Surgery is usually performed under IV Sedation or IV general anesthesia. The surgery is done either through the mouth, or through a small incision under the chin. The procedure can sometimes be done by placing a prosthetic implant. In more advanced cases, Dr. Mueller completely repositions your chin bone in the best possible position. This is usually performed when the chin needs to be lengthened. It is not unusual to combine genioplasty and chin implants with face lift and liposculpture procedures or jaw surgery to improve the profile and the neck drape. The chin implant procedure takes about 30 minutes once the patient is anesthetized.
Many doctors place chin implants without stabilizing them. This leads to unsatisfactory cosmetic results when the implant moves due to activation of facial muscles. This leads to “rejection” of the implant because the body views mobile objects as “foreign.” Dr. Mueller places chin implants with a micro screw to avoid this complication. If for some reason the patient wants the implant remove, it can be removed in about 15 minutes.
The recovery takes 5 – 10 days. Most people resume their normal activities within 4 – 5 days. Following the procedure, a special bandage is sometimes applied to the chin area to aid with a speedy recovery.
Pain is minimal and is controlled with medications. Bruising occurs around the chin, but begins to fade within a few days. Discoloration usually disappears in two weeks.
One of the most notable signs of an aging face is the loss of volume in the midface, or the area between the eyes and mouth. The fat pad that sits underneath the cheekbones begins to sag. Also, the shape of our face is determined by the underlying skeletal framework. High cheek bones have been regarded as a sign of beauty. Unfortunately, not everyone develops nice, high, prominent cheek bones. In individuals who do not have pronounced cheekbones, the drape of the skin gives the appearance of less volume and a flattened midface. When the cheeks are prominent and have volume, the face has a much more youthful appearance.
There are several different treatments to augment the cheeks, including fillers, fat, silicone (permanent) fillers, and implants. Fillers and fat last about a year and therefore are a temporary solution. The problem with fat injections is that up to 1/3 of the fat injected can be lost within the first few weeks due to breakdown and metabolism. Therefore, over-filling is necessary. Injecting fat in the cheeks (and lips for that matter) can therefore result in an asymmetry in if the early fat loss is not equal on both sides. Silicone fillers will sag over time, taking the skin with it. Cheek implants give a permanent lift and will not sag, as they are fixed to the bone with micro screws. Also, cheek implants can be easily removed. Ease of removal is important, because occasionally, implants need to be removed either because the patient wants a different size or due to some other type of injury. Dr. Mueller uses silicone implants because they feel natural and are easy to remove if necessary. Polytetrafluoroethylene (Gore-Tex) and polyethylene implants are difficult to remove, because the surrounding tissues are able to grow into the implant. Removal of these types of implants can result in soft tissue loss and undesirable facial defects.
There are three designs of cheek (malar) implants. They are the submalar, malar shell and combination submalar implant. The choice of which implant to use is based on the patients specific needs and desires. Cheek implants are commonly placed in combination with facelift, blepharoplasty and chin implant procedures.
Cheek implants can be placed with local anesthesia or light sedation. They are placed through a small incision inside the mouth. The implant is positioned and held in place with a small micro screw so they will not move around. The incision is closed with sutures. The results are immediately evident. Some doctors simply make a small incision, slide the implant in and close the incision. These implants eventually move around and leave an asymmetric appearance to the face. Dr. Mueller has had to remove many implants that were done in this fashion by others. The procedure to place cheek implants takes about 15 – 20 minutes per side. Swelling lasts for 2 – 4 days afterward and healing is usually completed within one week. The ability to smile and pucker normally takes about 7 – 10 days. Patients are also asked to avoid impact to this area of the face for four to six weeks.
Mandibular Angle Implants
A more defined jaw angle is a not uncommon request of men, particularly younger men. I am seeing more of these patients recently than ever before. This is presumably driven by the desire for increased facial angularity and jaw line definition as seen in many male models.
Either male or female, the procedure is the same. An intraoral incision is used along the back part of the jaw. The large masseter muscle is lifted up along the entire angle of the jaw. Dr. Mueller only places silicone implants, as they are kinder to the surrounding tissues. Whether to drop the existing jawline by an extended implant or simple along the current jawline to be widened is a consideration. This is where a good examination is more meaningful. As with chin implants, it is very important to secure mandibular angle implants in place with micro screws. The only common complication with jaw angle implants has been when doctors do not fix the implant with screws thus causing implant migration toward the incision. This risk is completely eliminated by secure screw fixation.
The procedure is performed with IV sedation or IV general anesthesia. The procedure takes about an hour and our patients are on a soft diet for about a day or two. Dr. Mueller advises his patients to use ice packs for 48 hours to help with the swelling.
After surgery, there is a decrease in mouth opening for a few days to a week due to muscle inflammation and swelling. However, jaw angle implants produce a nice lower profile change that is second only to what a chin implant can do. Sometimes, for maximum effect, jaw angle implants and chin implants may be done together to accentuate the entire jawline.
Reasons for Surgery
Patients usually present with concerns including the size and/or shape of their chin. Conditions may be due to natural development or due to external trauma to the face. The operation can be performed on all age groups, including teens and the elderly. Many patients with a deficient chin (retrogenia) have dental or jaw misalignment (overbite). Some patients are best treated with orthodontics and corrective jaw surgery. Many patients do not desire this lengthy treatment and simply desire an implant. Not all patients are good candidates for a chin implant. Patients that have a deep mentolabial fold (the crease below the lip and above the chin) may not be good candidates and patients that have the lower lip that is behind the upper lip may not be good candidates. These patients usually require a genioplasty procedure to lengthen and advance the chin bone.
A medical history along with a careful examination is performed in order to evaluate your general health and to evaluate your concerns. Dr. Mueller will discuss your concerns and explain the various ways your chin can be addressed to achieve a more harmonious, proportioned look. Dr. Mueller offers genioplasty, an osteotomy or movement of the chin bone, and chin / chin-jowl implants to achieve your desired look.