Chin Surgery
The before and after pictures below illustrate the dramatic but natural effects of a well placed chin implant.
Chin Implants
Don’t forget to view the articles and videos in the LIBRARY OF ARTICLES at the bottom of this page.
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.
Chin implants can be placed from an incision inside the mouth for a completely hidden scar. They can also be placed through the skin under the jaw using a small incision. This images illustrates both incision approaches.
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 chin implants are known as anatomic implants which means they come in many shapes and sizes to personalize the aesthetics 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 chin 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.
Advantages of Silicone Implants
- Can be placed from the inside of the mouth without ANY facial scar.
- Simple procedure that takes about 20 minutes.
- Is a safe, predictable and permanent procedure when using screw fixation.
- Can be easily removed in 5 minutes if the patient desires
ImplanTech Silicone Chin Implant
We commonly see out-of-town and international 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. The patient shown here came in from NYC for several days for chin surgery.
When is a patient not a candidate for a chin implant?
Many patients with a deficient chin (retrogenia) have dental or jaw misalignment (overbite). Some patients are best treated with orthodontics and jaw repositioning (orthognathic surgery). Many patients do not desire this type of treatment and want a simple chin implant. Although many patients are good candidates for chin implants, some are not. Patients that have a deep mentolabial fold (the crease below the lip and above the chin) may not be good candidates and patients that have the lower lip that is behind the upper lip may not be good candidates.
Placing an implant in patients with deep mentolabial folds or lips that are not in line can actually make them look worse as the chin point sticks out in an unnatural manner. A patient with this type of situation should be treated with a lengthening genioplasty to add vertical height to the chin. The patient shown on the left had a chin implant placed and instead, should have had a lengthening genioplasty to augment the chin in the vertical and horizontal direction.
A deep mentolabial fold or lip misalignment may indicate that the patient is not a good candidate for a chin implant and should be treated with a lengthening genioplasty.
If the lower lip is considerable behind the upper lip, the patient may not be a good candidate for a chin implant and may be better suited for a sliding genioplasty.
Chin implants don’t work?
Unfortunately, many surgeons will say that a given procedure “does not work” when in reality they should say “I am not proficient at that operation”. Many surgeons are too proud to admit that just because they are not good at something does not mean that someone else is. When I finished my maxillofacial surgery residency, I was taught that “chin implants don’t work”. I was told they “get infected, move around, cause the bone to dissolve and will eventually fail.” When I entered private practice in 1983, I sat down and tried to identify the factors that contribute to this supposed failure. After a while it became quite obvious that there were four main problems that caused chin implants to fail.
Reason #1: Improper implant shape
Older style chin implants were not “anatomic”. This means that they were not made to fit the underlying bone in a precise and cosmetic manner.
The older style implants were sometimes merely hunks of silicone or other material that was not shaped to fit the jaw and did not cover enough of the jaw.
The not only produced a compromised cosmetic result, but the shape was not conducive to the implant lying on a stable base or to resist movement. This shows an old style “button” implant next to a contemporary anatomic implant. The longer implant has a more stable base for biocompatibility and aesthetics.
Reason #2: Improper implant biomaterial
Surgeons familiar with the orthopedic literature know that materials can play a huge role in biocompatibility and implant survival. Silicone implants are the most biocompatible. Rejection is rare and they are easy to put in and take out. Some implants are made of porous materials and they can be almost impossible to remove as they become ingrown to muscle and other tissue and fragment upon attempted removal. Never put something in that you cannot take out! Silicone implants are extremely easy to remove if desired.
Reason #3: Unfixated (unsecured) implants
Another very important orthopedic principle is fixation. A chin implant is subject to many forces. Think about how much we use our lips and mouth and the muscles in this area. These muscles and related funciton can be very powerful and move unsecured implants. Any implant that rests on bone and is mobile (even micromovement) can cause severe inflammation of the bone leading to bone loss. A general rule is that any implant that is not fixated (secured to the bone with a screw) may be viewed by nature as a foreign body and the immune system will do it best to get rid of that foreign body. By simply securing the chin (or cheek) implant to the underlying with a single microscrew (sometimes a second anti rotation screw is used), this movement can be minimized or avoided. Some surgeons claim they secure the implant with a suture, but this is not the same or as secure as using a screw as a suture still allows movement because it is not a solid fixation. After placing hundreds of chin implants over a 30 year period, I can testify that it is extremely rare to see failure or bone problems with screw retained silicone implants. This image shows a silicone chin implant placed through a very small chin incision with a microscrew fixation of the implant to the bone. See the section below for more information on why screw fixation is important.
