Genioplasty Research Articles

Taking it on the chin: recognizing and accounting for lower face asymmetry in chin augmentation and genioplasty.

During the course of thousands of preoperative facial analyses, it has become apparent that the chin, in most individuals, appears weaker on the left than on the right. This previously unreported disparity spans age, sex, and ethnicity. To document this finding, frontal and lateral photographs of 20 random patients from the senior author's practice were subjected to a battery of soft-tissue measurements. Analysis of four celebrities further demonstrated the ubiquity of relative left chin weakness. Precedent for asymmetry in human anatomy is abundant (e.g., handedness). Asymmetry, moreover, often is conserved throughout the population (e.g., sidedness of visceral orientation). Left-sided chin weakness appears to be another example of well-preserved anatomical asymmetry. The presence of this asymmetry should be considered in planning chin augmentation and genioplasty.

Different maxillomandibular advancement methods for the treatment of severe obstructive sleep apneahypopnea syndrome

To review the outcomes of three different methods of maxillomandibular advancement for the treatment of severe obstructive sleep apnea-hypopnea syndrome (OSAHS). Twenty-four patients with severe OSAHS from January 2011 to January 2014 treated by three different methods of maxillomandibular advancement (MMA) and genioplasty, maxillomandibular advancement without rotation plus genioplasty, maxillomandibular advancement with counterclockwise rotation plus advancement genioplasty, maxillomandibular advancement with first premolars extraction and subapical osteotomy setback under general anesthesia were included in the study. Comparison of per-operative and post-operative cephalometric analysis, polysomnography (PSG), apnea and hypopea index (AHI), body mass index (BMI), average blood oxygen saturation (AOS), lowest oxygen saturation (LSaO2) and posterior airway space (PAS) data were performed. The operative time and post-surgical orthodontic treatment data were collected and analyzed. According to Stanford criteria, the success rate of 100% was achieved with all the three methods. The difference between per-operative and post-operative AHI, AOS, SNPg and PAS were statistically significant (P<0.0001) for all the three methods. Significant difference was found between per-operative and post-operative SNA (81.51°±3.36° vs 88.17°±4.51°, P<0.0001), (82.25°±2.71° vs 86.54°±3.65°, P=0.0002) and SNB (72.37°±3.99° vs 80.59°±3.40°, P<0.0001), (73.65°±3.80° vs 81.37°±2.96°, P<0.0001) among MMA without rotation plus genioplasty and MMA with counterclockwise rotation and advancement genioplasty respectively. However, no significant difference was found between the pre-operative and post-operative SNA (82.18°±4.27° vs 84.19°±2.70°, P=0.2015) and SNB (73.28°±3.04° vs 75.35°±2.56°, P=0.2640) among MMA with first premolars extraction and subapical osteotomy setback. The average duration of postoperative orthodontics treatment was 8.3 months. MMA and advancement genioplasty is an effective surgical management for severe OSAHS. Cephalometric analysis and computer aided design are needed for personalized surgical methods. MMA without rotation and advancement genioplasty method leads to the protrusive skeletal deformity. MMA with counterclockwise rotation and advancement genioplasty method is effective in curing severe OSAHS with little effect on facial profile. MMA with first premolars extraction and subapical osteotomy requires longer operative time and longer postoperative orthodontic treatment.

The research of SurgiCase CMF software in surgical simulation and prediction for mandibular asymmetry

