Genioplasty Research Articles

Role of the Pedicled Mentalis Muscle Flap in Closure of Chin Implants in Genioplasty

Summary:With the purpose of obtaining an aesthetically pleasing chin appearance, genioplasty or chin augmentation can be performed through osteotomy or chin implantation, with the latter available in different sizes and materials such as silicone and porous polyethylene. The implants are traditionally placed in a subperiosteal or supraperiosteal plane with different advantages and disadvantages to each. This procedure has evolved through time with many techniques and modifications; and this article is an addition to this ongoing refinement by advocating for closure of the mentalis muscle (a paired chin muscle originating from the incisor fossa to the chin skin) over the implant after securing its position with screws (in the case of porous polyethylene) or creating a snug pocket (in the case of silicone). In this retrospective analysis, 15 patients underwent this procedure with an excellent outcome. A single patient developed numbness in the mandibular nerve territory, while another one developed a fistulating radicular cyst that was unrelated to this technique. In addition to the simple learning curve, the potential advantages of this technique include less chances of fistula formation, implant exposure, infection, extrusion, or malpositioning. Prospective studies with more subjects are required to cement our findings.

Validation of a Chin Retrusion Scale for Chinese Subjects.

Chin augmentation procedures are gaining in popularity. The purpose of this study was to validate the China (Allergan) Chin Retrusion Scale (CACRS) and to evaluate the reliability of the scale. A team of 10 physicians based in Beijing, China, consisting of 1 principal investigator and 9 independent raters, assessed a pool of subject images. Using standardized equipment to capture 2-dimensional images, 100 subjects were photographed from a left, lateral, 90° view. Two measures were used to assess the validity of the scale: rater evaluations of clinically significant differences in 52 pairs of images and rater assessment of chin retrusion using the CACRS to grade the 100 images. The CACRS demonstrated almost perfect inter-rater agreement during 2 validation sessions, with intraclass correlation coefficients of 0.89 and 0.90 at sessions 1 and 2, respectively. Overall inter-rater agreement for all 9 raters was almost perfect, with a weighted kappa of 0.82. Based on inter- and intra-rater agreement, the CACRS was validated for physician ratings of chin retrusion in Chinese subjects. Results from clinical significance evaluations indicated that a 1-grade difference between image pairs was considered clinically meaningful for the CACRS. The CACRS is a validated and reliable photonumeric scale for the assessment of chin retrusion in Chinese men and women. The scale is a clinically significant reference tool for evaluating the effect of chin augmentation.

Special Considerations for Chin Augmentation in the Professional Violinist

The extensive training and unique positioning of a stringed instrument (eg, professional violinist) may subject the mandible to compressive forces that may lead to asymmetric micrognathia. Prior cephalometric studies have shown a right-sided facial dominance with an underdeveloped left mandible. Surgical correction must account for occupational demands, as the chin is uniquely load-bearing in violinists. The use of three-dimensional planning with a customized implant facilitates the correction of asymmetries and allows shared decision-making for optimal implant fit. Our case outlines important considerations for alloplastic chin augmentation in violinists.

A Reliable Method for Chin Augmentation by Mechanical Micronization of Lipoaspirates.

Desire for improved aesthetic contour of the lower third of the face has resulted in an increase in chin augmentation. Although many fillers, including hyaluronic acid (HA), autologous fat and stromal vascular fraction gel (SVF-gel), have been used to improve facial morphology, chin augmentation requires fillers that provide greater support. The elastic and viscous moduli of SVF-gel and Coleman fat were assessed in vitro by rheological testing, whereas their elasticity were evaluated in vivo by ultrasonic elastography. Results in vitro were compared with those of highly elastic HA (HE-HA) and highly viscous HA (HV-HA), whereas results in vivo were compared with HE-HA. Changes in chin volume, SVF-gel retention rate and absorptivity for at least 12 months were measured by 3D white light scanning. Questionnaires were administered to assess patient satisfaction. The elastic and viscous modulus of SVF-gel was, respectively, slightly lower than HE-HA and HV-HA but higher than the other two in vitro, with the elasticity of the three layers of SVF-gel lower than HE-HA but slightly higher than normal control in vivo. The average retention rate was 62.34±3.34% at 12 months. The absorptivity of 90% of the samples was <3% from 6 to 12 months, which was considered stable. Patients expressed satisfaction with their results. SVF-gel has ideal rheologic characteristics in vitro, which has slightly higher elasticity than normal fat tissue of chin in vivo, and could keep well retention rate for chin augmentation in clinic. This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .

