While custom chin implant generally costs more than the “pre-made” version, using it makes it easier to achieve natural and proportionate results. This is particularly true for patients with an extreme case of recessed chin or notable asymmetry.
Leading Beverly Hills plastic surgeon Dr. Tarick Smiley has recently posted Snapchat videos demonstrating a female patient who required custom chin implant to address her receding chin, which contributed to her poor facial proportion.
Before-and-after photos of a patient with chin implant surgery
To achieve natural results from any facial implant, Dr. Smiley says the first step is to have a deep understanding of what constitute the ideal proportions and beauty paradigm, some of which transcend culture and ethnicity. For instance, he says that the ideal projection of the chin is “congruent with the anterior portion of the iris of the eye.”
Laser helps Dr. Smiley determines the ideal chin projection, which he says should be congruent with the anterior of the iris of the eye.
Other facial elements that are taken into account include the tip of the nose and the forehead projection. Together with the chin, they have a large influence on the perceived attractiveness of the facial profile and proportion.
The patient’s customized implant was made of firm silicone material (silastic), which has an impressive safety record. Unlike other chin implants that have microspores that allow tissue ingrowth, silicone implants are easier to remove in the event that the patient is not happy with the result.
Moreover, her implant has been designed to improve her chin profile or how much it projects from the lower jaw; it has no or very little effect on the vertical height of her chin.
During surgery, Dr. Smiley placed a small incision inside the patient’s mouth, a technique he says he prefers due to the “invisible scar.”
(The external incision technique is another option; it uses a small cut beneath the chin to position the implant right beneath the bone. In most cases, the scar fades into a barely visible mark, although the risk of visible scar cannot be completely eliminated.)
Dr. Smiley says the chin implant must be positioned precisely in the middle to achieve proportionate and natural-looking results. Hence, the implant always has a mark in the midline to guide doctors during the implantation process.
In the first few weeks of implantation, a thin scar tissue gradually encapsulates the prosthesis (this happens to any implanted device as the body attempts to contain any foreign material it detects), allowing it to stay in place.
A pre-jowl chin implant extends more laterally to fill in the skin creases or conceal the “bulge” on each side of the chin caused by sagging tissues such as the skin and deeper structures. This is different from the standard chin implant whose primary purpose is to improve the convexity and profile (or forward projection) of the chin.
A face that is deemed youthful and attractive has a taut jawline, but with aging (or massive weight loss) it develops dips and bulges on each side of the chin; these are referred to as pre-jowl sulcus.
Unlike the jowl that extends far more laterally and so facelift might become warranted, the pre-jowl sulcus can be concealed with a special type of chin implant, as suggested by leading Los Angeles plastic surgery expert Dr. Tarick Smiley.
Placement of pre-jowl implant to conceal the bulge or dip on each side of the chin. Notice that it extends more laterally compared to “ordinary” chin implants. (Photo Credit: Implantech website)
Pre-jowl chin implants are typically designed having a relatively thin anterior portion while the lateral sides are thicker so only the pre-jowl sulcus is augmented. However, some newer designers provide additional volume to the chin and the pre-jowl area as well.
To determine the most ideal pre-jowl chin implant design, Dr. Smiley highlights the importance of a candid discussion between a surgeon and his patient to outline the latter’s specific goals. Of course, a physical exam will further help the surgeon identify the most cost-effective approach.
Instead of using pre-jowl chin implant, patients with smaller “bulges” on each side of their chin may opt for dermal fillers such as Radiesse. By adding volume along the depressions, the dip is concealed and there is now a smoother transition between the chin and the adjacent area.
But for a full-blown jowl—i.e., the entire jawline is affected by the loose skin and deeper structures—facelift is generally the best approach. This surgery can create a tauter jawline by pulling its skin at a 45 degree angle, which is the correct vector of pull as it can also tighten the neck skin and reposition the sagging mid face.
