Patients often ask: what is more suitable?
An osseous genioplasty or a chin implant?
A genioplasty can augment or reduce the chin for:
- Altering the profile of the chin and lower face by increasing or decreasing chin projection.
- Increasing or decreasing the height/vertical dimension of lower face.
- Narrowing of the chin and consequent narrowing of the appearance of the lower jaw for a more oval appearance.
- This can be done in combination with lower jaw recontouring.
- For feminisation or masculanisation of the face depending on patient requirements.
- In combination with facial implants such as lower jaw and cheek implants to alter appearance or facial recontouring procedures such as mandibular angle reduction.
- To improve or camouflage a lower jaw or facial asymmetry.
- As part of a lower jaw Osteotomy or a Bimaxillary Osteotomy for Orthognathic surgery or Sleep Apnoea surgery.
- Rhinoplasty patients often have recessive chins.
Advantages and disadvantages of an osseous genioplasty
- The majority of surgeons who are experts and experienced in an osseous genioplasty and who also have placed implants, would report that an osseous genioplasty is the optimal and most controlled technique of augmenting the chin, particularly with moves larger that 3-4 mm.
- It can be employed to surgically camouflage a deficient mandible where a mandibular osteotomy is not possible or desirable.
- A major advantage of an osseous genioplasty is that the result stays permanently where the surgeon fixes it. In a situation where there is an infection, it is normally treated with antibiotics and it resolves. In the unusual situation and subsequently the micro-plates require removal these can be removed without the osseous chin shifting away or changing its position, once the bone has healed: it is part of you and solidly mended. In my surgical experience the screws and plates from a genioplasty are removed in 2% of cases. The disadvantage is that another general anaesthetic is required to remove them.
- An osseous genioplasty has a text book risk of about 10% permanent alteration or permanent numbness to the lower lip/chin, lower anterior gums and even lower front teeth. The numbness maybe partial, total, a small patch, a big area or sometimes decreased sensation, paraesthesia, tingling pins and needles sensation that can last life-long. These same complications maybe experienced by a chin implant as well but more rarely. My personal surgical experience in 2 decades of performing these is one recorded case of numbness to one side of the lip which was permanent. I have done and continue to do a respectable number of these per year.
A chin implant can be considered for:
- Augmenting the profile of chin projection but not by more than 3-4 mm in most cases.
- A chin implant isn’t generally suitable for altering the height/vertical facial dimension.
- In combination with other facial implants to augment the face: chin, mandibular, and cheek implants. These can be custom made after a CT scan or off the shelf.
- Not generally considered for camouflaging facial asymmetry.
- In combination with a rhinoplasty, to augment the rhinoplasty result by giving a better chin profile, but generally not for more than 3-4 mm.
- In combination with a facelift and neck lift to give more support to the soft tissue elements, rejuvenate the face further and enhance the profile if that is needed.
As a rule of thumb chin implants are reserved for when:
- The chin enhancement forwards and in height is not more than 3-4 mm.
- Mostly reserved therefore for smaller adjustments to the chin and in combination with a facelift or rhinoplasty again when the adjustment is relatively smaller.
Advantages and disadvantages of implants:
- They can get infected, more so if inserted via the mouth. If they do get infected, a significant number need to be removed.
- If they are inserted from under the chin then there is a scar that is left under the chin, but in neck and face lifts this seldom bothers patients.
- The most commonly used off the shelf chin implants are made of silicone. I have removed many of these over the years as they sometimes drift, cause a feeling of irritation and almost always cause some resorption on the underlying bone. They also form a tough capsule around them which patients are normally not aware of. If removed, the chin the implant supported is often floppy and loose after the removal of these implants. This either needs to be accepted or an osseous genioplasty needs to be done.
- Advantages are that placement is almost always a day case or out patient’s procedure and less traumatic than an osseous genioplasty in terms of recovery.
- There is also a risk of temporary and permanent numbness to the lip and chin area (not in moving the lip or chin, but feeling/sensation), but less so than a genioplasty.
- Very suitable for patients undergoing simultaneous face and neck lifts who need extra soft tissue support or profile augmentation because a submental incision is made for the neck lift anyway, so it is ideal access.
- Suitable for augmenting the neck profile in older patients who need a better neck definition and who want a smaller procedure.
- Custom made chin and facial implants: the surgeon cannot alter the surgical plan on the table if it is felt that the overall result is not optimal. Having said that one can contour a custom-made implant to make it smaller, but it is not ideal. These also tend to be very expensive to make and not advisable if only the chin is done, but more suitable for multiple facial build ups.
- Silicone implants for breasts have been shown to have the possibility of giving rise to lymphomas and auto-immune conditions in a small number of patients.