Written by Dr Julian De Silva
A chin implant gives balance to a person’s face and is a very low-risk implant that can greatly improve facial harmony. Chin deficiency is typically noticeable when looking at a person’s side profile, as the chin should align with the philtrum (junction between nose and upper lip).
Dr De Silva inserts chin implants on their own as a single procedure, or commonly n conjunction with another procedure, such as rhinoplasty, facelift or neck lift surgery to enhance the result.
He uses silicone implants and sculptures it to fit each patient’s individual jawline. The chin implant can be inserted under a local anaesthesia with or without sedation, by making a small incision under the chin in a natural, hidden crease.
Patients are given a week of antibiotics as a preventative measure against infection, the stitches are removed after one week and the implant requires no further management.
Chin surgery traditionally involved making cuts into the jaw (mentoplasty) and resetting of the position of the jaw. This involved substantial surgery with realignment of the jaw. There was a long recovery time, with a risk of crossbite and nerve injury.
Chin implants provide a very safe way of avoiding mentoplasty while restoring natural proportions to the face. In a woman, a chin implant restores harmony and natural beauty. In a man, the chin is one of the features of sexual dimorphism and makes a male face more masculine and attractive.
A chin implant, or chin augmentation, is a procedure that Dr De Silva performs relatively frequently. It is an option if you have a small chin or if the lower portion of the jawbone lies behind the lips. The name given to this appearance in medical jargon “microgenia” (micro means small, genia means chin).
Chin implants are frequently needed to give a better result with rhinoplasty surgery in about 20% of patients. Dr De Silva takes multiple high-definition photos of your face in profile and uses the latest in Digital Animation to simulate the size of the chin implant. In some cases, he can provide a visual approximation of how your chin implant surgery will look.
This figure on the left shows the normal position of the chin in relation to the lips. In a person with good facial proportions the lower lips is 1-2mm behind the upper lid and the chin is 1-2mm behind the lower lip. There are variations in facial harmony and balance based on genetics, gender and ethnicity.
The figure on the left shows the position of a recessed chin which is positioned (>5mm) behind a vertical green line drawn through the lips. With chin augmentation the chin is moved forward and the relative distance from the lips to the chin is reduced. Dr De Silva uses reference points on the face to evaluate proportions, however the artistry of chin augmentation also includes taking in to account gender, ethnicity and chin shape into account with chin shaping.
Common reasons why patients ask Dr De Silva for help
Dr De Silva recommends:
Chin implants are often used in conjunction with rhinoplasty to improve facial proportions and give a more balanced result. In addition, neck fat reshaping can be beneficial for some patients to improve the natural jaw line and create an attractive angle between the jaw and chin.
In patients wither further signs of facial ageing, there may be laxity of the skin and soft tissues with the appearance of jowls, deep facial lines and neck skin folds. Patients with these signs of facial ageing would benefit from a face and neck lift in addition to the chin implant.
*Results May Vary
There are two techniques for the insertion of a chin implant—surgery from the inside the mouth (Intra-Oral) and insertion of the Chin Implant from a small hidden incision under the chin (Sub-Mental Crease).
Dr De Silva performs both techniques, tailoring the surgery to each individual. His procedure of choice is the insertion of the implant through the sub-mental crease as this enables good access for optimal position of the implant.
Intra-Oral insertion of chin implants is associated with an increased chance of infection of the implant and a longer recovery period. Dr De Silva sculpts every chin implant to fit a person’s unique jawline. Every jawline is different and requires a different 3-D enhancement to give the best result.
Natural variation in the chin, jaw, neck, soft tissues and skeletal structure means that optimal proportions differ in all faces.
There is a degree of artistry in all individuals’ faces that each surgeon interprets and adds to, much like a chef does when preparing a dish. Of particular importance is shaping the implant to soften the appearance of the chin to ensure a natural jawline (shown with hatching in the figure below).
Dr De Silva is known for delivering natural-looking work and customising techniques that are to ensure harmony with a person’s facial characteristics.
This figure is taken from Dr De Silva's forthcoming book on facial cosmetic & plastic surgery. The figure on the left shows a recessed chin in which the chin lies behind a vertical line from the lower lip. The image on the right shows the improved position of the chin following augmentation of the chin with a high-grade silicone implant that sits along the lower part of the jaw, simulating bone. Hatching shows the area of the implant that Dr De Silva shapes to fit the individual's jaw line. The front aspect of the implant is where the position of the specialised screw sits. The small circle that is positioned above the chin implant is the position of the mental nerve that supplies sensation to the jaw and teeth, which is avoided during the chin augmentation procedure.
Dr De Silva recommends silicone chin implants to patients in preference to other forms of chin augmentation as it is long-lasting, safe and effective.
While partial chin augmentation can be completed with the use of volumising fillers (e.g. hydroxyapatite, Radiesse). However, these only offer a temporary result and need repeating.
Other volume augmentation procedures, including fat transfer is less predictable and less effective for replacing bone deficiency.
