Genioplasty / aesthetic chin surgery
Genioplasty, or aesthetic chin surgery, can have several objectives:
- Reduce a bone volume that is too large or asymmetrical
- Bring forward a chin that is too small or set too far back by adding an implant
- Liposuction of excess fat under the chin
The aim is to embellish the face through surgery by changing one or more aspects that are aesthetically displeasing to the patient whilst maintaining a natural and viable look with regards to morphology. The desired shape is determined by the patient and surgeon through the analysis of photographic clichés which allow the definition of the best compromise between:
1. the psychological aspect (what the patient wants and what would be best adapted to their personality)
2. the morphological and aesthetic aspect (what would be best adapted to the shape of the face)
3. the technical aspect (what the surgeon considers to be technically viable)
The chin moves to a varying degree depending on the facial expressions of each patient. This leads to different degrees of healing and appearance. The project has, therefore, a virtual base: the surgeon cannot promise that a result will be super imposable, but he will do his utmost to make the result as similar to that as possible.
The operation can be realised on its own or potentially, where an overall improved facial appearance is desired, at the same time as rhinoplasty (cosmetic surgery on the nose). It is necessary to wait until the patient has stopped growing (16/18 years of age) before proceeding with this type of surgery.
In most cases incisions will only be made in the mouth and the surgeon will perform the entirety of the surgery passing through the mouth. It is imperative to have a dental check-up prior to the operation since latent dental infections can spread and put the result in danger.
If the chin is to be reduced or made symmetrical, the surgeon remodels the bone that makes up the structure of the chin. If the chin is to be made bigger, the surgeon will use a hard silicon implant (there are many types available).
After surgery, the skin elasticity enables it to redrape on the new structure. Skin quality and skin reaction will thus be key to the final result.
To remove excess fat under the chin, a small incision is made under the chin. The fat is then suctioned and the incision is closed and a chin bandage is put in place under the chin to help the skin to redrape.
Warnings and therapeutic alternatives
Genioplasty does not treat pre-existing asymmetries unless treatment targets them specifically. However, like after any aesthetic operation, it is usual for the patient to look at and analyse themselves more, and, since the features that they did not like have been treated, certain patients come not to like a pre-existing asymmetry that they had seen as insignificant prior to the operation. Therefore, it can be useful to discuss possible corrections of asymmetry prior to the operation. In some cases the overall profile may need to be analysed and the possibility of performing a rhinoplasty too should be discussed to avoid post-op disappointment.
In some cases it is possible to intervene under the chin without invasive surgery by using filling products (for chins that are too small) or botulinum toxin (to change the facial expression and therefore the position of the chin.) These techniques enable temporary yet real improvements and are therefore discussed with the surgeon prior to the operation.
The problem can sometimes be due to a dental anomaly that pushes the chin too far forward or backwards. In these cases, Dr Le Louarn will refer you to a maxillo-facial surgeon in order to better evaluate the situation. The surgical decision is made after consultations of the two specialists.
For example: when the chin is set too backward and too long, performing a « jumping bone flap » is sometimes necessary. This maxillo facial surgery consists to topple forward the vertical excess of bone. A simpler alternative with surgical abrasion of the vertical bone coupled with a chin implant may be proposed in other cases.
When the chin is set too forward (progenia) it may in some cases be necessary to set backward the mandibula (maxillo-facial procedure) while in some other cases a simple surgical grinding of the mental bone (cosmetic surgery) can suffice.
It must be noted that whatever the surgical choice, the risk of infection exists and may in some cases conduct a failure: graft bone wasting or necessity to remove the implant
If the operation is intra-buccal, have a dental check-up far enough in advance to be able to undergo any hygiene treatment necessary.
Do not arrive too morally or physically tired to the operation. Let us know about any change in your state of physical or mental health and do not forget that there is never any urgency to carry out an aesthetic operation. It is imperative that all aesthetic operations be foregone if you are ill or, for women, if you are pregnant on the day of the operation.
