We had an extensive discussion about chin surgery, also known as genioplasty or mentoplasty. A well-proportioned chin plays a major role in facial balance. It influences your profile, jawline definition, and how your neck looks from the side. The goal of chin surgery is not perfection. It is facial harmony that looks natural on you, as if you were simply born with better proportions.
Understanding Chin Position and Facial Balance
We reviewed how the chin affects overall facial aesthetics:
- Profile balance: A properly positioned chin creates an attractive line from the forehead through the nose to the chin.
- Lower-face proportion: The chin should balance the midface and upper face.
- Jawline definition: Adequate projection supports a clean jawline.
- Neck definition: A stronger chin improves the chin-to-neck angle, making the neck look tighter and more defined.
Chin Deficiency (Microgenia)
When the chin is under-projected or recessed, it can cause several aesthetic concerns:
- A weak or recessive profile where the chin seems to disappear into the neck
- A heavier or less defined neck, even in thin individuals
- The nose appearing larger because the chin is not balancing the profile
- Shortened lower-face height
- Reduced jawline definition
Chin Excess (Macrogenia)
When the chin projects too far forward or is too large for the face, it can also disrupt balance. Concerns may include:
- An overly prominent profile
- A lower face that dominates other features
- An aggressive or overly masculine appearance
- Difficulty achieving facial harmony
Chin Augmentation for Chin Deficiency
Unlike the cheeks, where descended tissue can sometimes be repositioned, a deficient chin usually needs structural augmentation. For most patients, chin implants provide the most predictable and lasting improvement.
Medpor Chin Implants as the Gold Standard
Dr. Freedland uses Medpor (porous polyethylene) implants almost exclusively for chin augmentation.
- Secure fixation: The implant can be anchored to bone using titanium screws, preventing shifting.
- Tissue integration: Your tissue grows into the implant over time, stabilizing it naturally.
- Long-term stability: Once integrated, it becomes essentially permanent.
- Lower complication rates: Reduced infection and migration risk compared to smooth implants.
- Natural feel: After healing, it feels like your own bone.
Why Not Silicone Implants?
Smooth silicone implants cannot be anchored to bone and have a higher risk of shifting in the future. Medpor with screw fixation provides superior long-term stability.
Surgical Technique for Chin Implants
Chin implants can be placed through an incision inside the mouth or under the chin. Dr. Freedland prefers the submental approach (under the chin) for several reasons:
- Lower infection risk: Avoids exposure to oral bacteria.
- Reduced nerve injury risk: Keeps the implant placement below the mental sensory nerves.
- Better visualization: Allows optimal positioning and shaping.
- Minimal visible scarring: The incision is small and well hidden under the chin.
During surgery:
- A pocket is created on the surface of the chin bone.
- The Medpor implant is shaped and positioned to achieve the desired projection.
- The implant is secured with titanium screws drilled into bone.
- This fixation prevents movement or migration.
Alternative Augmentation Options and Their Limits
- Temporary fillers: Hyaluronic acid fillers can offer a short-term preview, but they rarely provide enough correction for true structural deficiency.
- Fat grafting: Fat survival in the chin is unpredictable because the area moves constantly. It is hard to achieve meaningful projection and results often resorb.
Potential Issue: Implant Visibility or Palpability
In patients with very thin soft tissue coverage, implant edges may be visible or palpable. If needed, this can be addressed by:
- Exchanging to a smaller or differently shaped implant
- Adding fat around implant edges to camouflage transitions
- Combining both approaches when appropriate
In most patients with normal soft tissue thickness, implants integrate well and are not visible once healed.
Chin Reduction for Chin Excess
When the chin projects too far forward or is too prominent, reduction techniques can restore balance. There are two primary approaches.
Technique 1: Direct Burring (Osteoplasty)
This uses a high-speed burr to remove a controlled amount of bone through a small incision under the chin.