Other implants, including Medpor and polytetrafluoroethylene (ePTFE) are available. However, they are associated with a high risk of infection and integration with soft tissues compared to silicone.
The surgical use of jaw sliding (genioplasty) is more invasive and associated with longer recovery and risk of nerve injury. A silicone chin implant should last a lifetime. Rarely, they can move or become infected and are easily be removed in these circumstances.
The results of the surgery are immediate, although local swelling can make the chin look too large for the first week. The swelling and local bruising take about a week to mostly resolve, and the great majority of patients return to work after that.
There is a small incision under the chin and the sutures are removed after approximately a week. Patients are advised to have a soft food diet for the first couple of days and to avoid strenuous activity until 3 weeks after the chin implant. Most patients have minimal (if any) pain which responds to oral analgesia.
All cosmetic surgery has some risks but generally speaking, chin implant surgery is very safe.
With chin surgery, there is a small risk of infection, bleeding, allergy, movement of the implant and of bone absorption under the chin implant. Dr De Silva advises against chin surgery in patients with an increased risk of infection.
Dr De Silva uses advanced technical skills to reduce the risk of implant movement or dislocation, by sculpting a narrow and deep pocket for the insertion of the chin implant under the facial muscles that make the movement of the implant minimal.
Dr De Silva has treated patients with rotated chin implants by other surgeons. Using a novel technique to prevent implants from rotating he secures all implants with a specialized mini screw.
This screw is approximately 8mm in size and prevents any long-term movement of the chin implant. The screw is specialised and cannot be seen or felt once in place. It is not detectable on airport security, although is visible on an x-ray or CT scan of the head.
Dr De Silva only specialises in the face and does not perform body surgery. With chin augmentation, the shape and size of the implant needs to be tailored to the individual so the result looks natural, complements the face and is long-lasting.
The appearance and strength of the jawline is different in both men and women and requires tailoring of the individual implant. Dr De Silva uses high-quality silicone implants made in California that are shaped to the individual’s jaw line, enabling the implant to be in harmony with the person’s face.
Dr De Silva’s techniques enable a precise operation with minimal discomfort. His expertise is called for revision procedures when implants placed by other surgeon’s need removing for out of balance with an individual’s face or moving out of place.
Chin augmentation can be completed with local anaesthesia. Dr De Silva prefers his patients to have sedation anaesthesia, also known as twilight anaesthesia, which enables his patients to have a comfortable and relaxed experience with a fast recovery.
With sedation, Dr De Silva’s patients are able to go home within 30 minutes after the procedure has finished. General anaesthesia can be used for chin augmentation but it is not necessary, and the recovery is longer than other forms of anaesthesia.
The removal of chin implants is dependent on the type of implant that has been inserted and how it is secured:
While removing the chin implant completely is one option, it may result in a weaker looking chin. Dr De Silva has removed the implants other surgeons have placed. If the chin was previously recessed, inserting a smaller implant in the optimal position with an improved and tailor-made shape may be a preferred option.
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The chin and jawline are important characteristics in male and female faces and if weak or recessed can result in facial imbalance. With chin augmentation care must be given to the chin augmentation so that it is natural looking:
*Results May Vary
Augmentation of the chin with jaw advancement surgery (termed sliding genioplasty) requires more invasive surgery than the insertion of a chin implant.
Often the treatment is coupled with orthodontics requiring braces to realign bite that requires many months of treatment, there is numbness in the area of the jaw after treatment which can be permanent.
*Results May Vary
Non-surgical augmentation of the chin with fillers (hyaluronic acid, Radiesse) offer a conservative augmentation that is temporary for between 6-12 months.
Fillers are generally softer materials so the augmentation of the bone along the jawline is generally limited in effectiveness. They offer the advantage of a non-surgical procedure that enables a patient to “try out an improvement” before surgery.
Chin augmentation with a chin implant requires a surgical procedure to insert the chin implant. However, the size of the implant can be tailored to the individual and the implants will last long-term.
*Results May Vary
Most patients have minimal numbness that resolves within 1 week of surgery. Relatively few patients may have numbness after chin implant surgery that takes 6-8 weeks to resolve completely.
Stretching or swelling of the nerve that supplies sensation to the lower lip can result in this numbness as part of the surgery and as this swelling resolves the numbness fades.
Very rarely, the numbness does not improve and may be a consequence of the implant lying too close, or at the sensory nerve. This may occur because of the location or size of the implant or unusual anatomy of the nerve.
In these exceptional circumstances, the implant may need to be further reduced in size. With a good surgical technique, the nerves can be avoided and numbness after surgery is generally uncommon and temporary.
Dr De Silva takes care to avoid the sensory nerve with chin augmentation surgery. He marks the anatomy of the nerve before surgery, shapes the implant for the best fit, and is cautious by paying attention to every detail during surgery.
*Results May Vary
Renowned expert in Facial Cosmetic and Plastic Surgery. Signature techniques in Blepharoplasty, Rhinoplasty and Facelift surgery. Expert in revision surgery and in natural looking results
