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Read on…
One of the most dramatic operations in plastic surgery for improving appearance is chin augmentation (mentoplasty or genioplasty). When the chin is deficient the face has a very weak appearance and the profile suffers tremendously. The impression projected may be that of a defect in character or a lack of personality strength. Deficient chins are further masked by shadow producing the illusion of a facial portrait for which the artist failed to complete the lower part of the painting.
There are basically three ways to enhance the prominence of the chin: (1) placing a silicone implant over the front portion of the jaw, (2) making a vertical sliding cut in the bone on each side of the posterior jaw and moving it forward, and (3) making a horizontal cut (or multiple horizontal cuts) in the anterior half of the jaw. In all three methods, the cuts, or incisions, are made inside your mouth in the lower inner lip. In Method 2 the incisions are made inside your mouth posterior to the molars, allowing the cut slices to move forward.
The first procedure is by far the simpler and less expensive. The second and third procedures usually require hospitalization and are more expensive, but they have the advantage of using only the patient's own tissues. The second type often requires preparation by an Orthodontist.
What’s different at The Flowers Clinic?: One thing very special about chin implants done by Dr. Flowers is that each is designed and made especially for each patient. Experience has proven that patients vary so much that only a specific contour especially designed can be expected to give the best possible result. This is the reason for measurements taken in millimeters prior to your operation. We know of no other surgeon anywhere who gives this individualized service. Dr. Flowers' skill as an artist and sculptor uniquely qualifies him for such careful individualized preparation.
Related operations reduce a chip which protrudes too far forward and shorten a chin which is too long. If a chin that is too long is also deficient, the bone that is removed can sometimes be moved to the front of the lower jaw to increase its forward projection. Sometimes asymmetry of the two sides of the jaw must be addressed surgically.
The contour of the chin may be a little rounded and swollen for some months after surgery, but this eventually goes away. Early after surgery the chin will be more prominent than it will eventually appear. Most swelling subsides in several weeks, but many months may pass before the last bit disappears. Patience is essential in the period after surgery to allow the scar to soften and the surgical area to settle down to normal. One cannot attempt to judge the ultimate outcome in the early weeks or even the first few months postoperatively.
The stiffness and resistance to lip motion that is felt early after surgery will totally subside, and normal softness will eventually replace the early postoperative rigidness.
Possible Complications
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Infection. Infection may occur after any surgical operation. In an attempt to prevent infection we use meticulous sterility in our operating rooms and we prescribe routine postoperative antibiotics for all patients. It is important for the patient to take them. When cartilage or bone grafts are used, as well as when alloplastic (nonbiological) materials, such as silicone implants, are used, a special risk of infection exists. Since these materials do not have their own blood supply, they have no ability to fight infection. Removal of the implant or graft could become necessary because of infection. Also, if infection is present, as suggested by swelling, redness, etc., and the implant is not removed, the infection will eventually find a route to drain to the outside. This could result in an external scar. If good care is promptly sought, an internal incision can satisfy the need for drainage. lnfection may require the removal of grafts or implants but they may typically be replaced after the infection has cleared. Among our many hundreds of patients who have undergone this operation, we are aware of no one who has required implant removal because of infection.
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Extrusion. When a nonbiological material is used in the mouth as well as when grafts from a person's own body are used, there is a risk of the overlying skin thinning, eventually leading to exposure. This would necessitate removal of the implant. When this happens it almost always is caused by infection. We are aware of only one of our patients who experienced such thinning which led to removal of the implant.
Scarring and resultant deformity can result, but in most instances can be prevented by seeking medical attention if thinning of the skin is noticed or if signs of infection (redness, swelling, etc.) occur. Prompt treatment usually prevents permanent scarring and/or deformity.
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Implant sinking into bone. If severe, this could put pressure on the roots of the teeth and could require removing the teeth and/or implant. We have not experienced this complication.
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Mental nerve damage. This could result in temporary or permanent loss of sensation to the chin and/or lower lip. We have not experienced this complication.
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Mandibular branch of the facial nerve damage. This would result in weakness of the lower lip and asymmetrical movement of the mouth and/or smile. We have not experienced this complication.
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Shifting of the implant. This would require a simple operation to readjust the implant's position and modify the amount of projection of the implant. No readjustment has been required in any of our patients.
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Stiff lower lip. This is not a complication, but rather a symptom which can be bothersome. It is a feeling of stiffness in the lower lip, sometimes persisting for several months after surgery.