Chin implant is primarily used to improve the appearance of “weak” chin, which is generally defined as having inadequate projection to the point that it “disappears” from the neck.
Nonetheless, some patients with pre-jowl sulcus (a “dip” on each side of the chin) and skin creases along their chin may benefit from a carefully selected chin implant size and design, as suggested by leading Beverly Hills plastic surgeon Dr. Tarick Smiley.
Dr. Smiley performs rigorous physical exam to identify the most ideal chin implant size and design based on the patient’s starting anatomy and cosmetic goals.
The “ideal” chin—or at least according to popular definition of proper aesthetic harmony—has a projection that is 1-3 mm behind the vermilion border’s (of the lower lip) when an imaginary vertical line is dropped from this point.
Hence, if there is a greater disparity between the chin and the vermillion border’s projection the chin is perceived to appear recessed or weak.
Most chin implants have a central thickness between 4 mm to 12 mm. Some people may assume that simply using a dimension that will compensate for the deficiency (measured in millimeter) is the “end all and be all” of chin implant size selection. On the contrary, relying on this factor alone may not deliver the desired results and may even create an unnaturally deep lip-chin sulcus (depression).
The lip-chin sulcus may become exaggerated when an implant with a significant central thickness (more than 10 mm) is used in a markedly recessed chin. This of course does not look natural and so a good surgeon will also take into account the postop convexity of the chin.
Contrary to popular belief, chin implant not just improve the profile of the chin but also its convexity. Furthermore, it has no or very little effect on the vertical height of the chin.
Simply put, identifying the ideal chin implant size based on its central thickness starts with meticulous evaluation of the chin’s convexity and its shape in profile view.
In most cases, the central thickness of the chin implant has the most effect on the final result (and of course, the patient’s underlying anatomy). Nonetheless, the horizontal length of the implant might be used in some cases of noticeably narrow chin.
It is not uncommon to customize chin implant due to the rather limited sizing and shape of “regular” or “standard” designs created by manufacturers. Custom-made implants are particularly ideal for patients with markedly narrow chins and obvious asymmetry between the left and right side of their face.
Buccal reduction surgery aims to deliver a more chiseled face by removing some portion of the fat deposit deep in the cheek, specifically between the corner of the mouth and the nostril.
Instead of removing or obliterating completely the buccal fat pad in the cheek region, leading Inland Empire plastic surgeon Dr. Tarick Smiley says reducing it only (i.e., leaving behind some fat) will ensure a natural result and prevent the “scrawny” appearance, which may appear soon after surgery or several years down the road.
Aside from going to the “conservative route,” Dr. Smiley says the success of buccal reduction surgery also relies on strict patient selection; hence, he only reserves this procedure for patients with full, round face who are near their ideal weight.
(Note: Overweight people can have “chipmunk” cheeks, which may deflate to some extent after losing the extra pounds. Meanwhile, some normal weight individuals have a markedly round face due to large buccal fat pad, a feature that is generally hereditary.)
And while there is no “magic number” when it comes to the ideal age for buccal reduction surgery, many surgeons recommend postponing it until one has reached her mid-twenties. It is important to note that aging causes facial volume loss and so the face will thin out naturally.
The caveat with having buccal reduction surgery before reaching the age of mid-twenties is the perceived increased risk of looking scrawny several years down the road. In fact, dermal filler injection is the most popular non-surgical facial rejuvenation in women between late thirties to early fifties.
Dr. Smiley has recently posted a series of Snapchat videos to demonstrate buccal fat reduction surgery combined with chin implant. He created a small incision inside the patient’s mouth (between the cheeks and gums) to expose the buccal fat. Then, he teased some of the fat out with forceps to remove it.
To achieve a more proportionate result (and a more chiseled facial contour), the patient had a simultaneous chin augmentation in which a short inconspicuous incision was made beneath her chin in order to position a small implant. The incision is expected to fade into an invisible scar after 6-12 months.