What it can achieve:
- Reduction in projection by about 5 to 6 mm
- Reduction in vertical height
- Refinement of chin shape
- Smoothing squared or prominent edges
Advantages:
- Simpler procedure with less complexity
- No bone cutting or repositioning
- Direct control over bone removal
- Lower mental nerve risk compared to osteotomy
- Allows soft tissue adjustment through the same incision
Limitations:
- Best for modest reductions
- Cannot create large setbacks
- Requires careful technique to avoid surface irregularities
Technique 2: Setback Genioplasty With Plates and Screws
This involves making precise bone cuts, moving the chin segment backward, and securing it with titanium plates and screws.
What it can achieve:
- Greater reduction than burring alone
- Adjustments in multiple dimensions
- Correction of asymmetry when needed
Limitations and concerns:
- Relies on hardware for stability
- Plates or screws may become palpable or require removal
- Bone healing takes months
- Higher technical complexity
- Increased mental nerve risk during bone cutting
- Soft tissue excess must be managed to avoid chin droop
Choosing Between Reduction Techniques
The best approach depends on:
- How much reduction you need
- Desire to avoid hardware if possible
- Your soft tissue thickness and skin quality
- Whether asymmetry needs correction
For most patients needing reduction, direct burring offers excellent results with greater long-term stability and less complexity. Setback genioplasty is reserved for larger reductions.
Soft Tissue Management Is Critical
When bone is reduced, the overlying soft tissue must be adjusted to prevent:
- Chin ptosis (drooping of the chin pad)
- Submental fullness under the chin
- Loss of chin and neck definition
The submental approach provides strong access for tightening, resuspending the mentalis muscle, and removing excess soft tissue when needed.
Chin Surgery With Neck Procedures
Chin augmentation or reduction can be combined with neck contouring to improve the chin-to-neck angle. This may include neck liposuction or a neck lift depending on your anatomy and goals. If neck definition is a concern, a combined approach can produce a more complete lower-face result.
Recovery From Chin Surgery
Early Recovery
- Swelling and bruising are expected, most noticeable in the first few days.
- Discomfort is usually well controlled with oral pain medication.
- A chin strap or compression garment may be recommended to reduce swelling.
Activity Guidelines
- Avoid strenuous activity for 2 to 3 weeks.
- If an intraoral incision was used, stay on a soft diet for about one week and follow careful oral hygiene instructions.
- Sleep with your head elevated for the first week.
Healing Timeline
- Most visible swelling resolves within 2 to 3 weeks.
- Subtle swelling continues to improve over 2 to 3 months.
- Final results are typically visible at about 6 months.
- Medpor implants continue integrating over several months.
- Temporary numbness is common and sensation usually returns gradually.
Setting Realistic Expectations
What Chin Surgery Can Achieve
- Improved facial balance and proportion
- A stronger or softer profile depending on your goals
- Better jawline definition
- An improved chin and neck angle
- Long-lasting results
What Chin Surgery Cannot Achieve
- Eliminate all facial asymmetry
- Stop the aging process
- Change your entire facial structure beyond the chin
- Correct severe jaw misalignment that may require orthognathic surgery
The goal is facial harmony, not perfection.
Potential Complications and Risks
As with any surgery, risks exist, though they are uncommon with meticulous technique. Possible complications include:
- Infection
- Bleeding or hematoma
- Temporary or rarely permanent numbness of the lower lip or chin
- Minor asymmetry
- Small bone changes under an implant over time
- Hardware issues in setback genioplasty
- Bone healing problems in osteotomy techniques
- Chin ptosis in reduction procedures if soft tissue is not managed correctly
- Need for revision
Making the Decision
For most patients with chin deficiency, Medpor implants provide the best balance of predictability, stability, and lasting improvement. If your concern is an overly prominent chin, direct burring is often the safest and most stable reduction method, with setback genioplasty reserved for larger changes.
Take time to consider the options we discussed and review before-and-after photos to understand realistic outcomes. If questions come up as you think it through, please reach out. My goal is to help you achieve facial balance that feels right for you.
Photos were obtained, a quote was given, and the patient will return in a week for further discussion if needed.
