Chin Implant

A chin implant can enhance the contours, shape and balance of the face by increasing the projection of the chin and strengthening the jawline. Implants may be used as an isolated procedure or combined with other surgeries to provide symmetry and to create a balanced rejuvenation of the face.


The chin is the most important aesthetic feature of the lower face, and together with the nose determines facial shape and profile. A prominent chin strengthens the jawline and prevents soft tissue ptosis and the formation of jowls.


There are two ways of improving lower facial proportions: 1) the use of implants, or 2) surgical reshaping of the jawbone (genioplasty).


Chin implants are by far the most frequent solution employed for aesthetic enhancement of receding chins. It is a gentle and straightforward surgical procedure that adds volume and structure to the jaw without changing the patient’s natural-given anatomy.


Genioplasty, a more complex procedure, alters the shape of the jawbone and is a technique especially useful for the correction of deformities (reconstructive surgeries) or for the adjustment of pronounced cases of receding chin which are not suitable for chin implants.



This article focuses on the use of chin implants and on the aesthetic improvements that can be achieved by chin implant surgery.

Chin and jawline anatomy

The mandible (or jawbone) frames the mouth, holds the teeth and provides the foundation for the soft tissues of the face and neck. It is also a point of muscular attachment essential for movement of the mouth. The chin is the raised prominence of the mandibular bone, composing the lowermost part of the face; for this reason it is one of the primary components that determine facial shape.


With age, gradual and progressive bone resorption results in decreased mandibular height and reduced chin projection. This may change the balance between the lower third and upper two-thirds of the face, and can result in a ‘weak chin’ that often becomes more pronounced with age.


If the height and buttress of the jawbone is reduced, the surrounding soft tissues become prone to laxity and yield increasingly to gravity, which is especially noticeable on the front half of the jawline and on the neck (double chin).

Analysis and assessment

The simplest means of assessing chin positioning and possible facial disharmony is to take measurements relative to the chin line (chin meridian). The ideal positioning of the chin can be determined by superimposing a line on a photo of the facial profile. If the chin falls behind the line, it is an indication of microgenia (receding chin) in the horizontal direction, which can be corrected with genioplasty or an implant.


During a chin implant consultation, calibrated measurements will determine the degree of projection required and reveal possible asymmetries. Proportions, facial topography and aesthetic preferences are taken into account, and a functional analysis can identify bone quality and whether an underlying dental occlusion is present.

Anatomical chin implants (blue) are used to improve the projection of the chin by augmenting the lower portion of the mandible. In addition to improving contour of the jawline and facial balance, a chin implant will also support the soft-tissue and prevent jowls.

Enhancement with implants

In the case of facial contouring, implants provide localised enhancement of the mandibular bone, the effects of which are conveyed through the soft tissues to the surface of the skin as improved contours.

 

By providing structural support to the overlying facial soft tissues, implants counter gravitational changes, restore fullness and offer a lift with gentle skin expansion. It also provides a ‘forward push’ to all the soft tissues of the jaw, including the superficial neck muscle, such that neck contours usually become better defined.

Implant shape and size

Implants come in several pre-formed shapes suitable for both males and females, and accommodate a wide range of requirements. Each shape is available in several sizes according to the dimensions of the mandibular bone. Variables include thickness, height and point of maximal projection.

 

All implants may be further refined during placement (in-place contouring) to accommodate the specific needs of the patient.

 

Today’s gold standard for chin implants encompasses a number of alloplastic (non-biologic) materials with high bio-compatibility, such as silicone, PEEK (Peek-Optima), ePTFE (Gore-Tex) or high-density porous polyethylene (Medpor).

Types of implants

 

● Central chin implants

The original chin implant shape, it provides various degrees of chin projection and to a lesser extent changes to the jawline.

 

● Anatomical chin implants

A modern implant design that provides enhancement of both chin and jawline. This implant simultaneously provides chin augmentation as well as mild to moderate contouring of the front part of the jaw. Two wings positioned at 45-degree angles allow the implant to blend around the front portion of the mandibular bone, providing stability and smooth contours.

 

● Extended anatomical chin implants

An extended version of the anatomical implant. These implant's wings are extended in length to provide further enhancement of the jawline. They taper along the lower mandibular ridge (wrap-around design) for the restoration of the mandibular buttress and to counter jowls. Specialised extended chin implants may also be used to widen the jaw or to provide more angular or square definitions, something especially suited for male chin/jaw enhancement.

 

● Mandibular implants

Implants used to augment the angle of the jaw and increase width and jawline definition in the frontal view. These implants are often used in combination with anatomical implants or extended chin implants, as the combination enables a complete re-contouring of the jaw.

 

● Custom implants

For reconstructive purposes or complex aesthetic requirements, a Cone Beam CT Scan is used to develop customised three-dimensional implants (PEEK implants). Custom implants can effectively correct mandibular bone deficiencies or asymmetries.

A mandibular implant (red) combined with an extended anatomical chin implant (blue) provides complete contouring of the jawline. Mandibular implants will increase the width and angularity of the lower 1/3 of the face when viewed from the front.