The following images are from a patient that had an implant placed by another surgeon. The implant was over trimmed and was “fixated” with a suture. It is easy to see that the implant was mobile which would not have happened if screw fixation was used. While not every implant will have problems when not secured with screws, most of the problems I see are from implant mobility or displacement. This can be avoided by using 1-2 micro fixation screws.
The left image below shows two major implant mistakes. The implant is too small and non anatomic in the left picture. The right picture shows the implant secured with suture instead of screws and hence it is loose and mobile. The right picture below show the problem implant placed by another surgeon and the new anatomic implant placed by Dr. Niamtu and stabilized with a micro fixation screw.
Reason #4: Improper technique by the surgeon
Like any surgical procedure, the competence of the surgeon can have a lot to do with the result. Experienced facial implant surgeons are aware of the implant position in three dimensions. Silicone implants are made to fit the jaw or cheeks in a very precise position and if this is not followed, the implant will not look or feel right. Obvious asymmetry is visible when the implants are tipped or not placed in the intended position.
The images on the right show a model of improper placement in the vertical plane. Note that on the picture A (taken from the tongue side) shows the implant extends below the border of the jaw. Sometimes this is done intentionally, but this will frequently produce a noticeable step that that most patients do not like. The image in figure B show an implant placed to high above the jaw border. Again, this will produce an unnatural result as well as a crooked appearance. The average patient needs the implant placed exactly on the border of the mandible (jaw).
Also common are surgeons not placing the implant in the correct position in the horizontal plane. This leads to the implant being tipped and obviously can skew the intended result. The implant does not look as good and frequently appears tilted to one side or the other. This is also very noticeable to the patient when they feel one side of the implant compared to the other. The right side image shows a model of chin implants that were not placed in the proper position in the horizontal plane resulting in a tipped, uneven and unnatural result. Dr. Niamtu frequently corrects similar problems from improperly placed implants from around the country. It should be noted that sometimes it is impossible for various reasons to control implant position and minor asymmetries can occur, but major malposition is a complication and should be corrected. Fixating implants with microscrews can prevent improper implant position after surgery. During surgery it is the care and expertise of the surgeon that makes the difference.
The images on the right show a chin implant placed by another surgeon that is malpositioned. The top images show the actual CT scan and the bottom images show an outline of the implant to better visualize the problem. Not only is the implant not properly positioned in the vertical and horizontal plane but it is also in close contact to the mental nerve (shown as red dots) which can cause pain and numbness. It is difficult to say if the implant was placed this way or moved after surgery because it was not secured with microscrews. In any event, the cosmetic and functional value of the implant is compromised and the surgery will likely need to be redone. This is something that I see on a regular basis with cheek, chin and mandibular angle implants. I have fixed many of similar cases. Even the best surgeons may have some asymmetry of an implant but small displacement is generally not a problem.
Inexperience and the Wrong Size Implants
Obviously, the success of any implant procedure has to do with placing the correct size and shape implant. Females don’t look good with masculine implants and vice versa. Volume, taper, extension, thickness and height are just some of the factors that experienced implant surgeons take into account when matching the proper implant with the patient’s desire. Although custom implants are sometimes required, most often, the surgeon can customize the “off the shelf” implant by sculpting it to best match the patient.
The patient below presented to Dr. Niamtu and was unhappy with her chin implant that was done elsewhere. The main problem with the bulky and masculine chin implant was that it simply did not fit the patient. Dr. Niamtu removed this implant and placed an off the shelf implant that he trimmed to fit the patient better.
The above and below images show a patient with an improperly sized implant that was replaced with a more suitable size and shape for the patient.
Vertical Lengthening Implants
A newer type of implant is available that can lengthen the chin and in selected cases substitute for surgical genioplasty.
The patient below was treated by Dr. Niamtu with the Vertical Lengthening Chin Implant with simultaneous facelift.
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.
