Written by Dr. Sam Rizk
Chin surgery, also known as mentoplasty, is a surgical procedure to reshape the chin either by enhancement with an implant or reduction surgery on the bone. Many times a plastic surgeon may recommend chin surgery to a patient having nose surgery in order to achieve facial proportion, as the size of the chin may magnify or minimize the perceived size of the nose. Chin surgery helps provide a harmonious balance to your facial features so that you feel better about the way you look.
Are you a candidate for a chin implant or chin augmentation?
A chin implant or chin augmentation is a procedure that Dr. Sam Rizk performs frequently using synthetic materials. Dr. Rizk performs chin augmentation in his New York practice if a patient has a small chin or if the lower portion of the jaw bone lies behind the lips and the lower lip becomes more prominent than the chin. This condition is often called microgenia or a "weak chin". It is sometimes associated with a large nose. Dr. Sam Rizk performs chin implant in association with rhinoplasty in about 30% of his rhinoplasty surgery. Chin implant is also often performed with neck liposuction for patients with fat under their chin in addition to a weak chin. Dr. Rizk will help determine your needs by examining your facial structure and use of photographs. Dr. Sam Rizk, a NYC board certified facial plastic surgeon and director of Manhattan Facial Plastic Surgery, sometimes performs computer imaging to show the patient a simulated surgical result from a chin implant/chin augmentation. Patients have to be medically and mentally ready for surgery. Patients with immune disorders or smokers are not good candidates for a chin implant surgery. Diabetic patients have a higher incidence of infection of the chin implant if their diabetes is not under good control. Dr. Rizk will require blood work and medical clearance prior to any surgery involving a chin augmentation/chin implant. This procedure can significantly improve facial balance. Sometimes it is performed by Dr. Sam Rizk in conjunction with a necklift or a facelift as well if there is sagging tissue in the neck or face. If a patient has bone disorders, then a chin implant is contraindicated. It is important for the patient to discuss their goals and just as important for the facial plastic surgeon to explain goals of the surgery as well as risks, alternatives and benefits to chin implant or chin augmentation.
How does Dr. Sam Rizk decide if a patient needs a chin implant or chin augmentation? How about size of the implant?
Dr. Sam Rizk, a NYC chin implant expert will perform a detailed facial proportion analysis to determine any areas of imbalance that can be corrected. This analysis includes dropping a vertical line from the most prominent part of the forehead to the most prominent part of the chin and this line should be vertical. In females, the chin could be a little behind this vertical line and still be acceptable. Beauty and facial measurements are not an exact science and variability exist depending on facial shape and ethnicity.There are ideal facial guidelines which Dr. Rizk uses to evaluate your face but Dr. Rizk will individualize the analysis to your particular face. The cheeks, chin, and nose have certain symmetry and angular measurements which are considered ideal but variability is normal and attractive-it creates one's individuality. According to Dr. Sam Rizk, creating balance with a chin implant or cheek implant while maintaining one's individuality is an art which cannot be confined to just absolute "measurements". Many types of abnormal angles can exist between the chin and neck (mentocervical angle) and this angle can often be too obtuse due to a pushed back jaw or excessive fat under the chin or both. Dr. Sam Rizk will evaluate your jaw position in relation to the lip, neck, nose and forehead position and make recommendations based on his ideal look for your face. Each surgeon has their own artistic addition to any procedure much like each chef has their own individual ingredients they add to their food. This is why it is important to like the pictures in a website prior to visiting a surgeon. Dr Sam Rizk customizes the implants intraoperatively using 3d high definition systems which reconstruct the chin/face in 3d and compares facial symmetry in 3d, allowing for much more precision.
What surgical approaches are available for a chin implant or augmentation?
There are 2 main approaches for chin implant placements- 1. Placement form inside the mouth (called intraoral). 2. Placement from a small incision under the chin. Dr. Rizk uses the approach from the small incision under the chin because intraoral placement has a higher incidence of infection due to contamination of the implant with mouth bacteria and also has a higher rate of movement up. Dr. Sam Rizk prefers the approach from a small incision under the chin which becomes inconspicuous with time because of the lower incidence of infection as well as better placement of the chin implant and less chance of its movement up on the chin. Dr. Rizk will not perform the intraoral placement due to the high risk of infection.
What are chin implants made of? Are there other options other than an implant?