To evaluate the predictive accuracy of the SurgiCase CMF software in surgical simulation and prediction for mandibular asymmetry with 3-dimensional simulation and measurement. CBCT data of 27 patients with mandibular asymmetry were observed in CMF, and postoperative soft tissue physiognomy were predicted by simulating sagittal ramus osteotomy with or without genioplasty. The measurement parameters representing the symmetry of soft tissue were selected and the horizontal, coronal and sagittal planes were established. The results were analyzed by SPSS 19. 0. The overlap compared color grading charts were observed. Angles between cheilions and the horizonta plane (Ch-Ch-FH) in the simulation and postoperative soft tissues are (2. 35 ± 1. 81)° and (1. 44 ± 1. 13)°. The angles constructed among subnasale, upper lip and lower lip (Sn-UL-LL) are (4. 02 ± 3. 05)° and (2. 59 ± 1. 64)°, showing statistically different (P < 0. 01, P < 0. 05), which means that predictive accuracy of the lip canting and lip vertical deviation is relatively low. Distance between gonioi and sagittal plane (Go'-MS), distance between gonion and pogonion (Go'-Pog') and angle betweer subnasale to menton and the horizontal plane (Sn-Me'-MS) are not statistically different, which mean! high predictive accuracy of mandibular angle and chin. By observing the overlap compared color gradin-) charts, the predictive accuracy is not good in the cheek, especially in the deviate side. The predictive accuracy of CMF system for patients with mandibular asymmetry is relatively high, but it is not good in the lip and cheek. The software improvement is still necessary.

A Modified Technique For Expanded Polytetrafluoroethylene Shaping in Chin Augmentation

In the current study, we restricted our focus on a modified approach to address the poor curved attachment of expanded polytetrafluoroethylenein chin augmentation. The implant is shaped generally in accordance with the chin, followed by 5-to-8 longitudinally parallel "V"-grooves carved in the median of posterior site where the implant directly attaches to the mandible. Thus, it enhances bend ductility of the prosthesis and renders better attachment from the curved surface of prosthesis to the mandibular embedded region. This procedure was performed in 15 patients. After follow-up for 2 to 6 months, there were no complications observed postoperatively including mobilization, dead space, subcutaneous dropsy, topical infection, or palpable edges in the subcutaneous area. The introduction of longitudinally parallel V-groove technique provides an effective method for avoidance of increasing hardness, decreasing flexibility, and palpable edges after implantation.As a novel and effective technique, it is beneficial for better attachment and satisfactory outcome without causing extra expenses.

Do YouTube videos Serve Reliable Information about Chin Aesthetics and Chin Augmentation?

Do YouTube videos Serve Reliable Information about Chin Aesthetics and Chin Augmentation?

Complications of Silastic Chin Augmentation Implants: A Report of Four Cases

Complications of Silastic Chin Augmentation Implants: A Report of Four Cases

Applications of Coronoid Process as a Bone Graft in Maxillofacial Surgery

The coronoid process can be easily harvested as a donor bone by an intraoral approach during many maxillofacial surgery procedures. The purpose of this study was to evaluate the utility of autogenous coronoid process bone grafts for maxillofacial reconstructive surgery. Twelve patients, who underwent coronoid process grafts for reconstruction of maxillofacial deformities due to trauma, alveolar atrophy, or temporomandibular joint ankylosis, were included in the study. There were 3 orbital defects after extended maxillectomy, 1 blowout fracture of the orbit, 2 cases of reconstruction after temporomandibular joint ankylosis surgery, 1 case of additional chin augmentation following horizontal flip genioplasty, 1 defect of anterior wall of maxilla due to trauma, 2 mandibular defects, and 2 cases of bone augmentation for implants.We recommend the use of coronoid process of the mandible as a source for autogenous bone graft as it can provide sufficient bone in quantity and quality for selected maxillofacial reconstructions.

Dual Plane Augmentation Genioplasty Using Gore-Tex Chin Implants.

BackgroundThe chin shape and position is important in determining the general shape of the face, and augmentation genioplasty is performed alone or in combination with other aesthetic procedures. However, augmentation genioplasty using osteotomy is an invasive and complex procedure with the potential to damage mentalis muscle and mental nerve, to affect chin growth, and prolonged recovery. Our aim was to present our experience with a modified augmentation genioplasty procedure for hypoplastic chins using a Gore-Tex implant.MethodsTwo vertical slit incisions were made at the canine level to create a supraperiosteal pocket between the incisions, preserving the periosteum and mentalis muscle. Minimal sub-periosteal dissection was performed lateral to the incisions along the mandibular border. The both wings of implant were inserted under the periosteum to achieve a stable dual plane implantation.ResultsIn total, 47 patients underwent dual plane chin augmentation using a Gore-Tex implant between January 2008 and May 2013. The mean age at operation was 25.77 years (range, 15-55 years). There were 3 cases of infection; one patient was treated with antibiotics, the others underwent implant removal. Additionally, two patients complained of postoperative parasthesia that spontaneously improved without any additional treatment. Most patients were satisfied with the postoperative outcomes, and no chin growth problems were observed among the younger patients.ConclusionDual plane Gore-Tex chin augmentation is a minimally-invasive operation that is simple and safe. All implants yielded satisfactory results with no significant complications such as mental nerve injury, lower lip incompetence, or chin growth limitation.

