Chin Surgery
(Genioplasty)

Successful surgery is a result of good rapport between the patient and surgeon. Trust, based on realistic expectations and exacting medical expertise, develops in the consulting stages before surgery. We hope that this information is valuable to you for basic understanding of how this particular surgery works.  We discuss many alternatives, their benefits and their risks and complications.  These procedures are elective in nature and no one is forced to undergo surgery.  Finally, your body immune system may react differently and healing process could be shorter or longer.  In extremely rare cases, some procedures may need to be repeated.  This is one of the most rewarding procedures in facial profile correction since so many patients are not aware of the possibility of correcting a receding chin.

Chin surgery can be one of the most striking cosmetic facial procedures. Many individuals have very recessive profiles due to the fact that their lower face and jaw have not developed properly. This is frequently a genetic situation and other family members may exhibit similar traits.

If you are wondering how chin surgery could improve your appearance, you need to know how the surgery is performed and what you can expect from this procedure.

WHAT IS CHIN SURGERY?
Depending to the position of your chin there are several ways this question could be answered:

Small Chin:  If you have a small, receded chin and it bothers you or makes you self conscious about it then you may benefit from chin augmentation or advancement genioplasty. Chin augmentation is an operation that changes a person's profile by moving the chin outward to enhance the facial appearance. In some cases it is done for make you breathe better and sleep better too! 

Our findings which is supported by many major scientific organizations including the American Association of Oral and Maxillofacial Surgeons and American Sleep Disorder Association concludes that a considerable number of patients with a receded chin may in fact suffer from breathing problems.  When the lower jaw does not grow properly or may be too small, the tongue may drop back in the patients throat blocking the airway passage and has the potential for causing obstructive sleep apnea.  Many times, patients who have a receded chin have a very narrow windpipe. To artificially cover the chin with a plastic type chin will hide this problem and patients will continue to have sleep apnea disguised with chin surgery.  At our center, this condition is carefully analyzed and put into consideration when planning such a procedure.  This procedure could be done simply by itself or in combination with orthognathic surgery. In addition to complimenting the profile, chin surgery can also tighten and enhance the saggy or fatty tissues in the neck.

Large Chin:  If you have a very large, protruded chin then you may benefit from chin reduction (also known as reduction genioplasty). Chin reduction surgery involves removing excess bone from the chin bone. In most cases the very bottom tip of the chin is carefully separated and positioned backward to correct the problem.  The two segments are then secured with a space age technology using titanium and called rigid fixation.  In some cases the whole lower jaw in addition to the lower jaw is moved backward to correct this problem.  This type of surgery needs coordination with an orthodontist as well to make sure patient’s bite is corrected as well.

Small or Large Lower Jaw:  In many cases where the teeth do not fit together well or there is a severe underbite or overbite, jaw surgery (orthognathic surgery) may be required at the same time.  It is very important that a very strong chin with severe protrusion once corrected only by a lower jaw surgery alone may also lead to obstructive sleep apnea when patient is much older.  Simultaneous upper and lower jaw surgery in combination with chin augmentation may prevent that.

WHAT ARE THE DIFFERENT TYPES OF SURGERY?
There are many types are surgery available to correct a receded chin. We will describe each in detail to inform you of what is done at present time.  An intelligent patient must be aware of the benefits, advantages, risks and complications of these procedures and as with all surgical procedures, look at the surgeon’s credentials and his or her background.  A simple procedure may not always give a long lasting result.

WHAT IS ADVANCEMENT GENIOPLASTY?
One of the most advanced, precise and sophisticated types of chin surgery is to take the lower front part of your chin and bring it forward.  This procedure is called advancement genioplasty.  It uses your natural bone and if done properly will not move around at all!  This procedure is more involved than placing a chin implant and requires making incisions in the bone and also stabilizing it at the end with space age technology of rigid fixation.  In some cases bone grafting in front and the top of the chin plate may be necessary to create an attractive final results.  A great advantage of this procedure is that we can actually bring the muscles that are attached behind the chin (your tongue muscles) forward and you’re your airway significantly.  We have made a special modification for people with obstructive sleep apnea to perform a special type of chin surgery to address their problem.  One of the potential side effects of this procedure is numbness of the lips and chin, usually temporary but it could be permanent.  Your jaws do not need to be wired together with this procedure at all.  There will be some swelling and surprisingly moderate (not severe) pain involved.  We cover all our patients with antibiotics and steroids to control infection and swelling.  We encourage our patients to return to work as soon as they can within few days after surgery.

This procedure is favored by most oral and maxillofacial surgeons and not liked by other specialist performing chin surgery because of its complexity.  We perform most genioplasties in our state-of-the-art-center.  You will be asleep (sedation or general anesthesia without nasal intubation) while the surgery is performed.

