made to fit exactly to the patient's anatomy. They are most frequently used for facial reconstruction after injuries or deformities. The process involves the patient getting a specialized CT scan of the head and neck as shown in image at left. The images show 3D CT scans used to fabricate a custom implants for patients with facial deformities.
The CT scan is then sent to a company for a very technical process that makes a custom model of the patient's anatomy. The implants are then designed by Dr. Niamtu to correct the patient's problem.
The image above shows a computer generated jaw with customized computer generated implants to fill out defects in the lower jaw.
Implant Expertise
Dr. Niamtu is very involved with the use of facial implants and teaches other surgeons these techniques on an international basis. He has lectured to plastic surgeons in Las Vegas, oculoplastic surgeons in Italy and facial plastic surgeons in St. Louis.
The above brochure is from a plastic surgery course taught by plastic surgeon Dr. Ed Terino, facial plastic surgeon Dr. Bill Binder and Dr. Niamtu in Las Vegas. Click on the image to enlarge.
Drs. Niamtu, Terino and Binder shown at the cadaver instructional lab of Touro University in Las Vegas.
The above brochure is from a facial plastic surgery course taught by facial plastic surgeons Drs. Binder, Tobias, Shire and Dr. Niamtu in New York City. Click on the image to enlarge.
The above brochure is from an oculoplastic surgery meeting in Cervia Italy where Dr. Niamtu lectured on facial implants. Click on the image to enlarge.
The above brochure is from a multispecialty cosmetic facial surgery course at the University of St. Louis in July of 2006. Click on the image to enlarge.
The above brochure is from a multispecialty cosmetic facial surgery course at the University of St. Louis in February of 2007. Click on the image to enlarge.
The above brochure is from a maxillofacial surgery cosmetic surgery course at Louisiana State University in New Orleans where Dr. Niamtu lectured on facial implants. Click on the image to enlarge.
Dr. Niamtu teaches four courses in Richmond, Virginia that are attended by cosmetic surgeons from plastics, facial plastics, dermatology, ophthalmology, and maxillofacial surgery. Click on the image to enlarge.
