Plastic surgery options for patients with a small or recessed chin

"Doctor, I have no chin." I can't tell you how many times I hear that from a patient. It is a regular concern of many of my cosmetic facial surgery patients. In a majority of these cases, the patients report that they had prior orthodontics at one time in their life. And, in most of these cases, the patients usually states that they had a deep overbite.

Cosmetic chin surgery (genioplasty) can be performed on patients who have: a recessed or small chin, a large or protruding chin, or an asymmetric or crooked chin. During the consultation, the surgeon will examine not only the patient's profile, which is usually the most concerning to the patient, they will examine the patient's "dental bite" or occlusion. I will be reviewing "small or recessed" chin in this blog, and other chin deformities in future posts.

Pre-operative evaluation

The surgeon may recommend that the patient have a special radiograph to evaluate the boney architecture of the jaws, and its relationship to the skull bones (cephalogram). In a majority of the cases, the patient's lower jaw is anatomically positioned further back than normal, in comparison to the upper jaw.

Treatment options

Alloplastic genioplasty

If the patient is only cosmetically concerned about their small chin, and not the position of their teeth or jaws, then there are two common options for this patient. The patient can have the placement of a chin implant. The implant is fabricated from a form of synthetic material. The implants come in many sizes and shapes. The surgeon will perform measurements of the patient's facial aesthetics to determine what size implant will give the patient the cosmetic profile desired. The implants are surgically placed through an incision either through the mouth or under the chin. The surgery is commonly performed as an outpatient procedure with the assistance of local anesthesia and/or intravenous sedation.

Horizontal Sliding Genioplasty

This is another form of surgical procedure, in which the "boney" chin is surgically cut with a precision saw from inside the mouth. This boney chin segment is horizontally "slid" forward, giving the patient an enhanced chin profile. The boney segment is then secured and fixated in this new position, with a combination of specific plates and screws. In this procedure in comparison to the above, the patient's own bone is used to perform the augmentation vs. a synthetic implant. However, the extent of the surgery and postoperative course is greater.

Additional cosmetic facial surgery

I commonly recommend and perform a genioplasty (chin implant) on patients in combination with a facelift or neck lift. Chin implants are also commonly recommended in cases of rhinoplasty when the patient presents with a recessed chin. This presentation actually makes the nose appear larger and out of proportion to the rest of the face.

Postoperative course

The patient may be placed into a compression dressing on the chin for 3-5 days after surgery. There will be moderate swelling and bruising of the chin and neck region for 7-10 days after the surgery. In the case of the sliding genioplasty, there is a chance of numbness to the lip, usually temporary, after the surgery. This is due to the extent of the swelling, and stretching of the soft tissues forward. In both types of genioplasty, the final cosmetic results are not apparent for approximately 2-3 months after the surgery, to allow for all of the swelling and bruising to resolve.