Simultaneous Chin Onlay Bone Graft Using Elongated Coronoid in the Treatment of Temporomandibular Joint Ankylosis

Temporomandibular joint (TMJ) ankylosis is a disabling condition that causes problems in mastication, digestion, speech, appearance, and hygiene. Treatment goals are to restore the joint function, to improve facial appearance, and to reestablish harmony among them. To achieve these goals, various strategies have been reported as 1-stage or multistage protocols. We describe a novel method to augment the chin structure with elongated coronoid process of the mandible, which is a sequence of TMJ ankylosis. By this 1-stage treatment that includes gap arthroplasty with interpositional temporalis fascia graft and chin augmentation with autogenous bone graft (elongated coronoid), functional disability and facial deformity of the patient with TMJ ankylosis were improved simultaneously.

Esthetic makeover of a syndromic face

We present a case report of a 23-year-old female with syndromic face. She presented to us with typical facial features of Crouzon syndrome. Her childhood was uneventful except for the deformed face. Craniofacial surgeries to correct the deformation were not done in childhood due to risk and complications. Patient requested for the correction of facial deformity without major craniofacial surgery. She underwent two staged procedure. In the first stage, autofat grafting of forehead, left supraorbital rim and malar areas were performed with cheek fat removal. Chin and mid-face augmentation with costal cartilage grafts were done. Septorhinoplasty was done as a second stage procedure. She has got excellent outcome by this camouflage surgical approach. This approach can be used in selective cases with minimal risk. Excellent esthetic results can be achieved by thorough analysis and involvement of the patient and parents in planning.

Testicular Augmentation Using Chin Implants

Disturbances in testicular integrity have the potential to cause severe concerns about masculinity, body image, and sexual function. Testicular volume replacement surgery with prosthesis has been known about since 1941, although esthetic procedures for testicular augmentation have not been satisfactory. To describe an unprecedented testicular augmentation surgical technique that is specially focused on preserving testicular function and providing a favorable esthetic outcome. We present a case of a 45-year-old man with body dysmorphic disorder. Surgical treatment using a new technique by placing a chin implant on the testicle was offered and accepted. Good symmetry between both testicles was achieved. No complications were reported. One month after the procedure, the patient started a satisfactory sex life. Functional monitoring was normal during the year after the procedure. This technique is unprecedented in literature, it represents a safe and effective therapeutic alternative; nevertheless, more experience in performing this procedure is needed.

Rhinoplasty and Brow Modification

Plastic surgeons have long recognized the importance of performing chin augmentation concurrent with a rhinoplasty to achieve facial balance. However, few surgeons consider the benefits of combining a rhinoplasty with brow modification to achieve a better aesthetic result. By increasing the size of the middle third of the face, the nose will automatically appear smaller. The authors describe anatomical dissections that provided perspective on the facial anatomy of the areas being studied and report the results of concurrent browlift and rhinoplasty procedures in a retrospective series of patients. The present study consisted of 2 parts: anatomical dissections and a retrospective chart review. The nose and central forehead area were dissected in 7 fresh cadavers at the time of autopsy to understand the anatomical relationship between the various muscles in the radix/glabellar region and to assess the muscle resection occurring in the clinical procedures. We also reviewed the charts of 24 patients who underwent combined rhinoplasty and brow modification with the senior author (R.K.D.) during a 2-year period (July 2010 to June 2012). Younger patients underwent a central browlift (CBL) with screw fixation, while older patients (ages 34-60 years) underwent full 5-incision endoscopic forehead lifting. The age range for patients in this series was 14 to 60 years. Two patients were men and 22 were women. There were 12 primary and 12 secondary procedures in the series; 13 patients underwent CBL and 11 had EFL. The mean follow-up was 18 months. One patient had a persistent fluid accumulation in the glabellar region, which required drainage. One patient requested additional refinement of her nasal tip. Modification of the central brow can dramatically change the aesthetic polygons of the nose/glabellar region. A CBL with radix/glabellar muscle excision is important in younger patients who need a well-defined nasion and older secondary patients who feel that the upper third of their nose is still heavy. A full EBL can enhance the facial appearance of older patients in whom a rhinoplasty alone would have a modest impact.