New York Chin augmentation expert, Dr. Rizk uses mainly silicone chin implants as they have the longest history of use in the chin area and greatest longevity. As opposed to nasal implants where silicone is not recommended, the silicone chin implants are highly recommended by Dr. Sam Rizk. Other implant choices which are less popular are Medpor and polytetrafluoroethylene (ePTFE). The other implants are more porous than silicone which makes them more difficult to remove if they become displaced or infected. Other nonsurgical methods of chin augmentation/implant include fillers such as radiesse, restylane or juvederm. Fillers are temporary and achieve only a mild augmentation. Autogenous fat grafting/transfer, where fat is harvested from the patient's own body and transferred with microinjections into the chin, has a role and is very versatile. Significant augmentation can be achieved with fat transfer. Some of the fat will absorb with time and 50% will usually survive over a 5 year period. Lastly, a sliding genioplasty is another much less popular chin augmentation procedure-it is more a chin advancement procedure. In genioplasty, the surgeon removes a piece of bone of the lower jaw and slides it forward, then fastens it back onto the jaw with titanium.
How long does a chin implant last?
A silicone chin implant should last a lifetime, unless they move or become infected and need to be removed which is very rare.
How long does the chin implant procedure take and what kind of anesthesia is recommended?
The chin augmentation takes approximately 1-1.5 hours to perform and either sedation or general anesthesia is appropriate for this surgery. In either sedation or general anesthesia, the patient is asleep and is unaware of the procedure. The surgery is done in Dr. Sam Rizk's state of the art surgical facility as an outpatient surgery and patient goes home the same day and return to work usually in one week.
How long does it take to heal from a chin implant or chin augmentation?
It takes about 1 week to return to work after a chin implant or chin augmentation. There will be a small incision under the chin which will fade away with time. Sutures are usually removed in 5-7 days. If liposuction of the neck is also performed with the chin implant, then Dr. Sam Rizk will recommend wearing a neck elastic band at night for 2 weeks following the surgery. Numbness is the area of the chin is normal and expected and sometimes lasts for a few months. A soft food diet is generally recommended for 2 days after the surgery. No strenuous activity should be done for 2 weeks after the chin implant and no contact sports for 6 weeks after the chin augmentation. There will be some swelling (edema) and soreness after the chin implant for a few days. Some bruising may occur but is very limited and resolves within a week. Pain tolerance depends on the individual but you will feel tenderness, stiffness and soreness for a few days after the chin implant as to be expected. Pain medication will be prescribed such as vicodin, vicodin es, or percocet. Some patients only take extra strength tylenol and may not need to use the stronger prescribed medicines. Dr Sam Rizk will prescribe Arnica Montana as well as other vitamins. Ice compresses in the first 48 hours can help with swelling and bruising. Sometimes the swelling in the first week or two can make a chin implant look too large at first.
How long does it take to see results from a chin implant/augmentation?
The results are immediate but the swelling can make the chin look too large for the first week or two.
What are the risks or complication of a chin implant or chin augmentation?
All surgeries have risks and complications. Chin implant or augmentation surgery carry a small risk of infection, bleeding, extrusion, or movement of the implant. There is also a small risk of bone absorption over time under the chin implant. Dr. Sam Rizk selects his patients carefully to minimize risks and complications. Smokers, diabetics, and patients with a poor immune system are at higher risks of complications and infection. Dr. Sam Rizk places the implant deep under the chin muscles so that the chin muscles act as a cushion in case trauma occurs or patient sustains an injury to the chin. By placing the chin implant deep, this protects the implant and decreases its chance of movement. Dr. Sam Rizk also sutures the implant to the midline to decrease risk of movement. Allergic reactions or rejection of the implant is a potential complication but is also rare. If an allergic reaction occurs the implant needs to be removed. Prior to the placement of the chin implant, the patient is given an intravenous course of antibiotics half hour prior to the procedure which decreases the incidence of an infection. Also the patient's face and neck are cleaned with a solution which particularly targets an infection called MRSA or Methylcillin-Resistant Staphylococcus Aureus (a "bug" more commonly found in hospitals). Dr. Sam Rizk also performs the chin implant in his own Park Avenue JACHO-certified surgical facility which has a much lower incidence of infection than hospital-based surgery. In hospitals, there are multiple operating rooms with multiple patients which increases the chance of infection. In Dr. Rizk's facility, there is only one operating room with only one patient at a time. Patient is also given a postoperative course of antibiotics for 1 week after the surgery. Other complications include a hematoma (blood clot) from bleeding. If a hematoma occurs, it requires drainage. Hyperpigmentation may rarely occur from bruising and may be permanent but this is very rare.
Why should I choose Dr Rizk for my chin implant/augmentation?
Dr Sam Rizk is a double board certified facial plastic surgeon with extensive experience in both reconstructive and cosmetic chin surgery. His training includes performing jaw reconstruction and replacement after cancer at Memorial Sloan Kettering Cancer Center as well as reconstruction of other facial deformities after cancer surgery. This type of experience is important in understanding anatomy, pathology, cosmesis, function, and the ability to create something and visualize it from nothing is a key element in chin surgery. Creation of a new jaw from "no jaw" is a much more difficult procedure conceptually and technically than a chin augmentation. Dr. Sam Rizk having had this type of rare training at one of the top cancer hospitals in the world brings to you an unusual expertise in chin/jaw deformities and surgery. Dr. Rizk operates not only on small or weak chins but also on chin/jaw deformiteis with significant asymmetries and deficiencies requiring not only implants but also bone grafts and major chin/jaw sculpturing.