CAN MY CHIN BE MOVED BACKWARDS OR COULD IT BE SHORTENED IF I HAVE A VERY LONG OR LARGE CHIN?
Yes!  One of the other great benefits of genioplasty is that we can shorten a long chin or move the chin back if the chin was too long or protruded. This procedure is exactly like the advancement genioplasty with exception of removing a portion of bone from the incision sites.

I HAVE A GUMMY SMILE LONG FACE AND RECEDED CHIN WHAT SHOULD I DO?
If you have a significant bite and chin problem you might consider repositioning of your jaw with orthognathic surgery. This surgery necessitates being in braces first then the whole jaw is moved to harmonize your facial as well as dental balance. Normally no jaw wiring is needed and depending to your needs upper jaw may be operated on as well. If you have a gummy smile, open bite, overbite or a long face and a receded chin you should consider orthognathic surgery.     

WHAT IS CHIN IMPLANT SURGERY?
The most simple and unfortunately common procedure performed across the world is chin implant surgery. Unfortunate because the patient will look better but the underlying problem is not corrected and only bandaged.  A receded chin could be associated with bite deformity or even narrow airway structure and this procedure will address none of those problems.  The procedure is fairly simple and there lies its popularity.  An incision is made either inside the mouth or outside under the chin exposing the bony part of the chin. Then a chin implant of a size agreed both by patient and the surgeon is placed in front of the chin.  It is very commonly sutured in place, some surgeons may use a pin or wires to secure the chin implant in. The incisions inside or outside the mouth are closed with sutures and a dressing / tape is applied.

Usually the chin implant is made of soft medical grade solid silicone, Gore-Tex, hydroxyl appetite or even gel. These materials have a long history of use and they are generally well tolerated by the body. But they have several inherent risks and complications. Foreign body reactions and true allergic reactions are very rare. As with any other implants infection, 'rejection', loss of substance could occur. If the implant got infected it may be relatively easily removed.  Cases of implant displacement (moving to the side of the chin and not in the middle) and even resorbing the natural chin and causing bone infection has certainly been a concern with some of these materials and with this procedure.

WHAT IS POROUS HYDROXY-APPETITE (HA) IMPLANT?
This implant is taken from either coral or cultured appetite crystals. Just like Silicone HA has its benefits and disadvantages as described above.  Our preference is your own natural chin with many additional benefits.

The procedure is relatively simple and is generally done in the office. The implant eventually becomes incorporated as part of the bone. Infection, rejection or implant movements can be problems.

WHAT IS FAT IMPLANT?
One of the least stable procedures in cosmetic surgery is injection of fat into the chin area. Fat transfer is used to increase the projection of the chin. Fat can be obtained from the neck when it is suctioned or it can be taken from other parts of the body. Usually the amount of projection provided is not a lot and results are temporary. Other facial tissues obtained from face-lift procedures have also been used for the same purpose with the same short-term results.  Reabsorption (shrinking) is the most common problem. In our center this procedure is not recommended to our patients at all.

WHO PERFORMS CHIN SURGERY?
Our center with board certified oral and maxillofacial surgeons (OMFS) usually perform chin augmentation and reduction. Some plastic surgeons or otolaryngologists (ENT) may perform the implantable chin as well.  Our knowledge of facial and dental harmony plus a clear understanding of obstructive sleep apnea puts us in a very unique position of being able to provide the most sophisticated procedure in convince of an office and at the same time possibly correcting your airway problem.  We have made this procedure more of a science than a cover up for cosmetic surgery alone.  We invite you to see our photo gallery of patients.  

WHO IS A CANDIDATE FOR CHIN SURGERY?
As with all elective surgery, good health and realistic expectations are prerequisites. The chin surgery concepts have changed so drastically for the last several years that this question takes a lot more thinking for patients.  Most people do it to make their face look good.  Our new concept and findings is that it could improve your breathing, and obstructive sleep apnea as well.  It does not cure these problems but in some cases the degree of improvement is very drastic. 

Many people have a small chin - one that recedes or is not prominent enough. A small chin can make a persons nose appear more prominent than it really is, whereas a chin that is more in harmony with other facial features can draw attention away from the nose and give the entire profile a more pleasing balance. Building up a small chin also can improve dramatically the results of other facial surgery procedures.  As stated above the latest concept is to correct the position of chin in combination with its muscle attachment is most desirable to improve obstructive sleep apnea.  So you look good and you could breathe better when sleeping.  It can reduce the sound of snoring as well!  On the other hand, a chin may protrude excessively, either because of an abnormally large "chin bone" or because of a too long jawbone.

Please make sure to inform us about any medical conditions or allergies you may have and whether you are a smoker or have dental or gum problems. Also, tell us about any medications, herbal supplements or natural supplements you are taking (both prescription and non-prescription).

