Chin: the crux for the extension of charm Part I - 謝明吉、姜厚任 顎顏面 美學 重建 專科診所-風華整形聯合診所
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Chin: the crux for the extension of charm Part I
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Chin: the crux for the extension of charm Part I

The chin simply refers to the front end of the mandible in terms of facial skeleton. However, this is just too simple to describe its impact on the aesthetics of a facial profile. A wrong doctor, position or material for facial sculpture will result in an unnatural and misplaced chin, not to mention a frustration to the original beauty a patient has had.

Mei received a chin surgery at other clinic (left). The chin being formed and placed did not naturally go with the facial shape she had in addition to the use of a wrong material, which led to loose attachment to the mandible and formed a strange pad down there. (Right) After receiving osteotomy combined with genioplasty, Mei having a chin with unnatural protruding angles underwent a change into a woman with a reddish, mild and graceful face. The chin slightly bending up has added some seductive female characteristics.

I have to admit that "the chin plays a crucial role in sculpturing the beauty of a face!"Being engaged in the industry of cosmetic facial surgery for several decades, I have seen countless patients receiving unsuccessful cosmetic surgeries and some with a facial shape and beauty affected by poor formation of the mandible. Some people also feel there is something wrong with their facial shape but they are unable to find out why. As a matter of fact, the problem lies in the chin. Cases featuring a wide variety of conditions exist. Therefore, a preliminary collection of my surgical experiences for several decades is presented here. The eight "amazing"wonders of the chin most commonly seen today are described as follows:

Case 1 - OMG! My chin has deformed.
If you identify with that autologous fat or soft tissue like silicone should be used for breast reconstruction instead of hard materials like artificial bone, then contrarily the chin being a part of facial bones should be sculptured by using artificial bone close to real ones in a human body rather than soft tissue.   In other words, displacement of the chin can frequently occur if soft tissue is used and an unexperienced doctor is involved for sculpturing the chin.

(Left) Gang found that his chin often moved as his facial expressions changed after receiving genioplasty. The phenomenon became more obvious when he laughed out loud. This made him refrain from laughing. His facial expressions turned stiff. He only smiled while taking pictures and dared not to laugh because he was afraid that he might become a chin monster. (Right) Fortunately, artificial bone has been properly used for sculpturing his chin. Now he can regain his brilliant smile.

Case 2 - I am not having a slight underbite. My chin collapses.
The chin forms the extended line from the mandible. It's a perfect ending of the shape. However, I've seen many unsuccessful cases performed elsewhere because of the wrong materials used and unexperienced doctors involved. Not long after genioplasty, their new chins begin to collapse and form an unnatural pad like a slight underbite.

Ming's "new chin" soon became an extra pad(left). It was particularly easy to spot when he laughed so he was given a new nickname "Underbite Junior". (Right) The shape of his chin has turned right after using artificial bone. His natural appearance makes him handsom.
This is a picture of Ming taken from another angle. (Left) Obviously, the line of his "new chin" is unable to smoothly connect with the line of the mandible. (Right) After re-sculpturing, Ming's chin becomes natural and the shape always remains the same. People cannot tell that he has received genioplasty again.
Amy's new chin shows obvious underbite (left). There is a gap appearing along the line connecting with the lower face. (Right) Artificial bone is used for re-sculpturing. Her chin now looks bony. The line of the chin perfectly connects with her lower facial shape. Her chin looks like something naturally formed.

In fact, the chin should look bony since it's a part of the facial bones.  It shouldn't be like a soft persimmon.  The application of a wrong material fails to naturally extend the stiffer touch of the mandible line.  Undoubtedly, doctors should choose the most appropriate materials for different facial parts so as to sculpture natural, pleasant and delicate lines of the five sense organs and facial profile.

Even showing no facial expression (left), Coco's lower face had an uneven surface because of using the wrong material to sculpture her chin.  Her face also seemed to reveal a life full of hardships.  (Right) By applying artificial bone to re-sculpture her chin, the roughness on the surface disappears.  The shape of her lower face now is smooth and streamlined.  Her face shines with charm and happiness.

Case 3 - Well-shaped chin is the key to a perfect face!
Among the patients I've met, the rooted problem they had was not the chin.  Being a doctor, I would find out the real cause behind a problem for a patient.  Reviewing the caseswhich came to me later for a reconstruction of their chin, many of them told their doctors: "I want to have a chin like Angelababy."  The doctors of those cosmetic surgery clinics really gave them a camera face.  However, their new chin doesn't last long.  Everyone has different chin conditions and facial shapes.  We cannot apply only one solution for all problems.  Doctors have professional background and should find out the problems for their patients before selecting the most appropriate method to sculpture their chin.  I personally think this should be the permanent solution.

In this case, May was not born with a good lower facial shape.  Having a longer chin with a beautiful arch is not sufficient to form a smooth line of her lower face.  The real problem is not eliminated.  Therefore, genioplasty is applied by combining with osteotomy in order to perfect her facial shape.

May wasn't born with a beautiful chin shape (left).  Purely sculpturing a longer chin doesn't help change her facial shape.  (Right) The combination of osteotomy with genioplasty has brought a perfect change torecontour a new lower facial shape.  May has an oval face now and looks beautiful.