Surgical Reintervention in the Chin in a Patient with a Silicone Chin Implant - A Case Report

Surgical Reintervention in the Chin in a Patient with a Silicone Chin Implant - A Case Report

Vascular-nerve complications following oral surgery: hematoma and neuroma: A literature review

Introduction: Oral traumas and surgery frequently lead to injuries such as neuromas and hematomas.Materials and Methods: PubMed was searched up using the keywords: “oral traumatic neuroma”, “neuroma dental implant” and “oral hematoma”. Works about oral surgery were considered. Results: In some of the studies included in this review, traumatic neuroma was found following dental extraction; others following chin augmentation and sagittal osteotomy of the mandible. Implant surgery also appears to be linked to the development of traumatic neuromas. Bilateral bifid mandibular canal is a rare anatomic variation which, if present, can lead to the neuroma following surgery of the lower third molar and the placement of dental implants. The vast majority of cases of hematoma are consequent to oral surgery (rarely have spontaneous hematomas have been described in patients taking antiplatelets or anticoagulants).Conclusion: The literature shows a concrete risk of hematoma and traumatic neuroma following oral or maxillofacial surgery. Particular attention should be paid to patients with coagulation abnormalities.

Surgical Reintervention in the Chin in a Patient with a Silicone Chin Implant - A Case Report

Surgical Reintervention in the Chin in a Patient with a Silicone Chin Implant - A Case Report

Basal Extended Mentoplasty.

The chin is one of the most visible facial structures. Chin surgery, was initially described, for, the treatment of facial abnormalities, advancing the mandibular symphysis; achieved anterior displacement of the base of the tongue showing some value in the treatment of snoring and obstructive sleep apnea, and achieved adequate lip competence. We designed the Basal Extended Mentoplasty (BEM) based on the needs of patients orthodontically compensated, but dissatisfied with the appearance of his face as well as upper airway problems looking for a solution to this, design and planning the advances of the chin. Patients operated in the service of Maxillofacial Surgery, Specialist Hospital, "Dr. Bernardo Sepulveda "XXI Century National Medical Center, during the period of 2015-2019, orthodontically compensated patients, with labial incompetence and Class II skeletal. Sixty-five patients were operated during this period, and eight cases are presented. Lip competition, osseointegration of the segments is observed, with a proper projection of the lower third, no nerve or vascular damage in the area. The design of the osteotomy is for orthodontically compensated patients with labial incompetence and Class II skeletal, giving a result mandibular lengthening. The BEM achieved adequate lip competence demonstrated by an interlabial gap of 0mm, achieved adequate osseous consolidation of the fracture site with a more harmonious facial balance and profile, without nerve or vascular damage with spectacular results.

Commentary on Safe and Effective Chin Augmentation With a Hyaluronic Acid Injectable Filler, VYC20L.

Commentary on Safe and Effective Chin Augmentation With a Hyaluronic Acid Injectable Filler, VYC20L.

Expert Consensus on Hyaluronic Acid Filler Facial Injection for Chinese Patients.

Beauty standards vary by race and region, which must be accounted for in creating beauty. Chinese have unique features, including a depressed nose, flat midface, and small chin, and have different cosmetic concerns. We performed a consensus study on filler injections based on the Chinese standard of beauty due to a lack of such study. We organized the YVOIRE Consensus Group, including 5 plastic surgeons. We discussed common problematic areas seen in Chinese and described techniques based on our experience with hyaluronic acid fillers, while considering peer-reviewed articles, followed by multiple consensus-developing sessions. Chinese faces are characterized by retruded forehead, chin, and low nasal bridge, with certain features believed to bring good fortune. Therefore, profiles of the forehead, nose, lip, and chin have substantial effects on attractiveness. The demand for cosmetic procedures is high among the young generation who particularly desire nose and chin augmentation. Attractive Chinese facial shapes are characterized by a long, slender facial shape and pointed chin. Lips are narrow and thick. When injecting fillers for Chinese, it is necessary to apply special methods that produce results consistent with these characteristics. Understanding the concept and demand of beauty depending on race and region is important. Patients should be evaluated before aesthetic procedures. Maintaining hygiene during the procedure is crucial. Moreover, methods for preventing pain are essential. Fillers should be injected into the correct anatomical site and layer to minimize side effects and maximize effectiveness.

