Chapter 56
56
A “witch’s chin” is often a problem in elderly wom- en. It is prominent in a frontal and caudal direction.
To reduce it we make a spindle-like skin excision in- cluding skin in front and behind the submental skin crease. Then we remove a slice of mental subcutane- ous connecting and fat tissue if liposuction alone is not enough to reduce the chin volume sufficiently.
There seems to exist a gender-specific ideal of chin shape. Whereas men prefer a prominent, “character chin” as sign of social dominance, women have a ten- dency to prefer a smaller chin shape. This predicts the influence of oestrogen, which promises better fertility.
Consequently, chin augmentation is more frequent in men and chin reduction is more frequent in women.
Chin Corrections
Dimitrije E. Panfilov
Fig. 56.1. a Wide chin turning the “triangle of youth” upside down. b Reversion of this triangle makes the appearance more femi- nine, and more youthful
If the submental crease is too deep, we make skin excision. We cut the underlying slice of connecting and fat tissue so that a proximal distal flap can be formed, turned backwards, and sutured below the proximal edge of the skin excision. In this way, the submental depression has been filled up. An intrader- mal pull-out skin suture finishes the procedure.
The asymmetry could also arise as a problem either through atrophy on one side or as unilateral hyper- trophy.
If asymmetry is due to hypertrophy, we can correct it by gentle liposuction.
Fig. 56.2. a Submental skin excision with simulating cannula for liposuction above the skin. b Liposuction performed below the skin. Witch’s chin c before and d after its correction performed together with face-neck-lift
415 56 Chin Corrections Fig. 56.3. a Witch’s chin correction.
b Subcutaneous flap reversed and sutured. c Witch’s chin with submental excess skin. d After face-neck-lift and witch’s chin correction, submental skin is tightened and the mento-cervical angle is well defined. The same patient from the other side e before and f after correction
Fig. 56.4. a Hypotrophy of left side of the chin. b Four months after microlipofilling of the left chin, lips, and nasolabial folds
For chin augmentation a horseshoe-shaped sili- cone implant of proper size is the most suitable and least complicated method. This shape of implant does not produce pressure on underlying bone and conse- quent atrophy of it.
It is possible to make the implantation through a submental skin incision, but we prefer the infralabial approach without visible scars. The 3-cm-long inci- sion on the lower lip should be done at least 5 mm above the lower preoral vestibular crease. If the inci-
Fig. 56.5. a Slight lipohypertrophy of the right side of the chin. Ten years ago, this woman was Miss World. b We removed excess fat and used it for minimal lip correction. Nobody can get enough of beauty
Fig. 56.6. a Putting the implant over chin skin, we check if the implant size is appropriate. b Translabial approach of implantation.
Patient c before and d after face-neck-lift, submental liposuction, and chin implant
417 56 Chin Corrections
sion were in the deepest crease of the lower preoral vestibule, we could not suture it onto the gingiva.
Once we have come with our rasparatorium to the tip of the mentum, we should create a subperiosteal pocket symmetrically left and right, but not too wide and not too narrow.
After the silicone implant has been placed, we clean the pocket with dilute Betadine solution.
If somebody has a chin dimple which is undesir- able and has excessive alar cartilage of the nose, like
“cherry tip deformity”, we can diminish it by use of a crushed cartilage graft. Through translabial approach of the lower lip, we reach the subcutaneous layer be- low the dimple, divide the skin adhesions which con- nect skin and periosteum like a retaining ligament, and insert crushed alar cartilage into the preformed pocket.
Fig. 56.7. a Incision of 3 cm with radiosurgery does not bleed.
It is placed 5 mm above the lower preoral vestibule. b Implant insertion into prepared subperiosteal pocket. c Suture line
does not involve the gingiva. d Check of the ends of the “horse- shoe” silicone implant
Fig. 56.8. Chin a to be corrected and b after implantation it looks rejuvenated
Sometimes there is a supramental crease which is too deep and disturbs somebody’s facial harmony. We can flatten it in a similar way as for a witch’s chin. We excise 2–3 mm of skin, prepare a pedicled slice flap from mental subcutaneous tissue, which is pretty firm, overlap it, and suture it below the upper skin edge.
Bibliography
Please see the general bibliography at the end of this book.
Fig. 56.9. a Undesirable chin dimple b flattened with crushed cartilage. c Alar cartilage removed from the nose. d Crushing cartilage with a hammer
419 56 Chin Corrections
Fig. 56.10. a Supramental deep longitudinal notch en face. b After excisional flattening. c Preoperative side view of the same pa- tient. d Postoperative look