Severe Bone Resorption in Expanded Polytetrafluoroethylene Chin Augmentation

Expanded polytetrafluoroethylene implant is usually considered as a wonderful implant for chin cosmetic augmentation with no or less bone resorption compared with solid silicone implant. However, one severe bony erosion in expanded polytetrafluoroethylene chin augmentation was found in our clinical work. We consider that the possible reason about severe bone resorption in such situation is most relative to the mentalis muscle hyperactivity, rather than the kinds of materials. We also strongly advise that genioplasty is suitable for the cases with mentalis muscle hyperactivity caused by a dentofacial deformity.

Mandibular distraction combined with orthognathic techniques for the correction of adult hemifacial microsomia

To study the combination of Mandibular distraction and orthognathic techniques for the reconstruction of adult hemifacial microsomia. The three-dimensional CT reconstruction data was used with Mimics for preoperation design. The osteotomy location, distraction vector, distraction distance were decided before operation with a surgical guider. At the first stage, internal distractor was implanted after ostetomy through an extra-oral approach. The distraction begun 5-7 days after operation with a frequency of 1 mm/day. After distraction, the distractor was maintained for 3-6 months. At the second stage, the distractor was removed. Le Fort I osteotomy was performed in order to correct the cross-bite and improve the facial contour. Usually, bone graft was inserted into the gap after Le Fort I osteotomy. The genioplasty was also performed if necessary. 9 cases of adult hemifacial microsomia with severe mandibular deviation were treated. The facial asymmetry were improved greatly. 1 patient suffered an wound infection in the maxillary region after Le Fort I osteotomy and healed uneventfully with wound irrigation. Mandibular distraction combined with orthognathic surgery is an effective procedure for adult hemifacial microsomia with complicated mandibular hypoplasia.

A simple procedure to facilitate chin implants placement via submental approach

In order to facilitate chin implants placement by submental incision, the use of two threads is described. They are separately passed through the extremities of the implant and inserted into the previously created subperiosteal pocket using a grooved guide. Once the landmarks of dissection have been reached, the tip of the needle exits through the skin just a few centimetres laterally to the augmentation area and, only by pulling the free ends of the threads, the implant can easily be inserted into the pocket and the sutures cut and removed. This procedure was successfully performed in 79 patients of both sexes presenting with deficiencies in the sagittal dimension at the pogonion and in width, laterally to the symphysis. Therefore, in the authors' opinion, the before-described technique could be a useful tool that facial plastic surgeons can employ to facilitate alloplastic chin implants placement, by minimising the invasiveness of the procedure, reducing the operative time, and greatly improving the aesthetic result, without sacrificing the safety of the operation.

The Safe Zone for Placement of Chin Implants

Alloplastic chin augmentation requires the surgeon to predict the location of the mental foramen and the origin of the mentalis muscle to avoid the postoperative sequelae lower lip parasthesia, lower lip incompetence, or chin ptosis. The authors define a safe zone of dissection along the inferior border of the mandible for placement of alloplastic chin implants. Fourteen fresh cadaveric hemifaces were dissected with the aid of loupe magnification. Previously described anatomic landmarks were used to identify the origin of the mentalis muscle and the location of the mental foramen along the alveolar ridge of the mandible. Vertical distances were then measured from the mandibular border to the inferior aspect of the mentalis muscle origin and the lower edge of the mental foramen to construct the zone of safe dissection. The mentalis was identified as a fan-shaped muscle originating from the alveolar process below the incisors roots and inserting into the chin just below the labiomental sulcus. The mental foramen was located most commonly below the roots of the first and second premolars or in the space between the roots. The mentalis origin and the mental foramen were 1.8 ± 0.3 cm and 1.5 ± 0.2 cm cephalad to the inferior edge of the mandible, respectively. These distances define the borders of a safe zone above the mandibular border. A safe zone of dissection for alloplastic chin augmentation is identified. This study is applicable to implant placement through a submental or an intraoral incision. This safe zone is also useful for reconstructive or orthognathic mandible procedures.