An In-House Protocol for Fabrication of Patient-Specific Implants to Correct Genial Asymmetry

Facial disharmony as a result of genial malformation or malposition is a correctable condition with a mandibular osteotomy with subsequent repositioning and fixation. Surgical accuracy with osteotomy design and hardware placement in the correct position is paramount to achieve the appropriate surgical outcome and resultant facial balance. These cases highlight a unique protocol developed at Naval Medical Center San Diego to use computer-aided surgical simulation (CASS) to customize patient-specific osteotomy guides and titanium plates for corrective chin surgery. Cross sectional imaging was used to generate virtual stereolithic models of the patient’s facial skeleton. An osteotomy was then virtually performed to divide the patient’s lower jaw. A surgical guide was then designed to index the osteotomy in its precise location. Incorporated into the surgical guide were the fixation holes for a titanium implant. The titanium plate was designed in a similar fashion to align with the predetermined points of fixation and anatomically approximate the chin in its virtually planned position. The virtual files (STL) were then sent to 3D Medical Applications Center at Walter Reed National Military Medical Center for printing. The surgeries were performed in the main operating room with accurate replication of the computer assisted surgical simulation and excellent clinical outcomes to follow. Post-surgical accuracy was evaluated by comparing postoperative CT imaging with the predetermined surgical simulation. The mean difference in of the final chin position was < 1mm in the vertical and horizontal planes. These results reinforced clinical replication of the CASS with a level of accuracy less easily obtained through more traditional methods. Although the presurgical planning required time investment for virtual planning and design, intraoperative surgical time was reduced. Additionally, by managing the computer-assisted design in institution, a tremendous reduction in cost was realized. Surgical correction of facial imbalance requires the utmost intraoperative precision to optimize patient outcomes. Virtual surgical planning with guided osteotomies and patient-specific implants offers an avenue to enhance surgical predictability in the operating room. Further, guided surgery streamlines operating time and efficiency by effectively negating the need for intraoperative measurements or repositioning guides. This unique protocol nearly eliminates the significant financial burden often associated with such procedures, making it far more applicable globally.

An Easy and Effective Technique for Silicone Facial Implant Insertion and Fixation to Periosteum

In this paper, we present a simple way to place the implant into a harvested pocket and to subsequently fix it percutaneously. Eighteen patients (1 male, 13 females, 4 transgender), underwent facial implant placement; a total of 31 implants were placed (1 pair of angles of the mandible implants, 12 pairs of malar/sub-malar implants, and 5 chin implants). The intraoral approach was performed on 15 patients, and on the remaining three patients, the sub-ciliary lower lid approach was preferred. Patients were followed up for at least one year with a maximum follow-up of seven years (mean 1.8 years). In all the cases, except one, patients healed without complications. One case of implant displacement and infection was recorded. No other complication was documented. The technique described is similar to the one suggested by Peled, although some useful tips were added, namely the use of sutures, not only to fix the implant but also to drive it into the harvested pocket. In addition, larger absorbable “left in place” sutures were used, avoiding accidental implant dislocation during their removal. Further studies are required to gain a more complete understanding of the effectiveness and reproducibility of this surgical technique.

Bone Remodeling Under Screw-Fixed Chin Implants in Patients With Microgenia: A Cross-Sectional Study

The use of alloplastic chin implants has been associated with a risk of bone resorption. The aims of this study were to evaluate, in patients with microgenia, the association between chin implants and bone resorption and identify the associated risk factors for such resorption. The sample consisted of 51 patients with microgenia: 17 with chin implants (group A, placed over the course of a 15-year period [2002-2017]) and 34 without implants (group B). Cone-beam computed tomography was used to evaluate bone erosion in different areas of the chin. The patients were evaluated, and their medical records were reviewed to identify risk factors. A chi-square or Fisher exact test and the Mann-Whitney test were used to compare groups; resorption sites were compared with Friedman test. Linear regression models were used to evaluate associations between potential risk factors and resorption. Bone resorption was higher in group A than in group B (mean ± SD: 0.98 ± 0.63 mm vs 0.03 ± 0.12 mm; P &lt; .0001). Symphyseal buccal cortical bone in group A was thinner (1.66 ± 0.34 mm) than it was in group B (2.07 ± 0.45 mm), P &lt; .001. Group A showed appositional bone growth and no cortical bone perforation. The mean of the amount of bone resorption of chin implant patients compared with that of those without implants was, on average, 0.99 mm greater (95% confidence interval: 0.64-1.35; P &lt; .001). Although statistically significant differences in bone resorption were observed between groups, these differences were not clinically significant. Thinning of symphyseal buccal cortical bone without perforation and appositional bone growth occurred in chin implant patients, suggesting bone remodeling. Our results suggest that bone that is in contact with chin implants remodels and remains stable throughout the years, instead of undergoing progressive resorption.