How often is a chin reduction necessary and when does Dr. Rizk perform a chin reduction?
A chin reduction is not as common as a chin augmentation for facial balance. An overprojected chin or a wide chin or a vertically long chin can make a significant impact on one’s facial appearance, especially in female patients. Chin reduction surgery is more common in female patients who request it to create a softer and more feminine appearance to their face and more facial balance. Chin augmentation is more common in male patients. Also, some transsexual patients who are in the process of transforming from male to female also request a chin reduction surgery to feminize their appearance, along with rhinoplasty as well as shaving the Adams apple or thyroid prominence. Because chin reductions are less common than augmentation, less information is available on techniques and outcomes for it.
What are the chin deformities encountered by Dr. Sam Rizk which require a chin reduction procedure?
The most common type of chin reduction performed by Dr. Sam Rizk is a horizontally long or overprojected chin or a chin that sticks out too far. The second most common chin deformity is the Long chins or create a longer face. Other chin characteristics of either chins that are vertically or horizontally long may be a pointy appearance or an overly wide shape. Diagnosing the imbalance in the chin/facial proportions is critical to treating the deformity. Very often Dr. Sam Rizk performs this surgery with rhinoplasty and the nose/chin balance has to be addressed.
How is a large chin diagnosed?
An overly large chin in the horizontal position (where it sticks out too far) is diagnosed from the profile or side view whereas an overly large chin from the vertical view (vertically long chin) is diagnosed from the front view. Other characteristics such as overly wide or pointy chins are diagnosed from the front view. Dr. Sam Rizk always asks the patient to speak and smile and evaluates the mimetic nature of the chin since pointy chins often become pointier as the patient smiles due to the chin muscles.
What causes a large chin either vertically or horizontally? In other words, what are anatomical findings?
The vertical or horizontal excess in the chin almost always involves bone and some soft tissue component. The bone can be thick and excessive and the soft tissue can involve enlargement of the chin muscles as well as fat and soft tissue under the skin also excessive.
What are the treatments of a large chin?
Dr. Sam Rizk's approach almost always involves bone burring (sanding or grinding) or reduction through bone osteotomies and repositioning (bone cuts) in some cases. Burring or sanding has a more rapid recovery than actually cutting the bone out through osteotomies. Dr. Rizk also almost always reduces the soft tissue component of the chin. Also the mentalis muscle is usually suspended or shortened. This combined approach of bone reduction and soft tissue reduction works best for Dr. Rizk. The soft tissue enveloping the chin bone sometimes is reduced and also tightened with special sutures. The burring approach of bone reduction is preferred by Dr. Rizk for horizontal excess and the osteotomy approach for reduction is preferred by Dr. Rizk for vertical excess of bone where a segment of bone is removed vertically. Dr. Rizk likes to emphasize the importance of the soft tissue component of chin excess and the alteration/redraping of the soft tissue component of the over the new chin is critical to a successful outcome.
What incision is used in chin reduction surgery?
Dr. Sam Rizk prefers the small incision under the chin (submental incision) to gain superior exposure and control of bleeding than the intraoral approach through the mouth. Also the external approach from a small incision under the chin has a lower infection rate than the intraoral approach from inside the mouth.
How is the healing and postoperative course after chin reduction surgery?
Bony work involved in chin reductions does result in some discomfort, similar to the discomfort with chin augmentation surgery. Dr. Rizk does have restrictions on diet, which he limits to soft foods or liquids for 2 days after the surgery. It takes 2 weeks or longer for the major swelling to subside and the final result can take up to 12 weeks. The chin will be swollen and there may be some bruising for a week after the surgery.
What if there is a bite deformity associated with the chin deformity?
Dr. Sam Rizk evaluates patients with a team of specialists including dentists and oral surgeons prior to performing the chin reduction surgery and sometimes a team is involved if a more extensive procedure to correct a malocclusion problem.
What complications can occur with chin reduction surgery?
Infection, bleeding, hematoma or irregularities are rare but are potential complications of both chin reduction and augmentation surgery. Although no implant is used, the bone or soft tissue which was modified may become infected necessitating antibiotics but this is rare and more common with an intraoral than an external approach. Bleeding or a collection of blood (hematoma) is another rare complication which is treated with removing the fluid or blood either with a syringe or opening a suture from the external incision to drain some of the blood.