Implant positioning and refinement

Implants can be inserted either through the mouth (intra-oral positioning) or from below the chin (sub-mental positioning). Both are reasonable options. The main advantage of the intra-oral route is that it does not result in visible scarring.

 

For aesthetic surgeries using silicone implants, the implants do not usually need to be fixed to the mandibular bone as it is sufficiently secured within the narrow pocket between the bone and the sub-periosteal space (sheet of soft tissue that covers the bone).

 

For reconstructive surgeries or contouring with PEEK or high-density polyethylene implants, fixation of the implants to the mandible is usually required. Screw fixation (small titanium screws) will ensure instant stability, allow in-place refinement of the implant shape, prevent displacement and eliminate any gaps between the implant and mandibular bone.

Recovery after chin implant surgery

Recovery is usually uneventful and most patients go home the day of surgery. A bandage may be left over the chin to reduce swelling (usually removed the next day). A small dressing may be used to cover the chin for 7-10 days. Recovery is usually quick and is not associated with excessive pain or discomfort. Food should be liquid-to-soft for a week to avoid excessive chewing during the healing process. Transient paraesthesia (numbness) to the chin or lower lip is normal and typically resolves within weeks.

Expected surgical outcome

Implants can provide discrete enhancements or significant improvements alike. The average increase in chin projection is 4-8 mm. If improvement to the jawline is desired, an addition of 3-4 mm is usually sufficient to restore contours and counter jowl formation. Once positioned, chin implants will look and feel like normal bone. The tapered anatomical shape ensures that implants blend into the mandible and deliver smooth transitions. Results of chin augmentation are generally associated with a high degree of patient satisfaction.

 

Chin clefts come from the soft tissue and are not a function of the bone itself. As such, a cleft may persist even with a chin implant. For cleft removal (for example in female chin rejuvenation), a complementary fat grafting procedure is used to soften chin contours.

Safety and predictability

Chin and mandibular implant surgeries are associated with few complications. Revision surgeries often relate to local infections or aesthetic re-contouring (2-3%). Should this be required, implant removal is generally straightforward.

 

Alloplastic implants have been used for chin and jawline contouring for more than 50 years and the materials currently used (silicone and polyethylene) are safe, with good tensile strength, non-allergenic, biocompatible and very stable in the long term. More recent developments in implant design have especially focused on implant texture and porosity to enhance implant-tissue integration.

Chin implants combined with other surgical procedures

All tissues of the face (bone, soft tissue and skin) are closely interlinked. Whether the goal is to improve facial feature structure or to rejuvenate, the best results are often achieved when synergistic procedures are combined.

 

For example, the aesthetic improvement to the facial profile of a nose correction (rhinoplasty) is often vastly enhanced by simultaneous augmentation of the chin. For patients having a face-neck lift procedure, adding a chin implant will often significantly improve the results and help redefine both jawline and neck.

 

For the purposes of volumising facial contours, fat transfer (fat grafting) and facial implants also work well in tandem; implants enhance the underlying bone structure and fat transfer the overlying soft tissues.

Conclusion

Chin implants provide predictable and permanent results. They maintain their shape, do not suffer from reabsorption and improve on the natural structural appearance, which enhances the overall contours and aesthetic balance of the face.

A wide range of implant types, shapes and sizes offer great flexibility and potential for significant modification. Used either as an isolated procedure or in combination with other facial surgeries, chin augmentation is one of the most effective ways to obtain natural-looking three-dimensional enhancement of the chin and jawline.

Dr Sorensen's general recommendations for chin and jawline enhancement

 

Chin implants

●  Men/women with a mild to moderate receding chin

●  Men/women with jowls and a sagging jawline

●  Men/women with a loosely defined neck

●  Men/women with congenital or post-traumatic defects

●  Men who desire a well-defined 'strong' (square) masculine chin

●  Combination with other facial surgeries to improve on facial contours

 

Mandibular implants

●  Men who desire a wider and well-defined 'strong' masculine jawline

●  Men/women with a hypoplastic (underdeveloped) mandible

 

Customised implants

●  Men/women with complex aesthetic requirements

●  Men/women with contour deficiencies, irregularities or asymmetries

 

Osseous genioplasty / mandibular osteotomy

●  Men/women with a pronounced receding chin

●  Men/women with an elongated chin

●  Men/women with functional deformities or asymmetries

 

Fat transfer

●  Men/women who have lost soft-tissue volume (atrophy)

●  Men/women who require a conservative contouring of the chin and jawline

●  Men/women with soft-tissue deficiencies and asymmetries along the jawline

 >     Mandibular Implants

Chin Implant

Anatomically shaped silicone chin implant with grid pattern, allowing the implant to closely conform to the mandibular bone [+]

Mandible

Adult jawbone, outer surface (side view). The mandible is the largest and strongest bone of the face. The chin is the raised prominence (Mentum) of the front body of the mandibular bone.

Modern anatomical chin implant provides a proportionate aesthetic enhancement of both chin and jawline

Specialised extended anatomical chin implant for male contouring, providing a strong, defined and square profile

Classic central chin implant for female chin augmentation.

The short wings allow the implant to blend into the bone providing a smooth single-point projection