Captain America's Shield Genioplasty.

The chin represents one of the most important determinants of the facial aesthetics. Like many aesthetic parameters, the "ideal" chin has changed in history regarding projection and prominence. From the retrusive profiles of the Renaissance, stronger and more defined mandibular contour are nowadays desired both by masculine and feminine population.This change in the ideal references plays an important role in diagnosis and treatment planning. Various techniques for chin augmentation have been described, using both alloplastic materials and osteotomies.An interesting osteotomy variant, so-called chin shield osteotomy, has been described by Triaca et al to avoid a deep mentolabial fold. The authors describe herein the use of a shield plate, very similar in his form to Captain America's shield, that can at the same time provide bone fixation and soft tissues sustain in the mentolabial fold region, preventing the invasion of the gap between the bone fragments by the connective tissue, as it happens in a guided bone regeneration procedure.

About Chin (Genioplasty) Surgery

About Chin (Genioplasty) Surgery

Facial Soft Tissue Augmentation With Bellafill: A Review of 4 Years of Clinical Experience in 212 Patients.

Bellafill (Suneva Medical Inc) is a semipermanent injectable soft tissue filler composed of smooth and uniform polymethylmetacrylate (PMMA) microspheres suspended in a bovine collagen gel. It is a third generation PMMA filler, with more uniform shapes and sizes of the PMMA microspheres, which has been purported to decrease the incidence of granuloma formation. We performed a retrospective review of our clinical experience from 2014 to 2017 with Bellafill as a soft tissue injectable filler in the following clinical scenarios: deep nasolabial folds, depressed facial acne scars, malar volume loss, temporal wasting, tear trough deformity, chin augmentation, angle of jaw augmentation, and lip augmentation. The primary outcome is the rate of adverse events, and the secondary outcome is subjective patient satisfaction. From 2014 to 2017, 842 syringes of Bellafill were administered to 212 patients, for a total of 417 procedures. Of the 417 procedures, 96 (23.0%) were for acne scars, 82 (19.7%) malar volume restorations, 65 (15.6%) nasolabial fold augmentations, 45 (10.8%) chin augmentations, 42 (10.1%) tear trough volume restorations, 28 (6.7%) temple volume restorations, 25 (6.0%) rhinoplasty touch-ups for small areas of nasal depression, 22 (5.3%) lip augmentations, and 12 (2.9%) jaw angle augmentations were performed. A range of 1 to 12 syringes were injected into each patient, over 1 to 3 sessions; 6 cases of adverse events occurred (1.4%). There were 4 cases of solitary nodules in the injection site, 1 case of lower eyelid oedema which persisted for 3 months and 1 case of lower lip oedema which resolved within hours. Patient satisfaction rates ranged from 83.3% for angle of jaw augmentation to 99.0% for improvement of acne scars. Bellafill is a safe and effective option for a semipermanent soft tissue filler, with high patient satisfaction and a good safety profile.

Reduction genioplasty for mandibular prognathism and long chin.