Mandibular angle implants can be used to create a more angled look in both males and females. Some patients are born with rounded posterior jaw features and mandibular angle
implants can make the face more angular. Johnny Depp, Colin Farrell, and Leonardo DiCaprio and Brad Pitt are commonly referenced when well defined mandibular angles are discussed. It is important for patients to realize that although mandibular angle implants may broaden the lower face, they are not going to make a person look like a “model” or give a sculpted jawline to someone who does not have the anatomical basis for such a change. In other words, some patients look like “models” because their heredity and a combination of desirable features. Facial implants in themselves cannot account for all these features.
Mandibular angle implants can generally be placed using stock “off the shelf” implants. These are available in various sizes and shapes to accommodate a wide range of patients. In some cases more precision or customization is desired and the patient and or surgeon may want to customize the result.
This can be done by fabricating custom computer generated implants. This actually can be done for cheek, chin and other facial implants. Dr. Niamtu has an in office CT scanner that can make 3D scans which can be used to make a custom model of the jaws.
The implants are then made to this custom jaw model and should be a perfect and precise custom for that patient. Image A to the right shows a custom implant that is being planned and figure B shows the actual finished implants on the CT model.
Mandibular angle implants can be used “off the shelf” and come in several sizes or can be customized on computer generated models to perfectly fit the patient.
The patient below had 12 mm ImplanTech mandibular angle implants placed.
I am proud to have contributed to this special day
The patient below desired a wider lower face and more angled jawline and was treated by Dr. Niamtu.
Facial Proportion
Facial proportion is one of the key components of beauty. Look at the picture below. This was from a study done in Germany. A picture of a female was altered 25% in terms of proportions in each box. That means that the size, shape and spacing of the features changed. The images were then shown to 1,000 college students and they were asked to pick the most attractive picture. 100% of the people chose number 5 or 6. This shows the power of proper proportion to the overall perception of beauty.
The patient below underwent cheek and chin implant surgery by Dr. Niamtu and no other treatment. This case is an excellent example of how small changes in facial proportion can make big differences in overall beauty.
Chin Asymmetry
Some patients have crooked chins that are not lined up with the normal facial structures. The chin may be off to 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.
Some patients present with asymmetries or situations where the jaw line is uneven. This condition can be improved with implants as well. Sometimes these patients will have depressions in front of their jowls that make them look older. Dr. Niamtu can customize a standard off the shelf chin implant and by using only the sides of the implants, can fill in these depressions. This image shows a patient with pre-jowl depressions, the yellow figures indicate the size and position of the “implant tails” placed to fill in this void and the right side images shows the patients result after surgery.
More information about Chin Surgery from Dr. Niamtu's library of articles
Click Video Below to Watch
Dr. Niamtu discusses why some patients need a genioplasty and not a chin implant
Dr. Niamtu explains everything you always wanted to know about chin implants, genioplasty and angle implants
Although there are numerous ways to augment the chin, silicone chin implants have been the leading choice for 40 years. Silicone is very bio-compatible and is used in numerous medical devices. Dr. Niamtu secures all facial implants with micro screws, which means they cannot move or migrate and have much less chance of causing problems with the underlying bone. Although chin implants are a permanent solution to profile enhancement, they can be easily changed or removed if the patients desires. The procedure is generally performed with IV sedation and takes about 25 minutes to perform. The recovery is generally about one week.
The following videos show live surgery and may be graphic for some patients.
The following video shows Dr. Niamtu placing a silicone chin implant via the submental approach, which is through the skin under the chin.
Chin implants can also be placed through the mouth so there is not visible scar and the following video show Dr. Niamtu placing an implant through this approach.
Although you hear a lot of people discussing custom facial implants, it is really not a new technique. I believe I performed some of the first custom facial implants in the State of Virginia as evidenced by the balding young doctor in the 1990 article below.
Although the process is similar, a lot has changed in the past 22 years. The CT scanning has become much more finite and accurate and the implant modeling technology has also advanced. Today it is possible to make extremely accurate models of human facial anatomy from office CT scans. In the past, patients had to go to the hospital for an expensive scan. Our practice now owns two scanners and we can perform in office scanning that is very accurate.