Case 4 - Be careful! Shorter chin is usually accompanied by snoring and sleep apnea
Many patients having an excessively short chin are not aware of the problems of snoring and sleep apnea they have.  These conditions happen because they have a seriously receding mandible which leads to a narrower link between the chin and their neck and therefore presses the respiratory duct.  As a result, snoring or sleep apnea occurs.  Their partners thus are affected and have poor sleep quality.  One thing worth noticing is that many patients with a short chin usually ask cosmetic surgeons to create a new chin for them instead of applying orthognathic surgery to solve the problem of the receding mandible.  It's not an ultimate solution at all.

(Left) The X-ray shows the patient's short chin.  The chin seriously recedes and presses the respiratory duct. (Right) With the application of orthognathic surgery, the mandible has been moved forward and the respiratory duct becomes wider.  Sleep quality is improved accordingly.
Cheng had been bothered by his short chin (left) and extremely poor sleep quality.  (Right) The orthognathic surgery has helped him to move the mandible forward and thus a good-looking shape of his chin appears.  His breathing conditions now run much more smoothly.  He surprisingly learns that his sleep quality has been improved.

My experiences in treating patients for several decades taught me that the patients having a short or receding chin actually need to receive the orthognathic surgery. On one hand, it is because those who have a seriously receding chin are usually accompanied by sleep apnea; and on the other hand, some patients having a short chin are able to have a good-looking shape of chin after receiving the orthognathic surgery without any further chin sculpture. Moreover, the orthodontic problems of some patients are solved at the same time.

It's hard to tell Ling's chin from her neck (left). Such an appearance made her feel inferior to others for long. She even went to a doctor for orthodontics. When she first came to our clinic, she was expecting to have her chin sculptured. However, the main cause for her short chin and crooked teeth resulted from her receding mandible. (Right) The orthognathicsurgery and genioplasty have helped beautify her face a lot. Her friends and family members could hardly recognize her. A thorough change has been made on her. Now she looks quite distinguished and pretty. Her top and lower teeth have become even.

Orthopedics was my major. My long-term background knowledge and practical experiences fully support me for making accurate judgments. When patients having a short chin come to the clinic and ask me to reconstruct a new chin, I would suggest them to take an X-ray and observe their sleep conditions. By doing so, they would know how their short chin has formed. A professional doctor shouldn't follow a patient's request to create a chin but to make a professional consultation. This is the difference between a professional doctor and a patient. Such professionalism also distinguishes an orthopedist from a cosmetic surgeon.

Case 5 -Underbites, have you received the right surgery?
The patients having an underbite are often called "Moon Face".  Most of them usually receive orthodontic treatment or the surgery moving their chin backward, which actually doesn't help them much with solving their problems.  This is because what they really need is to receive the "orthognathic surgery + surgery moving the chin forward".

I once met a patient having an underbite.  He had received a surgery.  The previous doctor removed the protruding part of his chin to correct his underbite.  However, the underbite was actually caused by the protruding mandible.  The reasonable solution should be to move his mandible backward via orthognathic surgery and then move his chin forward.  This is the proper method to substantially solve his underbite.

Alan (left) had had a serious underbite since childhood. He visited other doctors after he started working. Many doctors suggested him to have an osteotomy. He didn't realize he almost made the wrong decision for treatment until Dr. Hsieh explained the cause of underbite to him. (Right) After receiving the orthognathic surgery and slightly realign his chin, a handsome appearance has been shaped to his satisfaction.

 

Sarahad a bad underbite (left) which further led to malocclusion. She had lacked confidence since childhood. When she grew up and made some money, the first dream she wanted to fulfill was to eliminate underbite. (Right) The orthognathic surgery combined with the surgery moving her chin forward refreshed and injected an elegant quality in Sara's face. Her malocclusion has been dramatically corrected. Her smile spreads a sense of brilliance and charm.

 

By observing the poor alignment of Sara's top and lower teeth, we can clearly see the effect of the orthognathic surgery on correcting an underbite.  (Left) The picture shows the face having an underbite before performing the orthognathic surgery.  The lower teeth are protruding and unable to match with her top teeth well.  (Right) The picture presents the current condition of Sara's teeth after receiving the orthognathic surgery.  The lower teeth have been straightened.  Some of the lower teeth are even positioned behind the top teeth.  Further orthodontic treatment is needed for teeth alignment.  This is the difference in solving underbite problems from the perspectives of the mandible (the lower jaw bone) and the chin.

Removing the protruding part seems to be the most straightforward way, but it lacks further observations to explore the real cause of a protruding chin.  Today, there are still many doctors who do not know that the mandible and chin are different parts of the face.  Doctors have to probe into the overallstructure of our facial bones before improving an underbite.  A patient's mandible should be moved backward and then the chin forward in order to sculpture a highlighted facial profile with golden ratio.   Thus, underbite can be corrected followed by fulfilling a patient's requirements for contouring a perfect facial shape.