Due to the risk of necroses and infections, it is imperative that a patient stops smoking. Medicines that cause bleeding are prohibited during the days leading up to the operation: Aspirin, Anti-inflammatory medicines, Anticoagulants, Vitamin E….No progestin treatments (contraceptive pill) should be taken during the month before and after the operation to limit the risk of embolisms and scar inflammations.
It is imperative that you neither drink nor eat for the 6 hours prior to the operation.
The operation will be cancelled if pre-operative advices are not adhered to : assessment, no food or drink, stopping smoking…
When preparing your belongings DO NOT FORGET YOUR MEDICAL FILE.
Where possible, do not bring any valuable jewellery with you (or put it in the safe at the clinic with your other valuables during the operation.)
Have a shower or bath before coming to the clinic and make sure your hair is clean; women should obviously not wear nail varnish or make-up.
Prior to the anaesthetic contact lenses, dentures and hearing aids must imperatively be removed.
Anaesthetic and hospitalisation
The operation is carried out in the clinic, without hospitalisation, under assisted local anaesthetic and lasts approximately 45 minutes.
You will usually leave a few hours after the operation. However, in certain cases (nausea, stress..) it can be preferable to spend the night at the hospital. Ask an ABLE-BODIED AND RESPONSIBLE person to take you home. Since anaesthetics are euphoriants do not make any plans to do anything requiring concentration or the use of potentially dangerous equipment. If you are going home by car YOU WILL NOT BE ABLE TO DRIVE UNDER ANY CIRCUMSTANCES.
You should arrange for someone to be with you at home. In fact, you should not get up during the night following the operation without being accompanied, even to go to the toilet and even if you feel perfectly fine (anaesthetic products can produce effects identical to those of alcohol abuse).
Before leaving home prior to the operation, ensure that you have prepared everything for your return:
– Prepare a light meal
– Put Arnica 5CH, paracetamol-based painkillers (Dafalgan, Doliprane..) and a bottle of mineral water on your bedside table.
For the first few days at home you must relax as much as possible and avoid all over exertion. However, you should walk a little several times a day to prevent the risk of embolisms and should eat enough to enable healing.
It is important that you do not smoke for 15 days in order to facilitate healing and reduce the risks of necroses.
When an implant has been added, one should avoid any important trauma for one month after surgery since it could lead to the implant displacement and thus required further surgical readjustment.
Antiseptic mouth washes should be used for approximately one week after meals.
In theory no pain is experienced, only discomfort, notably when you chew.
Bruises remain for 8 to 15 days in general and can be concealed using make-up.
The swelling of the chin moves down progressively onto the neck and can be concealed using a polo neck jumper or a scarf. It is at its height on the 3 rd or 4 th day, then progressively fades, but the chin will take several months to reach its definitive shape. Like bruises, swelling and possible hardening vary from one side to the other. It is typical after the operation for there to be asymmetry. This does not negatively affect the result in any way.
In addition to common products such as Arnica, cold compresses calm bruises and swelling, helping them to heal more quickly. The face can also be drained by temporarily adopting a sleeping position with the chest slightly raised.
Note down the telephone number of the office (01 45 53 27 17 from France, 33 1 45 53 27 17 for international call), and the number of the clinic near your home telephone and in your mobile phone. Do not hesitate to call us if you are worried. Call us if you have a temperature, experience weeping, pain or other symptoms that give you cause to worry.
Leave from work: 1 to 2 weeks depending on your professional activity
Bruises 8 to 15 days
Swelling 15 days very visible
Exercise – combat sports that can lead to blows on the chin can be practised, but you should be aware that a violent blow, even long-term, can harm the result
In most cases, operations run smoothly and patients are happy with the result. However, before deciding to go ahead with an operation, you should be aware of the risks and possible complications.
General risks of all surgical operations: infections, haematomas, healing problems and risks from anaesthetics
Infections are rare, however, it is very important after the operation to respect antiseptic and antibiotic prescriptions. In case of infection, surgical draining may be necessary. Infections in the buccal tracts are rare if the dental assessment is carried out correctly.
Haematomas are very rare complications in chin surgery, but need to be evacuated rapidly. They tend to occur in the hours following the operation. The risk of haematoma rises considerably when medicines that can cause bleeding are taken pre and post-op.