Although incidence of complications at this facility has been extremely low, we have nevertheless attempted to describe the main ones. A few have occurred here, but our overwhelming experience with this operation has been positive. The ones which have been reported in the literature are principally those included here and are the ones we feel are the most significant.
About the Surgery
Surgery usually involves intravenous sedation and local anesthesia, unless it is done in conjunction with an operation which requires general anesthesia.
Postoperatively there may be some discomfort, but you will be given pain medication.
Preparing for Surgery
It is important to be in the best condition possible for this surgical adventure. Four weeks prior to surgery, discontinue the use of all aspirin-containing medication as well as any medication containing ibuprofen. The same goes for vitamin E.
(They are "blood thinners" and interfere with normal blood coagulation.) Multivitamins should be stopped well in advance of the operation to counteract all the extra blood vessels that develop with vitamin 6 complex ingestion.
Cigarette smoking should be stopped in order to make anesthesia safer and to have an easier recovery.
Alcohol consumption should be stopped or markedly reduced in order for the liver to be in optimal condition to manufacture the "building blocks" necessary for healing. Furthermore we strongly recommend that you avoid alcohol intake for several days prior to surgery. If you have a drinking problem and are accustomed to daily alcohol intake, please discuss this with your surgeon. Special arrangements will be made to accommodate your health needs.
If you take high blood pressure or diabetes medication, special arrangements must be made.
It is your responsibility to make us aware of any significant health condition which you have. Please let us know of any conditions that apply to you - especially any condition we have failed to ask you about.
The Trip Home
After surgery you will remain in the recovery room about two or three hours or until we feel that you are ready to go home. We will only discharge you into the care of a responsible adult. We will not allow you to travel home alone by taxi.
Make such arrangements in advance and plan for someone to be with you overnight after your operation. If suitable arrangements have not been made, it will most likely be necessary to admit you to the hospital for overnight nursing care.
In rare instances we may decide that your condition requires hospitalization although you had planned to go home. We always reserve the right to change plans and admit you if we think it is in your best interest.
A car with a back seat large enough for reclining is desirable for the trip home. Occasionally a person may be a little more dizzy and nauseated at the time of discharge than is optimal. Therefore the ability to recline is important.
Postoperative Visits
Plan to return to the office for a number of postoperative visits. Many of these visits will be brief. The point is to make sure that your chin is healing properly. It is a good idea to jot down any questions you have to be answered at that time. The cost of all of these postoperative visits is included in the surgical fee.
Photography
We will take photographs of your face before and after surgery. These become an essential part of your medical record. It is interesting to refer back to these photographs for evaluation of progress and improvement. You may request before and after photos if you wish, for the cost of the photo processing involved.
Activity
There is no restriction of activity after chin surgery apart from minor modification of diet. The night after surgery a liquid diet is in order, then a soft diet for the next two days. Afterwards, regular food intake is permissible.
Exposure to Sun
During the first three or four months after surgery, exposure to sunlight should be minimized. When you go in the sun, apply sunblock with a Sun Protection Factor (SPF) of 20 or higher.
Returning to Work
Most patients are able to return to work within one or two days after most types of chin surgery. When bones are cut and osteotomies are performed, you will likely experience more swelling. Therefore, several more days of disability should be anticipated.
In the case of Type 2 surgery described in the beginning of this booklet (vertical sliding cuts), profound swelling may characteristically the teeth must be wired together for six weeks. This is not the case in the other two types of chin augmentation.
Costs
In addition to charges which have been made to you for the operation, anesthesia, and operating room, there will be additional costs for prescriptions, blood work, urinalysis, and chest x-ray when required.
In the event of complications such as severe infection or other events requiring additional work in the early postoperative period, no additional fee will be charged provided your surgeon is able to perform the surgery. However, the expenses of operating room and anesthesia will be charged additionally. You will be expected to pay the costs of hospitalization or other medical consultants if required. Should you for any reason elect care by another surgeon, you must pay for that care yourself.
Warranty
All chins differ and so might the results after surgery.
The only warranty offered is that your surgeon will put forth his very best effort to achieve the best possible results. No further guarantee can be made. It should further be understood that fees paid are for the performance of an operation and NOT for a guaranteed result nor for improvement hoped to last indefinitely. A modification of your operation could be required at some point in the future.
Finally
The information contained herein is by no means complete. It is intended to reemphasize many of the points discussed during your initial consultation and to provide documentation which you may find convenient to refer to.
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