Case 6 - find out the real root for chin misalignment
Why does a doctor implant a pad to a patient's chin instead of realigning the inclined chin of a patient?  Chin implantation seems to be the method to straighten a patient's chin.  However, when we look a bit up at the middle face and then look down at the lower face, the inclined corners of a mouth still exist.  This is condition commonly seen from the patients who have received a chin surgery before coming to our clinic.  The truth of avoiding the selection of repositioning the chin is that "many doctors of aesthetic medicine are able to create a new chin for patients while repositioning and realigning the maxilla and mandible of a patient requires professional techniques at a higher level performed by a professional doctor in orthopedics".

Hua was born with an inclined chin (left).  Though his daily life was not excessively influenced, his appearance bothered him very much.  After receiving the orthognathic surgery (right), his lower jaw bone was corrected to the proper position.  It's not necessary for him to re-sculpture his chin.  The overall facial shape from the top to the bottom exhibits perfect proportions with asymmetry.

 

Take Hua's case for example, the real cause of his inclined chin can be clearly spotted by applying the perspective animation (left).  The skeletal shapes from the maxilla to mandible are not straight.  (Right) This picture shows the perspective of Hua's condition after receiving the orthognathic surgery.  When the maxilla and mandible is moved to the right positions, his chin naturally gets aligned.

 

(Left) This picture shows a perspective of an inclined chin before the orthognathic surgery was performed.  (Middle) This photo displays the maxilla being deconstructed and relocked while the mandible is ready for correction by applying the same approach.  (Right) This picture is the perspective presenting the maxilla and mandible being repositioned. These pictures explicitly explain that reshaping the chin is not the ultimate method to correct the inclination of the chin.

 

In fact, repositioning the maxilla should serve as a start for the correction of an inclined chin.  The maxilla and mandible have inseparable linking relationships.  The old saying tells us: "if the upper beam is not straight, the lower ones will go aslant."  Sometimes, the chin actually doesn't go aslant.  As long as the maxilla and mandible are repositioned and realigned, the chin turns back to its normal position without performing any further adjustments.  However, if the chin moves backwards after receiving the orthognathic surgery, all we have to do is to pull the chin out forward.  As smart as you are, this step has nothing to do with treatment.
 

Case 7 -the chin is the finishing touch creating the delicacy
Some people are in pursuit of beauty but they don't put much attention to the chin.  This is one of the eight amazing wonders concerning the chin.  However, my experiences conclude that the chin is the indispensable final touch for shaping a face with delicacy.  Therefore, I usuallydon't determinethe shape of the chin in its width, length or arch until the whole face is reconstructed and sculptured.

In other words, the chin shouldn't be shaped independently.  It's the extension of the shape of the lower jaw.  It's also the key note establishing a patient's style of appearance.  Mandibular osteotomy going with face V-line surgery for sculpturing the chin is able to strengthen charm and boost attractiveness and aesthetics.

Chi has a dainty look. (Left) Before sculpturing her chin, she thought there was something missing.  In fact, if we carefully observe her face, there is nothing wrong with her but the chin lacking a graceful and delicate line.  (Right) By correcting the arch and line of her chin, she now has a more exquisite facial shape radiating a touching disposition.  She looks gracious and attractive.  This is the crux of charm.

Case 8 - the chin determines a man to be manly?
Men shouldn't underestimate the importance of the chin.  A patient once having a seriously receding and short chin was nicknamed "Rat" by his friends in addition to his rumbling noise from snoring.  He felt uncomfortable with this nickname but he couldn't do anything about it.  He even made fun of himself while looking at the mirror.  It's not hard to tell that the chin strongly affects a man's distinguished manners and first impression on others.

Ahai has a name which can be compared to his characters.  He values brotherhood very much.  Interestingly, he made big noise of snoring.  Many of his friends called him "Brother Rat" in private because of his excessively short chin (left).   Some of his friends revealed that they thought he was a man without guts upon meeting him for the first time.  (Right) Having received the orthognathic surgery, he has stopped making rumbling noise from snoring.  Meanwhile, "Brother Rat" has no longer come out of his friends' mouths.  A well-shaped chin has restored his distinguished manners and imposing appearance.

 

Ken revealed that he almost had no attraction to women before reshaping his chin (left).  Having received genioplasty, his relationships with females have improved.  He has been highly praised by his friends and family members for growing up to be a handsome man.  He now looks much more mature.

 

Contrarily, if the males who were born after the 1980s are pursuing the trend of being a metrosexual like that in Korea, the style of the chin may turn to be neutral or more graceful.  Consequently, their appearances may also change.  Similarly, when the dainty and exquisite chin of a female can perfectly go with the overall facial shape, her face naturally shines with a coquettish and charming touch.

Having presented so many cases, don't you think that the chin being the "front end of the mandible" cannot be underestimated and ignored?  Take a look at yourself in the mirror and carefully review your chin to determine what type of the amazing wonders it is categorized into.

 

 

Results of surgery vary among patients. Please consult your doctor.
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Copyright © 2007-2017 

All Written Contents and Pictures Created by Dr. Adrian M. Hsieh and Dr. Scott H. Jiang

 

 

 

 

Results of surgery vary among patients. Please consult your doctor.