by Bellevue | Seattle’s Dr. Philip Young | Aesthetic Facial Plastic Surgery:

This is a response to a question that I answered for a person who had a procedure by another doctor:

Chin implants can have a tremendous impact on your looks. Because it is placed in the lower third of your face it will have the most impact in this area. But overall, it can change the appearance of your face as a whole to a great degree.  The changes to a box like appearance instead of an oval can definitely happen.  It might improve a little more over the next couple of months since you had it in the spring and right now it is fall going on winter. Your Physician will know the best on what to do.  But you can replace the implant. Work with the implant that you have in there by sculpting it.  It will most likely entail either a smaller implant, a more tapered implant and still you might need further tailoring of the implant to have it fit your face better. During the procedure, I will often assess the appearance of the implant and do contouring of the implant and the bone around the chin to help with this tapered look. Most surgeons just place the implant in and get results that will approximate what you want. Sometimes it takes a little extra time to shape the area and implant to achieve the best results. Here is a link to chin implant videos for you to learn more about this procedure.

chin-implant-before-after

Cheers!, Dr Young

Dr Young specializes in Facial Plastic and Reconstructive Surgery and is located in Bellevue near Seattle, Washington

Chin implant’s (Dr Young, Aesthetic Facial Plastic Surgery in Bellevue, near Seattle, WA) can enhance your profile and are much easier to recover from compared to a genioplasty.  A sliding genioplasty involves cutting through your chin bone and advancing it.  This can lead to issues such as longer recovery, nerve injury chances are increased, step off deformities can occur, there is much more pain with it, and the advanced bone segment can loss volume. It is harder to demonstrate the changes from the frontal view.  It requires your doctor changing the way the light hits the chin to show the changes.  For women, the chin implants always need to be done in a conservative way.  Generally, there are many options for augmenting your jaw including where on your jaw (location) and how much. There are many different types of implants that you can choose from. Also, there are different types of material and I generally prefer to implant silicone or medpor (porous polyethylene). Silicone is a the most common option. It is soft, does not get incorporated within your tissues but has a capsule formed around it. The advantage is that it can easily be removed and replaced with a bigger or smaller implant with relative ease. Medpor is stiff, and grainy to the touch and gets incoporated into your tissues. The incorporation makes the medpor implant more resilient to infection. But this incorporation makes it harder to remove the implant if you want to change it. Here is a video on chin implants.

Thanks for reading, Dr Young

Dr Young specializes in Facial Plastic and Reconstructive Surgery and is located in Bellevue near Seattle, Washington

This was the question:

I’d like to get some information on chin shaving. Overall, I’d say that I have a chin that is long (in the vertical direction). I would estimate my reduction would be somewhere around 7-8 mm. I read a blog website that chin reduction in the vertical direction is usually done via removing a wedge between the upper and lower portions of the chin, rather than shaving off the bottom – where a witch’s chin deformity may result. Is this the procedure you would recommend, or it is just one Dr’s preference ? Would this procedure be done under general anesthetic ??

That is one way of doing things.  But if you read more articles on chin shaping (Dr Young is in Bellevue, near Seattle WA), the articles reflect the opinion of many people doing this, is that when you cut a wedge of bone there are other risks.  You are more likely to get nerve damage.  After you remove the middle part of the bone, it usually creates a step off on the sides that makes it more difficult to smooth out.  Also after doing the wedge of bone you need to use plates and screws to fix the bone cuts.  The bone that is left also has the potential to become devascularized and lose volume.  Also this method doesn’t allow you as much room for contouring the soft tissue after the reduction. If you try to contour the soft tissue like skin etc you can further devascularize the bone segment. Also this procedure can be done under local and iv sedation.  Also I would approach this from the outside under your chin.  I would not go through your mouth as this leads to more complications. Here is a video on chin reduction for you to see.

Thanks for reading,

Dr Young

Dr Young specializes in Facial Plastic and Reconstructive Surgery and is located in Bellevue near Seattle, Washington

So a common question is would I benefit from a chin augmentation (Dr Philip Young Seattle/ Bellevue Wa)?  I addressed this question in a recent blog but I didn’t talk about the vertical component.  How much vertical augmentation do I need and do I even need to add anything to the vertical dimension of my chin? Firstly, it is good to have some anatomical terms to refer to. In the first picture, the Glabella, labelled “G” is the most projecting point on the lower parto f the forehead and is usually right between the eyebrows. The nasion, labeled “N”, is the most depressed point below G and is usually at the root of the nose.  The Subnasale, labeled “SN”, is the point of transition from the nose to the upper lip.  It is where the nose, columnella, intersects the upper lip.  The upper vermillion is the point of transition from the white part of the upper lip to the red portion of the lip (Called the Vermillion) and is labeled “VU”. The same point coinciding with the lower lip is labeled “VL”. The Pogonion, labeled “PG”, is the point of the chin that is the most projecting anteriorly.  The mentum, labeled “MN”, is the most inferior portion of the chin.  One thing to be careful of is when the patient has a double chin.  The mentum is the part of the chin that is associated with the chin and not the inferior part of the sagging that can occur under the chin and posterior to the chin. The first rule for vertical augmentation is based on three lines drawn through the glabella, subnasale, and mentum.  Each of these distances created by these lines should be equal.  If your chin is making the distance from the mentum to the subnasale shorter than the distance from the subnasale to the glabella, you could benefit from a vertical chin augmentation.  If it is longer than you could benefit from chin reduction. This is shown in the second picture.  Now, if you draw a line through the nasion instead of the glabella the distance from nasion to the subnasale should be 43% and the distance from the subnasale to the mentum should be 57% o the total distance from nasion to mentum.   If the your distance from subnasale to the mentum is less than 57% you could possibly use some vertical enhancement.  the In the third picture, three lines are drawn through the subnasale, stomiom (or the opening between the upper and lower lips), and the mentum. The ratio of the distance from subnasale to the stomiom to the distance from stomiom to the mentum should be 1:2.  If the distance from your stomiom to the mentum is less than this ratio, you could benefit from vertical enhancement or an increase of the vertical dimension of your chin.  Below are some results of chin augmentation for you to see how a chin implant could enhance your appearance.

Thanks for reading, Dr Young

Dr Young specializes in Facial Plastic and Reconstructive Surgery and is located in Bellevue near Seattle, Washington

Profile Landmarks

Facial Thirds

Mouth Ratios

Before Chin Augmentation

After Chin Augmentation

Before Chin Augmentation

After Chin Augmentation

Genioplasty or Chin Implant (Dr Philip Young, Seattle) to move the chin forward without increasing the vertical height during chin cosmetic surgery (or chin plastic surgery, chin enhancement surgery).  This can be done but can be tricky.  Anytime you project the chin forward, because the chin is usually angled in a inferior direction and not horizontally straight (you can see this by using two mirrors and looking at your side profile), Any lengthening of the chin will cause some vertical lengthening.  You can avoid this by making some adjustments to the chin implant, by tailoring the bottom of the chin implant.  The other more advanced way is to reduce the vertical chin height by taking the bone down in the vertical dimension and then augmenting it more horizontally.  In general genioplasty is favored among plastic surgeons due to the easier procedural steps, less complications, and less operation time to name just a few reasons.

I hope that is helpful.

Thanks for reading, Dr Young

Dr Young specializes in Facial Cosmetic and Reconstructive Surgery and is located in Bellevue near Seattle, Washington