If you feel you have a problem with your chin or jaw then you need to be assessed regarding your chin, jaw and dental occlusion. Sometimes the actual jaws themselves maybe either too small or too large and the dental occlusion may need adjustment with braces and jaw surgery combined. This type of treatment is known as orthognathic surgery and involves input from both a Consultant Maxillofacial surgeon and a Consultant Orthodontist.
All patients considering chin and jaw surgery should be assessed with appropriate x-rays which look at the amount of bony movement required at surgery and also assess the jaw for any dental or bony pathology which may affect surgery.
If you have a large chin then surgery maybe undertaken in one of two ways to reduce the size.
1. A simple shaving of the chin may take away any undue pointedness of the chin and reduce the projection of the chin. This can be undertaken through a small incision in the mouth or alternatively an incision underneath the chin.
2. If you chin is quite large then a simple shaving may cause problems with excess soft tissue and sagging (ptosis) of the tissues overlying the bone. In this case a procedure to make a small bone cut across the chin and move it back may be necessary. The bone of the chin is usually fixed with some small plates and screws which remain in place following healing. This allows the soft tissue to remain attached to the bony chin surface and reduce the possible soft tissue ptosis following surgery.
If you have a small chin then there a number of options which can be considered in order to give your jaw and face a better appearance. If your chin and jaw is of a normal height and width then a chin implant may be suitable to improve the projection of the chin. Generally implants are suitable for smaller advancements and if larger movements or movements are needed to change the width or the height of the chin then a genioplasty should be considered.
Genioplasty or Implants ?
These have been made from a number of materials but the commonest ones on the market today are:
All of these implant materials have been shown to be safe materials for this type of surgery. Implants maybe placed from an incision made either inside the mouth or from an incision made under the chin. The implant is placed adjacent to the chin point and fixed into position with either sutures or small screws and the wound is closed using resorbable sutures in the mouth or non-resorbable sutures under the chin.
Limitations of chin implants mean that they can only provide an augmentation of the chin without changing the vertical height or the width of the chin. They are usually placed for smaller chin augmentations. They risk getting infected and if this occurs the implant may need removing. This then needs to be either replaced once the infection has settled or a genioplasty undertaken. Sometimes the implant can cause wear on the underlying bone and occasionally cause damage to the underlying dental roots. They also can sometimes move around after placement unless securely fixed with screws. Sometimes the edges of the implant can be palpable.
Genioplasty is a procedure that is often perceived as more invasive than the use artificial chin implants as it means making a cut in the bone to move the chin. However, longer term the bones heal into the new position and the new chin is just a normal part of the bony skeletal framework of the face. Problems such as implant movements, infection, bony erosion and implant rejection do not occur. The bony fragments are fixed together during the healing process with small titanium plates and screws which usually remain in place. These can occasionally need removal if they get infected but this is a minor procedure and does not affect the position or appearance of the chin.
Another advantage of the genioplasty over a chin implant is that if the bony chin is advanced, the muscles that support the floor of the mouth and the upper part of the neck are also advanced as they attach to the posterior aspect of the chin. This will therefore improve the contour of the neckline at the same time.
The bony genioplasty also offers much greater versatility than an implant. As well as moving the chin forward or backward, you can also change the vertical height or the width of the chin by removing a small amount of the bone to reduce the height or the width, or by grafting to increase the height or the width of the chin. Grafting can be with either the patients own bone (preferred) or with a bone substitute which over a period of time (usually 12-18 months) will allow normal bone healing into the gap.
Chin surgery is usually carried out under general anaesthesia although sometimes can be performed under local anaesthetic with or without sedation if requested. Patients are usually discharged home following a one night stay in hospital although some patients having chin implants or a minimal chin reduction may go home the same day.
Some bruising and swelling will occur for the first few days and recovery to normal activity takes 7-14 days. The final shape of the new chin may not be fully appreciated until a number of months following surgery when all the swelling and tissue oedema has settled.
If an intra-oral approach is used then a soft diet is usually recommended for the first few days in order to allow the wound chance to heal. Antibiotics and mouthwash will usually be given and good oral hygiene is very important during this time.
Any sutures placed in the skin should be removed 6-7 days following surgery.
Complications of any surgery include the risk of bleeding, infection or damage to adjacent structures. In the case of chin surgery there are nerves that supply sensation (feeling) to the lower lip. These can be stretched and bruised causing the lip to feel numb or tingly. This is usually temporary although can take weeks to months to recover and in a small number of cases can persist permanently. The skin overlying the chin point can also feel numb following chin surgery, again this will usually recover with time.
The teeth can also be damaged in this type of surgery and this is why x-rays are undertake to assess the position and length of the teeth as well as to assess for any pre-exisitng dental or jaw problems.
Repeated chin surgery can weaken the muscle that helps support the chin tissues during talking and eating. If you require repeat chin surgery then occasionally we may recommend additional fixation of the soft tissues to try and prevent against problems with the soft tissues long term.
Chin implants are made primarily of a soft, rubbery, flexible material such as solid silicone that is inserted through a small incision under your chin.
The chin augmentation operation is usually performed using light sleep anesthesia or, if combined with other procedures, general anesthesia. This procedure takes from one to two hours to perform. The incisions will be placed as inconspicuously as possible, either inside the mouth or under the chin .The implant may be screwed into the jawbone to attach it firmly and permanently.
A sliding genioplasty, or chin advancement, is a surgical procedure that entails cutting a piece of bone from your lower jaw, sliding it forward and reattaching it to the jawbone. The incision for a sliding genioplasty is made within the lip.
Immediately following your chin augmentation surgery you may feel some mild to moderate discomfort which should be controlled with prescription painkillers from your surgeon. Due to the increased volume of the implant and natural swelling from the surgery, your chin may feel tight; this should disappear within two weeks. Your surgeon may apply tape to hold the implant in place and control swelling after surgery. If your stitches are inside your mouth, your diet may be limited to soft foods and you may be required to rinse with mouthwash for several days following the procedure. Your new chin should be fully apparent in about four weeks.
The sutures will be removed in approximately three to five days. The removal itself should not hurt.
There may be scarring. The degree of chin augmentation scarring depends on the incision technique used. If the incisions were made inside your mouth, the scars will not be visible. If external incisions were made, they should be hidden under the chin.
You can expect to resume regular activities in about one week and can usually return to work in a week also.
The results are immediate. At first you may think the implant is too big due to the swelling, but give it time. You may also need to adjust to the overall look of your new chin.
There is a chance of hematoma , seroma , numbness from nerve damage, implant shifting, asymmetry, and general dissatisfaction with the final results. Some complications may require revision surgery.
The silicone chin implants are made to last your lifetime, especially if the implants are the harder variety and are screwed into place.