First, it was breasts. Then, it was hips, lips, and buttocks. Now, patients’ insatiable appetite for aesthetic surgical procedures has seized upon another part of the body: the chin. Plastic surgeons in Britain, for example, are reporting a 35% increase in the number of patients—male and female—who are seeking surgical chin enhancement.

“The thrust of minimally invasive cosmetic surgery has fueled the popularity of cheek and chin implants,” says Joseph P. Niamtu, DMD, of Richmond, Va. “A chin implant can be placed in a half hour, and with local anesthesia if desired. If the patient does not like the result, the implant can be easily removed, making it a reversible procedure.

“Patients are very sensitive to their profiles, and a weak chin has a lot to do with confidence and body image. Weak personalities are often characterized by recessive chins. The ability to normalize the profile and enhance self-confidence in a small, reversible, and affordable procedure is a very attractive option.”

The Procedure
Chin surgery, also known as mentoplasty, reshapes the chin either by enhancement with an implant or by surgery on the bone. A plastic surgeon may recommend chin surgery to a patient who is having nose surgery to achieve facial proportion, because the size of the chin may magnify or shrink the perceived size of the nose.

“Although often overlooked, the chin is one of the major architectural elevations of the facial skeleton, providing the structural foundation for aesthetic facial beauty,” says Benjamin Bassichis, MD, FACS, Advanced Facial Plastic Surgery Center in Dallas.

“The goal of chin augmentation is to restore overall facial harmony and balance, both in frontal and profile views. A small chin can give the illusion of a larger nose and imbalanced or even sagging facial features. Chin augmentation redrapes the skin of the lower face as well as reorchestrates the elements of facial proportion for an improved cosmetic result and a more contoured and pleasing face.”

When patients look in the mirror, they focus on the size and shape of their noses, their ears, sagging jowls, or fine wrinkling of their skin. Even though few examine their chins with the same discerning eye, having a “weak chin” is certainly not an asset, according to physicians.

To augment the chin, the plastic surgeon makes an incision in the natural crease line just under the chin or inside the mouth, where the gum and the lower lip meet. By gently stretching the tissue, the surgeon creates a space where an implant can be inserted. Implants, made from synthetic material that feels much like natural tissue normally found in the chin, are available in a wide variety of sizes and shapes. This allows the implant to be custom fitted to the configuration of the patient’s face. After implantation, the surgeon uses fine sutures to close the incision. When the incision is inside the mouth, no scarring is visible.

In chin-reduction surgery, incisions are made either under the chin or inside the mouth. The incisions give the surgeon access to the bone and the surrounding tissue. The surgeon uses specialized instruments to reduce and reshape the bone. When the procedure is complete, the incisions are closed with small stitches.

Postsurgical Recovery
Immediately after surgery, the surgeon applies a dressing that will remain in place for 2 to 3 days. Patients experience some tenderness, and postoperative discomfort can be controlled with prescribed medications. Chewing will probably be limited immediately after chin surgery, and a liquid and soft food diet may be required for a few days. Most patients feel a stretched, tight sensation after the surgery, which usually subsides in 1 week.

Physicians note that after approximately 6 weeks, most of the swelling is gone and patients can enjoy the results of their procedure. Rigorous activity may be prohibited for the first few weeks after surgery. Normal activity can be resumed after approximately 10 days.

Is It Right for Your Patient?
As with all elective surgery, good health and realistic expectations are prerequisites for a successful outcome. It is important that patients understand all aspects of the surgery, including the different methods of surgery. A balanced profile can be achieved by inserting an implant, by moving the bone forward to build up a receding chin, or by reducing a chin that is too prominent. Another possibility is submental liposuction, in which excess fatty tissue is removed to redefine the chin or the neckline.

During consultations, it is imperative that physicians help patients decide on the type of surgery that addresses their concerns. Physicians should also provide information on new medical techniques for chin surgery and offer recommendations for supplementary surgery that can ensure the greatest improvement.

“I use chin implants on more than 50% of my chin surgeries,” Niamtu says. “I tell my patients that the facelift is the cake and the implants are the icing. This little procedure can make a huge difference in the overall look of the patient. As far as I am concerned, facial implants have been one of the best-kept secrets in facial surgery. It appears that the secret is out!”