You are interested in information regarding the surgical procedure for enlarging the chin. The goal of this procedure is to bring the profile into better alignment, to correct ‘thin’ chins, and to help contour chins that are thought to be less than desirable for the individual. There are a number of options that are available to accomplish this. The Doctor will discuss the options for the operative procedure and anticipated results with you, including possible risks.
No matter which procedure is chosen there are common problems and complications that may occur. Some of these include but are not limited to bleeding, infection, temporary and/or permanent muscle or nerve bruising or even injury, rejection of the tissue or implant, temporary and/or permanent numbness in the area, thick scars on the inside of the mouth, problems with the underlying bone, unequalness of the results, incomplete correction, over-correction, edges of the tissue or implant can be seen (especially in thin skinned individuals), risks of anesthesia, etc. The probability is that if problems should occur they would be minor and self limiting, however significant problems that are long lasting could occur.
You must be willing to accept the risks and complications of surgery before you decide to go ahead with surgery. If you cannot accept these risks, DO NOT HAVE SURGERY! If you have particular questions regarding the risks mentioned or any other risks that you might know or have heard about please ask the Doctor or his staff about same.
This surgery may be performed either under LOCAL ANESTHESIA, LOCAL ANESTHESIA WITH MEDICATION, or GENERAL ANESTHESIA. Doctor Capuano will discuss these options with you. Usually LOCAL ANESTHESIA OR LOCAL ANESTHESIA WITH MEDICATIONS can be used unless there are other more extensive procedures to be done.
The operative procedure involving tissue implant or chin implants uses an incision within the inside lower lip or from the outside beneath the chin, separating tissue from the bone of the chin. At this point an implant, tissue graft, fat, or sliding of the chin and placement of screws or wires can be accomplished bringing out the chin. Sutures are used to close the tissues. The sutures usually dissolve within seven to ten days.
Following surgery, the chin may be taped to help prevent movement in the area. 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, with little or no chewing. You should not attempt to talk very much, and generally should rest and relax without straining.
You will be given prescriptions for or asked to purchase over-the-counter medications following surgery for swelling, discomfort and infection. Please finish all prescriptions as directed. If you have a problem with any medication, please call the office.
You will be seen in the office for follow up care. At the time of your first post-operative office visit, the dressing and tape may be removed and you will be advised regarding activity. You should be able to slowly resume your regular diet as tolerated. The ESTIMATED time away from work depends upon what was done and your job. If you have a job which does not involve a great deal of communication, you may be able to return to work within a week or sooner. If you have a job where you must talk a great deal then more time may be advisable. Please discuss your job with the Doctor so you may obtain a better estimate of time away from work.
Photographs will be taken before, possibly during and after your surgery.
INSTRUCTIONS FOLLOWING CHIN ENLARGEMENT SURGERY
The following are general instructions that will give you some idea as to the post operative care usually needed after chin surgery. Your chin will be taped following surgery. Do not remove the tape and reinforce it with additional tape if needed. Do not get the tape wet, which means no showers. We ask that you remain on a soft diet, i.e.. no chewing until advised otherwise. You may eat soups, liquids, soft sandwich such as tuna fish or egg salad as examples, or foods that need with little chewing. In most cases you will have dissolvable stitches on the inside of your lower lip. You should rinse your mouth with salt water (1/2 teaspoon in an 8oz glass of water) following meals and as needed. If needed, you should gently remove any food particles from the incision using a Q-tip. You may brush your teeth if the brush is soft and you are quite careful to keep the bristles away from the stitches. The morning following surgery you should rinse your mouth with two parts water and one part mouthwash, then rinse again with water. Try not to talk excessively. Smoking, with pursing or puckering of the lips is not advised immediately after surgery.
You will be given prescriptions and/or asked to buy over-the-counter medications following surgery. These medications will be for swelling, discomfort and infection. Please take all medicines as directed.
Signs of problems are severe pain, sudden swelling, fever over 100.5, drainage after 36 hours, redness that is increasing and tender, foul smelling drainage. We encourage you to call us if you think you are developing a problem. It is much easier to treat problems if they are early as opposed to late. So call if you have questions or concerns.
You will be advised regarding activity, and should be able to gradually resume your regular diet as tolerated. You should take care not to hit or bump your chin. No contact sports for one month. Activities such as walking is ok but jogging or her treadmill walk is not as an example.
Again, if you have any questions, please call the office.
TYPES OF SURGERY TO ENLARGE THE CHIN
CHIN IMPLANT SURGERY
The most common procedures across the nation and globe is chin implant surgery. An incision is made and the front and sides of the bone of the chin are exposed usually from the inside of the mouth. Then a chin implant of a size agreed upon (the doctor has to make the final decision) is put into place and may be sutured in place. No screws, pins or wires are put in place. The wounds inside or outside the mouth are closed with sutures and a dressing / tape is applied.
Usually the chin implant is made of silicone solid material. I have not used the gel material that has been controversial (see silicone). The material used has a long history of use and approaches a material that is ideal in its characteristics according to many experts. It is well tolerated by the body. Reactions and true allergies are unproven but of course could occur. As with your own tissue such as bone, infection, ‘rejection’, loss of substance could occur. If the implant should get infected it may be relatively easily removed. To this date This has not occurred. The number of complications with chin implants are much fewer than bone surgery for chin enlargement and the problems are more easily handled.
BONE – JAW ADVANCEMENT (PUSHING FORWARD) FOR CHIN ENLARGEMENT
If you have a significant problem with your “bite” then you might consider repositioning of your jaw vs an implant. This surgery necessitates being in braces with your jaws wired. This is more involved surgery. The chances of bone infection , nerve damage, lip problems and so forth are greater than with an implant. However this is the surgery that should be done if you have a significant underbite, overbite, or other symptoms of malocclusion (teeth not meeting together very well).
BONE – CHIN ADVANCEMENT (PUSHING FORWARD)
Another operation is chin (vs jaw) advancement. The end of the chin is cut with a saw and then fixed in a forward position by screws, wires or plates. This is more involved surgery than a chin implant and has a greater chance of problems and complications at least in the short term and perhaps long term. A recent study lists some of the problems encounter. These include infection, nerve injury, slipping of bone, dissolving of the bone, problems with the wires or screws used to hold the bone, etc. The incision is longer for this operation. No wiring of the jaw is needed in most cases. A bone graft may be needed if the original bone dissolves.
In certain cases fat transfer can be 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 ether parts of the body. Usually the amount of projection provided is not a lot but the operation is relatively very safe and simple. Such a procedure allows one to see how an implant or other operation might improve one’s looks. The draw back is that some of the fat will absorb and less than the desired correction will be obtained.
NASAL – SEPTAL IMPLANT
In certain cases when nasal surgery is performed at the same time as the chin surgery the material from the nasal surgery can be used to increase chin projection. The amount of projection depends on the amount of material available i.e. the amount of bone obtained from the nose. A small nose allows only a small amount of projection, etc.
POROUS HYDROXY-APPETITE IMPLANTS
This implant is taken from either coral or cultured appetite crystals. I have some experience with this material and it is relatively simple to implant. The implant eventually becomes incorporated as part of the bone. Infection, lack of ‘taking’ of the graft, absorption etc can be problems. I believe that eventually many more implants will be of this type.
BANKED BONE -CARTILAGE GRAFTS
Bone can be obtained from human tissue (bone and cartilage) donor. This is not part of my operative technique.
FASCIAL & FASCIAL-FAT GRAFTS
During face lift surgery, fascia or fascia and fat can be used. Re-absorption (shrinking) is the most common problem.