Chin & Cheek Implants
To reduce the size of a large chin takes a very thorough evaluation either by an oral maxillofacial surgeon well versed in bimaxillary surgery (oral surgery of the cheek and chin region).
Facial balance is important when determining if someone has facial harmony. When you look at attractive movie stars, you are drawn to their facial harmony. The balance of the facial features makes them appear beautiful. When a chin is small or set back, the proportions of the face in profile seem off balance. All of a sudden, the nose looks larger, the neck seems more obtuse, and the face does not seem to be in appropriate harmony or balance. The same is true when the chin is too large. A large chin on a man denotes strength and power—it is “masculine.” The same chin on a woman, however, would make her seem too masculine. With age, a chin can begin to droop and look like a “witch’s chin.”
When I examine a patient for facial surgery, I am interested in facial balance. I will check the profile from the nasal bridge to the upper lip, and to the most prominent part of the chin. The “line” I use should be close to a straight vertical. If it is skewed one way or the other, it will determine whether the chin seems too prominent or too retrusive (set back or small). It is almost a predictor of personality for some patients. Men and some women with smaller, retrusive chins may be more shy than people with larger chins.
After determining facial harmony, I make recommendations to patients about what I think would work best to improve their profiles. Sometimes, it’s the placement of a small chin implant, which is a relatively easy operation to perform with very little risk. Other times, it’s actually necessary to move the entire lower jaw forward, a more involved operation, but one with beautiful and dramatic results.
Facial balance is important when determining if someone has facial harmony.
What can be Done with a Small Chin?
If a chin is small, there are a few different ways to enlarge it and improve the profile. The most common and probably the easiest for most surgeons is to place a Porex chin implant through a small incision inside the mouth or through an incision just under the chin in the small crease that most of us have. The simple procedure takes minimal time, and the recovery is relatively easy. After the operation, your doctor will instruct you to drink clear to full liquids for about ten days. There will be strict orders for minimal talking and laughing. Expect your lip to be swollen and uncomfortable for a period of time after the procedure if the incision is placed inside the mouth. It usually takes about five to six days to start feeling close to normal.
Most patients will be placed on antibiotics for approximately ten days following the procedure. There are very few complications with this type of procedure; however, it is important that you follow all instructions set forth by your oral and maxillofacial surgeon. Most surgeons recommend mouthwash irrigation every four to six hours. Infections are rare, but if they do occur, patients are placed on antibiotics and usually improve over a short period of time.
What About a Huge Chin?
A large chin can denote strength and be very desirable; however, if it seems out of proportion to the rest of the face, it may be necessary to “trim” some of the size of the jawbone. This can be done through small incisions just inside the lower lip and just underneath the chin. Before any of this is done, however, your surgeon will spend time evaluating your photographs, X-rays of your face, and your occlusion (bite), or how your teeth fit together.
First and foremost, we must evaluate how the teeth fit together. Some patients with really prominent chins have a prognathic jaw line. In other words, their bottom teeth are in front of the upper teeth when the teeth come together. If this is the case, the jaw must be repositioned. Sometimes the surgeon only needs to set back the lower jaw. Other times the upper jaw, called the maxilla, needs to be set forward because the lower jaw, called the mandible, is just fine, and it is the midface (the area of the cheekbones and upper lip) that needs improvement. Whatever it is, the chin needs a very thorough evaluation with X-rays and the appropriate specialist.
If the dentition is fine and the teeth fit together well, then it becomes a relatively easy problem to correct. The bony tissue needs to be burred (literally) down to a size that is more cosmetically pleasing. This can be performed under general anesthesia or heavy IV sedation rather easily through an incision located just under the chin or inside the mouth.
What About a Nice Square Jaw?
A large majority of patients are extremely happy after these procedures.
The procedure of creating a square jaw line, similar to that of many models you see on magazine covers, is one that has been around for about five or six years. The operation is for those that have a very long-looking face and need some “facial width” in their faces’ lower aspect.
The operation is performed under general anesthesia. Incisions are made inside the mouth along the lower aspect of the cheek. Small pockets are developed, and implants in the shape of an “L” are placed right along the side of the jawbone.
Again, it’s important to remain on liquids and soft foods for two to three weeks after the procedure. Most surgeons ask that any dental work be postponed for six months after placement of any facial implant.
Major facial swelling improves in the first few weeks, but expect to have some persistent swelling for about two to three months, and expect your lip to be numb. It will feel like it doesn’t belong to you, as when you are injected with Lidocaine at the dentist, but this will all get better with time. Prepare to see a pleasant improvement in facial harmony following any one of these operations. A large majority of patients are extremely happy after these procedures.
With the development of cheek implants, a face-lift no longer is recommended as a first step toward a youthful, healthy appearance.
Prominent cheekbones are the current rave among cheek implant patients these days. As an oral and maxillofacial surgeon, I can’t help but notice faces all the time. They make the face more youthful in appearance, less tired, and less old.
As we age, we lose facial fat in the cheek area, causing it to droop and hang down toward the mouth. With the development of cheek implants, a face-lift no longer is recommended as a first step. The cheek implant can be placed through an incision just inside the mouth. This creates a partial lift, which brings a more youthful, vibrant, healthy appearance to the face.
The surgery itself is usually done under general anesthesia or IV sedation. The surgeon will make small incisions inside the mouth near the cheek. Before the operation, he or she will mark your skin with the positioning of the implant.
Once a perfect pocket has been developed, the surgeon will place the appropriate-size implant in the cheek area. The incisions will be closed. Afterward, expect to stay on clear liquids and soft foods for three to four weeks. You will also be on antibiotics for at least a week. Following the operation, expect to be quite swollen for several days. It is very important to limit the amount of talking and laughing that you do. Most of my patients are instructed to limit the amount of tooth brushing (using only a baby’s toothbrush), and to use a specific mouth rinse for several days several times a day. Expect to be somewhat swollen for three months. The initial swelling will diminish in about four weeks. You probably won’t feel comfortable with your final appearance for another three months after the operation. You can’t smile; your smile may be a little crooked initially; and it may not seem at all like you. With time, however, you can expect a full recovery.
Problems with Cheek Implants
It is extremely important that you remain on antibiotics as prescribed by your surgeon. One of the most common complications following this procedure is infection. If, for any reason, postoperatively you develop drainage from the incision or redness and swelling around an implant, it needs to be evaluated by your surgeon. Rarely will the implant have to be removed due to infection. If the surgeon suspects an implant is infected, he will tap the cheeks to see if he can express any fluid that may be sitting around the implants. This can easily be drawn off with a needle and syringe in the doctor’s office.
Occasionally, the implants need to be repositioned. One may slide from its appropriate location. In this case, it is very simple to remove the implant and reposition it. Discomfort from the cheek implants can occur, but it is rare and gradually improves with time.