Augmentation of Acquired Defect of the Forehead with Subperiosteal Silicone Implant

The need to look normal is a universal need. To be more than normal, i.e. to look exceptional is also possible now due to availability of various surgical and nonsurgical methods available to common people to either remove signs of old age or to enhance the present appearance. The technology for these procedures like nose lifts, chin augmentation, wrinkle removal, breast enhancements, etc. has advanced in leaps and bounds. The positive side of such technology is its use in case of disfigurement due to trauma. When a person experiences trauma, the appearance may be compromised. But corrections of such disfigurement have become routine surgical practice. The use of hard and soft alloplastic materials is also very much the norm. The following case presentation is about a patient with a concave defect on his forehead. This concave defect was augmented with a preshaped silicone implant. This silicone was preshaped with reference to a contoured acrylic mold that was made on a facial moulage of the patient. As it was contoured on the moulage, it represented the exact need of the patient and hence the surgery was done just to place it subperiosteally. The result was a patient with minimal pain and less morbidity.

Delayed Mental Nerve Neuralgia following Chin Augmentation

This paper describes a case of mental nerve neuralgia following a traumatic dislodgement of a chin implant ten months after surgery. Our case is unusual, both in the specific complication and the patients' atypical representation—delayed and initially without mention of trauma. To the authors' knowledge, this case has not been reported previously in the literature. We review the complications of chin augmentation and the techniques for fixation and discuss implications for the preoperative disclosure with patients.

Utility of high density porous polyethylene implants in maxillofacial surgery.

The aim of this paper was to determine the utility of high density porous polyethylene implants (HDPE) in a variety of facial skeletal deformities. Sixteen patients (age range 14-28 years) with facial deformities requiring skeletal defect reconstruction or augmentation, treated between January 2008 and December 2010. The follow-up of the patients ranged from 6 months to 2 years.The types of deformities and defects treated include: one patient each with hemifacial microsomia and nasal tip correction, two patients each with malar deformities and orbital floor reconstruction, three patients with paranasal deformities and mandibular hypoplasia and four patients with chin augmentation. A total of 24 implants were placed. The complications included infection and wound dehiscence in one patient. The implants were palpable extraorally in two patients. It is concluded that HDPE is an excellent alternative to autogenous grafts for facial skeletal augmentation. Its porous nature, excellent soft tissue growth and coverage are the advantages and disadvantages include its rigidity and sometimes it is palpable extraorally.

Skeleton and soft tissue contour reconstruction for severe progressive hemifacial atrophy

To sum up the various procedures for skeleton and soft tissue contour reconstruction in severe progressive hemifacial atrophy. From Jan 2004 to May 2012, 25 patients with severe progressive hemifacial atrophy underwent the procedures of lipoinjection, microsurgical flap transplantation, dermis grafting, distraction osteogenesis, orthognathic surgery and so on for both skeleton and soft tissue reconstruction. Among them, zygomatic augmentation and lipoinjection were performed in 24 cases, anterolateral thigh adipofascial flap in 10 cases and latissimus dorsi flap in one case, orthognathic surgery in 17 cases, including Le Fort I osetoectomy in 3 cases, genioplasty in 4 cases, mandibular distraction osteogenesis combined with secondary Le Fort I osteotomy in 3 cases, genioplasty combined with mandibular augmentation with Medpor implant in 7 cases. The patients were followed up for 6 months to 5 years. Through skelton and soft tissue reconstruction, the oblique occlusion plane and malocclusion were corrected with great improvement in face asymmetry. For severe progreassive hemifacial atrophy, comprehensive procedures should be adopted for both skelton and soft tissue reconstruction to achieve good results.