In the first hours after the operation there is generally moderate bleeding. Exceptionally, a haemorrhage can occur that will need to be treated in the operating theatre.
Risks from anaesthetics
Anaesthetic techniques and monitoring methods have improved immensely and safety is high when an operation is performed in non-emergency conditions on a person in good health, when the anaesthetist is competent and working in a recognised establishment. However, the effect of anaesthetics on the body can be difficult to predict and treat. Therefore there are still risks and hazards inherent to all anaesthetics before and after the operation. This is why it is imperative that you consult the anaesthetist prior to the operation and fully inform him of the state of your health. In function of your health and the planned operation, he will assess the risks related to anaesthetics and tell you of any potential precautions to take.
(see in chapter ” Before surgery ” section “Check up and anaesthetic consultation“)
Risks during any aesthetic operation: asymmetry, a result judged as insufficient or excessive, need to touch up results, sensitivity issues
The way in which tissues react to an operation is always specific and, to a certain extent, unpredictable. It depends on the patient correctly following the doctor’s recommendations, but luck also plays a role. This is why all risks of asymmetry, unsatisfactory or excessive results and the need to touch up results are evoked prior to any aesthetic operation.
Certain problems linked to results stem from misunderstandings between the patient and surgeon concerning the aim or from decisions taken without due consideration. This risk can be limited by good reflection prior to the operation.
Other problems are caused by unexpected tissue reactions specific to the patient that can lead to an excessive, insufficient or asymmetric result. This risk especially concerns patients with a poor quality of skin, but retractile fibroses are always a possibility. If resulting imperfections are not easy to bear, they can potentially be touched up in a second operation, generally much less intense than the first operation, but it is necessary to wait until the end of the healing process before proceeding to a second operation.
The operation can lead to general transitional problems (3 to 6 months) with regards to sensitivity of the upper lip and chin regions.
Potential genioplasty complications
Necroses and skin seizure
These are rare but still possible. Simple wounds or erosions usually heal without leaving marks, whilst necroses, though rare, require specific care that is often long and leaves a small scar. The risk increases greatly if a patient smokes or through traumatisms.
– Secondary slackening of the skin after certain liposuction:
If the skin is of a poor quality, if too large an amount of fat is removed or if the operation is followed by a significant weight loss, the skin risks slackening again and can cause a crease under the chin that is most inharmonious. This is why in certain cases we plan a possible oval lift in the months after the operation.
Two to three months after the operation, an initial evaluation of the result is possible. However, scars and tissues can experience an inflammatory peak at that moment, which is why it is often necessary to wait for nine to twelve months to see a final result.
Usually an appreciable aesthetic result is achieved with real psychological benefits.
By way of conclusion, we remind you that precise and detailed information, an in-depth analysis of the reasons for the operation, teamwork between the patient and the surgeon during the preparatory phase, the search for surgical excellence coupled with a good analysis of benefits and risks, the respect of pre-op and post-op advice and regular monitoring of the patient are all key elements for aesthetic surgery to be a success.
Specific information appearing on this website is based on Doctor Le Louarn’s practice.
The following publications and works can also be listed (this list is obviously not exhaustive and may be amended) :
1. GUERRESCHI P., LABBE D. : Le menton : un complexe dynamique
The chin: a dynamic complex
2. DRISSI QEYTONI H., ZRIBI A. RAPHAEL B., LEBEAU J., BETTEGA G. : Les génioplasties : techniques et applications – Genioplasty: technique and applications
Revue de Stomatologie et de Chirurgie Maxillo-faciale Vol 108, n°5, Nov 2007, 441-450
3. TERINO E.O. : Chin and malar augmentation
Chapter 6 in Complications and Problems in Aesthetic Plastic Surgery
Edited by George C. PECK – Gower Medical Publishing 1992 : ISBN 0-397-44613-6
4. COBURN R.J., REES T.D., HOROWITZ S.: Mentoplasty
Chapter 28 Volume II in Aesthetic Plastic Surgery
Edited by Thomas D. REES – Saunders 1980 : ISBN 0-7216-7521-2