Chin augmentation and rhinoplasty are commonly combined because the chin and nose—and their relation to each other—can greatly influence the level of facial attractiveness.
Rhinoplasty, or more commonly referred to as nose job, generally results in a more defined tip, which can appear in stark contrast to the recessed or near absent chin.
Contrary to popular belief, chin augmentation does not elongate one’s face, unless there is a specific need to do so. Either performed with permanent implants or dermal filler injections, the procedure primarily aims to improve the facial profile or the chin’s forward projection.
Many surgeons in Upland plastic surgery are now using 3D imaging technology to allow their patients “preview” the results of chin augmentation and rhinoplasty combinations, and ultimately make an informed decision.
Chin augmentation (via permanent implants) costs anywhere from $3,000 to $5,000, while the average rhinoplasty fees are more variable, ranging between $6,000 and $12,000. However, “combinations” can lead to potential savings since the patient will only have to pay for one anesthesia and surgical facility fee.
Most chin augmentation surgery uses implants made of solid silicone, which has a high tissue compatibility that the risk of adverse reaction is very rare. And should the patient is not happy with the results, it can be easily removed and/or replaced.
(Note: Some implants such as Gore-Tex promote tissue in-growth, so over the course of time they become part of the chin, leading to natural results and feel. However, they are very difficult to remove in situations where the patient is not happy with the results.)
But some rhinoplastic patients are not sure if they want a “permanent” chin augmentation. A good alternative is to use dermal fillers, which can cost between $500-$800 per session.
In the long run, dermal fillers injections are more expensive than chin implants because they generally require 2-3 touch-ups every year. However, they are a good option if the patients want to see first what a permanent chin augmentation can do to their facial profile.
If there is a desire to “try on” chin augmentation, most doctors prefer to use dermal fillers made of hyaluronic acid because their effects can be easily reversed by an injectable enzyme should the patients are not happy with the initial results.
Sometimes, chin augmentation is complemented by jaw implants, which are particularly needed by male patients whose weak jaw results in an effeminate appearance.
A chin augmentation alternative often pertains to injectable treatments such as dermal fillers or fat transfer. But for a long-lasting result, most experts in Los Angeles plastic surgery recommend chin implant, which is often made of medical-grade solid silicone.
Silicone implants (not the injectable ones, which are banned in the US due to their unpredictability and high complication rates) can be easily removed should the patients are not happy with their results.
before-and-after photos of chin augmentation patient
Contrary to popular belief, chin implants or chin augmentation in general do not elongate one’s face—unless the patient specifically requests for it. The surgery’s quintessential goal is to improve the front and profile view of the face.
Ideally, the chin should be at the same projection as the lower lip to achieve a more balanced face. While a recessed chin does not look good on men and women, the “look” is particularly detrimental to males because it undermines their masculine features.
A good alternative to chin implant is dermal filler injection, which provides temporary results (six months to two years, depending on the material used). But because in the long run it is more expensive than a permanent implant, some surgeons only recommend it to patients who want to “try-on” chin augmentation before they decide on a more permanent solution.
When perform chin augmentation via fillers, a good number of injectors prefer Radiesse, which is made of microsphere-like calcium hydroxylapatite. The surrounding tissue gradually absorbs this substance, which is naturally found in the body, after 12-18 months.
However, some injectors prefer hyaluronic acid based fillers such as Voluma because their results can be easily reversed by an injectable enzyme, should the patient is not happy with the results.
Instead of using readily available dermal fillers, some doctors prefer fat transfer in which they collect donor fats and use them to augment or reshape certain areas of the body or face. While it can provide near-permanent augmentation, it often provides variable results.
Most experts aim to achieve at least 60-80 percent survival rate, which is highly dependent on how the donor fats are harvested, purified, sorted, washed, and re-injected.
Meanwhile, some patients are suitable for mandibular osteotomy in which their jawbone is move forward to correct the recessed chin appearance. This is often seen as a last resort because it involves more potential risks and longer recovery.