WHERE IS THE SURGERY DONE?
Our state of the art Center For Corrective Jaw Surgery is well equipped for chin augmentation or reduction. You must stop eating or drinking for at least 8 hours prior to your procedure and must be accompanied by an adult driver. (Do not bring young children with you since you will be in our center for several hours).  You will able to go home without undue difficulty after the procedure. The operation is carried out under I.V. sedation, or general anesthesia.

Following surgery, the chin may be taped to prevent swelling. This must remain in place until you are seen in the office or until you are directed to remove the bandage and tape. You will be on a soft diet for few days and avoid chewing hard food for a week. You are encouraged to talk and move your lips as much as you like and of course smile a lot!!

You will be given prescriptions for swelling, pain and infection. For your convince our center offers in house pharmacy you can fill up your prescriptions in our center. Please finish all prescriptions as directed. If you have any problem with any medication, please call our center.

HOW DO I PREPARE FOR SURGERY?
Remember a pre-operative consultation and detail evaluation is defiantly needed.  If you travel from other states or countries we can make a very special arrangement to do the evaluation a day before your surgery and we will also assist you with finding a convenient hotel nearby.  You can mail or email photos of your face and chin taken from a front view as well as a side views so we can access your problem. But first follow these simple instructions.

WHAT IS THE RECOVERY PERIOD?
The recovery period varies with each patient and what type of surgery they had.  If the surgery included only the chin patients can return to work within few days after surgery.  You can actually fly the next day if you traveled from another state for this purpose.  If you required a combined lower jaw surgery and chin surgery or even an upper jaw surgery a 10-12 day recovery period is commonly recommended.

AM I GOING TO BE SWOLLEN OR IN SEVERE PAIN?
The majority of patients experience only very mild discomfort for a short time after surgery, which can usually be controlled easily with medication. Significant pain is uncommon. After the operation, swelling and bruising can be expected. Most of the swelling usually subsides within the first 2 week. After the operation, black and blue marks may be visible around the chin and neck.  You will be placed on antibiotics and anti-swelling medications as well.   Numbness of the lip, gum, chin, even teeth almost always occurs following surgery below the lower lip, this could be temporary or in very rare cases permanent.

WHAT ARE THE POST OPERATIVE INSTRUCTIONS?

1. Ice to face for 24 hours
2. Your chin will be taped following surgery. Do not remove the tape and reinforce it with additional tape if needed.
3. Take your medications on time and finish the course of treatment
4. Liquid food for the first day. Cold food for 24 hours.  Soft food for the next five days. Choice of food such as soup, ice cream, milkshakes, puddings, possibly ground meat, but nothing that requires chewing or is highly salted or spiced.
5. Rinse your mouth with Peridex rinse (A special prescription mouth rinse) only twice daily
6. Rinsing your mouth three or four times a day with warm salted water
7. You may brush your teeth if the brush is soft and you are quite careful to keep the bristles away from the stitches.  
8. Do not rinse or use straw the first 24 hours
9. Smoking or using straws not advised immediately after surgery
10. After a chin implant you can usually go back to work within a week.

HOW MUCH IS THE COST OF GENIOPLASTY?
The cost for genioplasty in our center is $ 4,400.00.  Additional expenses are the anesthesia and facility fees of $ 1,000 and the prescription are only $ 40.00.  All costs of pre-operative studies, work ups and the x-rays are included in most cases.  Insurance does not generally cover surgery that is purely for cosmetic reasons. Surgery to correct or improve genetic deformity or traumatic injury to the may be reimbursable in whole or in part. It is the patient's responsibility to check with the insurance carrier for information on the degree of coverage.

WHAT ARE THE RISKS?
As with any surgery, there is always a possibility of complications following chin surgery, including infection, bleeding, a reaction to the anesthesia, hematoma (localized swelling filled with blood resulting from a break in a blood vessel), seroma (a mass or swelling), extrusion (the implant works its way back up to the skin’s surface), capsular contracture (excess tightening of the scar tissue) which may distort the implant, asymmetry, nerve damage and bone erosion.

Sometimes, a facial implant can shift slightly out of alignment and a second operation may be necessary to replace it in its proper position. Whether you are interested in chin surgery for functional or cosmetic reasons, your choice of a qualified surgeon is extremely important. During the consultation, we will thoroughly examine your face and chin to pinpoint problems. In some instances, we may suggest chin surgery as a supplement to orthognathic surgery. We will weigh other factors that could influence the outcome of surgery such as your age, skin type, and attitudes toward surgery. The surgical procedure will be described in detail along with reasonable projections. If you opt for surgery, we will describe the technique indicated, the type of anesthesia to be used, the surgical facility, any additional surgery, and risks and costs.