The reason people choose custom facial implants is all in the name; it is custom! Some patients choose this to simply have a 100% personalized implant that they can have a say in designing. Others choose a custom implant because they have some type of asymmetry or similar problem that an “off the shelf” facial implant won’t address. It is similar to buying a tailor made suit. A man or woman could probably find a really nice fitting suit on the rack at a store, but no matter what, it would not fit as well as one that was custom designed. Same with the facial implants. I will say, that after placing over 1,000 facial implants since 1990 that the stock (off the shelf) ImplanTech silicone implants fit the average patient extremely well. This is because they are designed on human skulls and are anatomically averaged for most patients. Usually they work fine, but again, there are those patients that want or need more customization and this is the power of custom facial implants fabricated from a CT generated model.
The actual scan takes about a minute and is very similar to having a panoramic dental Xray (Panorex).
Dr. Niamtu is shown with some custom facial implant cases and the office CT scanner is show on the right.
The scan can then be interpreted by the surgeon and sent off to a medical modeling company. The company I primarily work with is Medical Modeling in Golden, Colorado as they have been a leader in the business for decades. The company takes the digital information from the CT scan and enables an anatomic model to be fabricated by complex laser modeling technology.
The CT scan shows the facial structures, this data is then sent off for model fabrication.
The actual anatomic model is then sent back to the surgeon to study and begin the custom facial implant fabrication. I, personally, like to involve the patient and if they are local they can come in and provide hands on fabrication with modeling clay. We use polymer clay to determine the general outline and contour of the facial implant. We may also use wax or silicone in the fabrication. For our of town patients, we do it virtually via Web.
The above image shows the custom implants being fabricated from clay and silicone to the exact dimensions of the model.
Once the surgeon and patient agree on the implant it is sent back to ImplanTech, Inc. for preliminary fabrication. They then send back the preliminary implant and again the patient and surgeon to approve. Sometimes this takes several trials and one negative thing about custom implants is the fact that there is time lost sending preliminary trials back and forth to the company. Fortunately, experienced surgeons and realistic patients, usually get it on the first trial.At this point, the final implants are sent back to the surgeon in sterilized packaging and the surgery is performed.
The above image shows final implants ready to be sterilized and placed in the patient.
Custom facial implants are more expensive than stock implants due to the obvious steps of having a CT scan, an anatomic model, and surgeon time in case planning. The process usually adds approximately $2,500 to the normal stock implant fee.
Facelift surgery is the ultimate cosmetic procedure for improving aging of the lower face and neck. Dr. Niamtu frequently recommends chin implants for facelift patients as this small procedure can make a big difference in the result of the facelift. A simultaneous chin implant can enhance the facelift by extending the chin and thus improving the profile. In addition, some patients develop a droopy chin (sometimes called a “witch’s chin”) and a chin implant can lift and support the sagging chin which greatly enhances the facelift. Browsing the pictures in the facelift pages on this site will show numerous cases of facelift with simultaneous chin implant augmentation and illustrate the beneficial effects of combining these two procedures.
The patients below had simultaneous facelift and chin implant surgery.
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 by Dr. Niamtu.
Along with the chin improvement, the neck skin laxity is improved. This is a variable improvement and is significant in younger patients and less dramatic in older patients.
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.
Dr. Niamtu has published a 1,000 page comprehensive textbook on cosmetic facial surgery which includes a large chapter on his cheek, chin and facial implant techniques. Few surgeons receive the honor to publish such a text with a major medical publisher like Elsevier.
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 all cosmetic specialties including plastic surgeons, oculoplastic surgeons, dermatologists, facial plastic, ENT, oral and maxillofacial, here and abroad. Some of the multiple specialty lectures given by Dr. Niamtu are shown in the course brochures below. Click on any images below to enlarge.
Dr. Niamtu among distinguished faculty at St. Louis Facial Plastic Surgery Facelift Course Nov. 2010
Dr. Niamtu speaks in Vegas with other recognized facial implant experts
Dr. Niamtu speaks in Vegas with other recognized facial implant experts
Dr. Niamtu addresses osteopathic physicians on facial implants and facelift techniques
The brochure to the right 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 brochure to the right 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 brochure to the left is from an oculoplastic surgery meeting in Cervia Italy where Dr. Niamtu lectured on facial implants. Click on the image to enlarge.
The brochure to the right 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 brochure to the left 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 brochure to the right 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.