When evaluating patients' profile, surgeons usually note the lack of the chin projection and may suggest chin augmentation, but they rarely discuss reduction of an over-projecting chin. This is unfortunate, since there are quite many individuals who have macrogenia and would aesthetically benefit from corrective surgery, but the chin reduction is seldom offered. The reason for this is the lack of experience, lack of the technical equipment necessary, or sometimes lack of knowledge. The present study conveys 25 years of experience with the reduction genioplasty. From 1994 to 2019, 47 patients (39 females, 6 males, and 2 male to female transsexuals) underwent 49 chin reduction procedures. All patients were operated and followed up by the author. The transoral approach was used in 23 patients, and in 24 patients the procedure was done through the straight 4- to 6-cm-long submental incision. The air-driven pneumatic chisel was employed for reduction of the mandibular bone (MicroAire, Charlottesville, VA, USA). Forty-eight operations were carried out under dissociative and local anaesthesia on an outpatient basis, and one procedure was done under general endotracheal anaesthesia. Both mandibular bone and the soft tissues of the chin were reduced, or modulated according to the needs of each patient. Operations were technically easier when executed by the submental approach because of better exposure of the mandibular rim and the higher precision in the remodelling of the soft tissues. Thirty-six patients (77%) could be followed up for a mean of 2.5 years (range 9 months to 12 years). Twenty-eight of evaluated patients (78%) described the outcome as very good or good. Four patients described the result as acceptable and another 4 as bad. In the majority of cases the evaluation by the surgeon correlated well with the opinion of patients, but in five cases surgeon estimated result with the higher score than the patient. Overall good results were illustrated by the photographs of the clinical examples. Complications were few and manageable. Transient neuropathies were common and more frequent with the transoral approach. Five patients required minor intervention for skin indentations at the jaw line developed during the healing phase. Skilful chin reduction surgery is safe and the aesthetic improvement could be quite spectacular, which is also rewarding for the patients. Complications in this patient series were few and manageable. More surgeons should include chin reduction in their repertoire.

Focusing on chin augmentation: treating the lower face using dermal filler

Aesthetic treatments to enhance body parts, such as the lips, cheek and jaw, are on the rise, and chin augmentation in particular is a popular choice. Alex Henderson details the process behind lower face augmention and considerations that should be made

Standard and Customized Alloplastic Facial Implants Refining Orthognathic Surgery: Outcome Evaluation

Conventional orthognathic osteotomies provide appropriate functional outcomes but might be unable to correct midface deficiency, achieve a satisfactory outcome in asymmetrical cases, or allow sufficient chin advancement. We evaluated the outcome of both standard and customized facial high-density porous polyethylene implants used to refine the cosmetic outcome of orthognathic surgery. We implemented a retrospective study. The sample was composed of all patients who underwent facial alloplastic augmentation between June 2011 and October 2018 in our department. The complication rate was recorded after a mean follow-up period of 41months postoperatively, and patient satisfaction was assessed through a qualitative evaluation based on an 11-item questionnaire. The sample was composed of 24 implants placed in 14 patients: 13 mandibular angle implants, among which 4 were customized; 8 malar implants; and 3 chin implants. No physical complications such as hematoma, infection, migration, or hypoesthesia were observed. Two implants had to be removed because of early unsatisfactory esthetic outcomes. Of 14 patients, 11 answered our questionnaire. Eighty-two percent strongly agreed that the overall outcome was satisfactory. The results of this study confirm the low physical complication rate described in the literature, and the esthetic complication rate remains lower than the rates observed in previous reports. A high satisfaction rate was found among patients. The lowest mean satisfaction score was noted for appropriate implant symmetry (3.5), whereas the highest mean satisfaction score (3.8) was achieved when using customized implants. If standard high-density porous polyethylene implants appear to be relevant adjuncts to orthognathic surgery, customized implants seem to achieve higher satisfaction, although their prohibitive cost should be considered.

Short Face Dentofacial Deformities: Changes in Social Perceptions, Facial Esthetics, and Occlusion After Bimaxillary and Chin Orthognathic Correction.

The purpose of this study was to document changes in social perceptions and facial esthetics, and document occlusion outcomes in a series of short face (SF) dentofacial deformity (DFD) subjects. The investigators hypothesized that subjects would achieve positive change in social perceptions and facial esthetics, and maintain a long-term corrected occlusion after undergoing bimaxillary and chin osteotomies.A retrospective cohort study was implemented. Photographic records and occlusion parameters were studied preoperatively and >2 years after surgery. The first outcome variable was social perceptions of SF subjects, judged by laypersons. The second outcome variable was facial esthetics, judged by professionals. The third outcome variable was occlusion maintained long-term.Fifteen subjects met inclusion criteria. Mean age at operation was 33 years. Consistent facial contour deformities at presentation included deficient maxillary dental show and downturned oral commissures. As a group, there was improvement (P < 0.05) in 11 of 12 social perceptions, judged by laypersons, all subjects achieved correction of the facial esthetic parameters studied by professionals, and all subjects maintained a favorable occlusion long-term.In SF DFD subjects, bimaxillary and chin surgery proved effective to improve social perceptions, to correct facial contour deformities, and in achieving a long-term corrected occlusion.