Index
Also called genioplasty is referred to as the plastic surgery procedure used for the chin.
The word mentoplasty comes from the Greek verb “plastic,” which means to form, and the Latin word “mentum,” which implies chin.
A well-defined chin balances the face, an essential part of the profile.
Mentoplasty improves the profile and contours of the face creating a balance.
Purpose
The mentoplasty is performed to correct malformations of the chin that come from the abnormal development of the bones of the jaw.
In some cases, the jaws grow on only one side of the face, which causes a facial asymmetry; in others, a fraction of the jaw is missing, and this condition of the jaw is called congenital agenesis.
But it is also done to:
- I am modeling a chin whose proportion does not please the patient because it does not match the facial features.
- The size the shape of the chin and jaw have differences between men and women. Some people opt for mentoplasty to modify these differences in gender reassignment as part of this transition.
- Mentoplasty is performed as part of a craniofacial reconstruction after an accident or cancer surgery causes bone destruction.
- When an orthognathic surgery is performed, the facial bones are repositioned to correct those deformities that affect the patient’s ability to speak or chew normally.
Mentoplasty is generally recommended in adult patients, it should not be done in children until the jaw reaches its maximum development and all permanent teeth are present.
Diagnosis
The previous diagnostic evaluation to carry out the mentoplasty is done through a facial analysis, a dental history, and a complete medical examination.
The chin is one of the three most significant parts of the face when we analyze it from the aesthetic point of view; the other two are the nose and forehead.
To perform the mentoplasty, the surgeon compares the proportions and characteristics of each third to determine which is the most appropriate procedure to restore this facial balance.
The patient is photographed from various angles to document the condition of the chin before surgery and to diagram the changes together with the patient.
Also, to examine how the face changes over time, how aging affects the chin, and recommend if it is necessary to perform a rhinoplasty because it changes the complete balance of the face when changes are made.
Studies of the patient’s dental history and x-rays of the head and jaw are necessary to establish whether it is possible to correct facial disproportion through an implant with a simple reduction or if orthognathic surgery is needed.
An evaluation must also be made of the patient for any sign that may present psychological instability, including when the expectations of the surgery results are unrealistic.
Types of mentoplasty
Mentoplasties are usually done to increase small chins and to reduce protruding chins.
Chin augmentation surgeries are performed more frequently than chin reduction surgeries, reflecting that microgenia represents the most common chin anomaly.
Chin augmentation
In mentoplasty, chin augmentation can be done by inserting an implant under the skin of the chin or performing a sliding genioplasty.
This is done by inserting a prosthesis in the cut made in the lower part of the jaw, moving the fragmented part to get the desired shape.
The insertion of an implant lasts 30 to 60 minutes, while sliding genioplasty takes approximately 45 to 90 minutes.
The intervention can last three hours if mentoplasty is performed in conjunction with orthognathic surgery.
Chin reduction
Mentoplasty can reduce an excessively large or protruding chin through the practice of direct reduction or sliding genioplasty.
In the case of a direct reduction, an incision is made under the chin or intraoral, and the excess bone that one wishes to eliminate from the chin is eliminated.
The procedure involves moving back the bone segment in the reduction where a sliding genioplasty is performed.
Preparation
Before mentoplasty, patients should stop smoking and all medications containing anticoagulants such as aspirin or warfarin two weeks before mentoplasty.
An antibacterial should also be used to perform facial cleansing two days before surgery.
When mentoplasty is scheduled for an intraoral approach, cleaning the mouth with mouthwash three times a day for two days before the surgery should be performed.
Keep fasting for eight hours before the completion of mentoplasty.
The individual risks of each patient, especially those related to medical history, should also be taken into account, such as:
Hypertension tends to scars (ethnic origin), skin type, smoking, age, and any deficiency in blood clotting.
Process
To increase the chin, we cut the line where the natural crease is located below the chin (submental) or inside the mouth (intraoral), where the gum meets the lower lip.
This tissue is gently stretched, creating a space where the implant can be inserted.
This implant is made of synthetic material that resembles the natural tissue usually found on the chin and is available in various shapes and sizes.
This will allow the adaptation of the implant to the configuration of the patient’s face. These inert materials reduce the risk of infection.
The surgeon goes through several layers of tissue in the procedure, taking great care not to damage the central nerve of the chin.
After the implant is made, fine sutures are used to close the incision made. When the incision is made inside the mouth, no visible scars are left.
On the other hand, the scar is usually imperceptible if the incision is made under the chin.
To perform this type of surgery, the surgeon will make a replacement of the facial bones.
Immediately after the mentoplasty, a pressure bandage is applied, remaining for two or three days.
After about six weeks, the swelling disappears.
Postoperative
Medication administration for pain, inflammation, and antibiotics is recommended for a week to reduce the risk of infections.
The following is also recommended for the postoperative phase:
- Follow a soft or liquid diet for four to five days.
- Sleep with your head raised using several pillows.
- If you have undergone intraoral mentoplasty, you should rinse your mouth two or three times a day with a solution of warm water with hydrogen peroxide.
- You should avoid unnecessarily sleeping face down on your face and touching your chin area.
- Avoid vigorous physical exercise for approximately 15 days.
Risks
The risks that may occur include: Infection, bleeding, and allergic reactions to anesthesia; there are also risks inherent to the insertion procedure of a chin implant that provides for:
- Deforming the chin after contracting an infection.
- Injury of the central nerve of the chin can cause a loss of sensitivity of the chin or paralysis of the muscles innervated by that nerve.
- That there is an erosion in the bone below the implant.
- The implant moves or dislocates.
- Defect correction insufficiently or excessively.
- Failure of the proper union of the bone segment to properly fuse with the other parts of the jaw bone.
- That there is damage to the roots of the teeth.
- A hematoma forms with an accumulation of blood inside the tissue or organ caused by a rupture of the blood vessels, causing pressure and deforming the final shape of the chin.
Optimal results
The expected results in the execution of a chin augmentation or reduction mentoplasty include a correction of the asymmetry and disproportion of the face.
Chin surgery improves the shape and function of the lower part of the face, significantly improving the appearance.
Other alternatives
Fat injections
Fat is injected into the chin area, under the chin, to make a filling in the skin. This technique is limited to minor disproportions in the size of the chin. In addition, this procedure must be repeated to the extent that the body absorbs fat.
Liposuction
Liposuction on the face can be used in conjunction with or instead of mentoplasty.
To improve the profile, the fatty tissue located under the chin is eliminated, and with it, you can make the chin retreat or look more prominent.
A pocket is made in the connective tissue inside the chin, and the sterile implant is inserted in that pocket and placed correctly.
A sliding genioplasty is performed if the deformity is more complex or the chin is too small.
With this procedure, the jaw is cut with the help of an oscillating saw, and a part of the jaw’s bone is extracted.
Then, move the bone forward by placing it in the correct position and holding it with the help of screws and metal plates.
Finally, a pressure dressing is placed.