CHEEK AUGMENTATION/CHEEK IMPLANT SURGERY
Whether or not we notice it consciously, full cheeks are often a part of how we judge a person's face. Cheek implants can have a major impact on the appearance and self-confidence of patients whose cheeks have thinned or sunken due to age, illness or other causes. Implant sizes and shapes are tailored to each patient's desired appearance; for example, a relatively flat cheekbone area can be enhanced or made more prominent with the insertion of cheek implants.
What are the benefits of cheek augmentation/ cheek implant surgery?
A high cheek bone is often one of the most important features of beauty. According to Dr Sam Rizk, a New York Facial plastic surgeon who performs cheek augmentation surgery frequently, facial shape and symmetry is created by the underlying bony structure as well and skin and soft tissue. In order to augment or enlarge the cheek region, Dr Sam Rizk either augments the soft tissue or the underlying skeleton. As we age, the cheeks become flatter because we lose volume and fat in our face and it moves and drops lower down in the face to form the jowls. The cheek augmentation surgery can improve facial contour and balance out facial features. It may also be used to correct asymmetries or congenital facial defects or deficiencies.
How is the cheek augmentation procedure performed?
If Dr. Sam Rizk chooses to use fat in "autogenous fat transfer", the fat is first obtained from your abdomen or thighs with small syringes in order not to kill the fat cells as would occur in traditional liposuction. The fat in these syringes is then reloaded into microsyringes once the fat is treated by a system called puregraft to separate pure fat from other cells with the fat. Then it is re-injected with these small micro-syringes into the cheek region. If Dr. Rizk uses a cheek implant to augment your cheek area, the cheek implant is either inserted from a small incision inside the upper lip or a small incision under the eyelid. A pocket is created for the implant and the implant is customized and trimmed as needed and inserted and fixed to underlying bone with stitches. The implants can either be placed on the cheek bone (called malar implants) or below the cheek bone (called sub-malar implant). Sometimes the implant is shaped to go on the cheek bone and extend under the cheek bone as well (called-malar/submalar implant).
How long does procedure take and what anesthesia is recommended?
Cheek implant surgery typically takes 1 hour to perform and is usually done under sedation or general anesthesia with the patient asleep. Fat transfer also takes about 1 hour to harvest and inject the fat and is also performed under sedation or general anesthesia. The patient goes home the same day as an outpatient surgery and it is typically performed in a certified office operating room. No hospital stay is required-this is typically outpatient office based surgery.
What can I expect after surgery? swelling? pain?
Typically, Dr. Sam Rizk, a double board certified NYC facial plastic surgeon, recommends ice compresses and soft, bland foods for the first 2 days after cheek augmentation surgery. There will be some swelling, usually not much bruising, and some mild discomfort but the amount of pain can be variable depending on the individual. Most patients are able to return to work in a week. The sutures inside the mouth dissolve in 2 weeks after the cheek implant surgery. The swelling can persist to some extent for a few months and make the cheeks look larger-this is normal and should be a concern. Dr. Sam Rizk also gives herbal supplements such as Arnica Montana and vitamin k to decrease bruising and swelling. Avoiding aspirin products and vitamin E also diminishes bruising and swelling.
How do I know if I am a good candidate for cheek augmentation?
During your consult with Dr. Rizk, he will look at your cheeks in relation to your other facial features and determine after taking measurements if you would benefit form a larger cheek. Then, you would have to be in good medical and mental condition to undergo the surgery. Medial clearance is required. Typically, diabetics and patients who are smokers are not good candidates for cheek implant surgery as they are at higher risk of infection, so for these patients autogenous fat grafts/transfer to the cheeks is a better option with a lower risk of infection.
Can cheek augmentation be performed with other procedures?
Yes, Dr. Sam Rizk performs either autogenous fat transfer to the cheeks or a cheek implant in about 20 percent of his facelift patients if there is volume loss in the cheek area which can make a person look much older. Cheek implants can also be performed with an eyelift, browlift, or necklift.
What are the risks/complications of cheek augmentation?
If a cheek implant is used, potential risks include infection, movement or extrusion or allergic reaction. If any of these complications occur, the implant should be removed or repositioned. Sometimes a course of antibiotics if an infection is suspected can be used first before removing the implant. If infection is present, the area will be red and tender and fever may occur. Infections can happen but are rare in non-diabetic, non-smoking patients with a good immune system. Dr. Sam Rizk uses a preoperative dose of antibiotics intravenously half an hour prior to surgery and also soaks the implant with an antibiotic solution prior to placement. Surgery in the office setting also has less infection rate than in a hospital setting with many patients in many operating rooms. If autogenous fat transfer is used to augment the cheeks there is a much lower chance of infection as it is the patient's own tissue. Some complications from autogenous fat transfer are a lumpy-feeling for a month or two, quicker absorption than expected necessitating more fat transfer.