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Chin: the crux for the extension of charm Part I

Chin: the crux for the extension of charm Part II

客製化骨水泥下巴

Chin: the crux for the extension of charm Part II

Lower jaw bone encloses the lower alignment of teeth and extends toward the front of ears just before the temporomandibular joints. Chin is the extended lower frontal area of lower jaw (Picture 1). It is important to understand this relationship between the chin and lower jaw to appreciate the essence of genioplasty. Dr. Hsieh tries to describe genioplasty as collective of procedures beyond the most well known simple procedure of chin padding or augmentation.

                                                     

Currently, genioplasty can be categorized into two major procedural techniques with one involves osteotomy (Picture 2) while another involves insertion of chin implantation (Medpor) (Picture 3). The selection of one procedure over another is often carried out under the most stringent considerations that involved many facets. Dr. Hsieh tries to explain here with plain explanations that enlighten the artistry involved genioplasty and its advantages and disadvantages.

The Fundamental differences in Procedures：
Osteotomy must be performed under general anesthesia. The chin and lower jaw bone are separated with light-weighted bone sow by the surgeon. The separated chin is then moved to the ideal position and secured with bone nails and plates.
On the other hand only local anesthesia through intravenous injection is required for chin Medpor insertion surgery. It is applied on patients with minor and medium degree of receding chin.

Reconstruction of Chin for Receding and Shortness Features：
Generally, patients with receding chin will have the condition of narrowed airway that causes varying degrees of sleep apnea. If the patient receives osteotomy, the chin bone is moved forward while at the same time the muscle at the back of the chin is also brought forward so that the airway is opened. These movements of bone and muscle improve the symptoms of sleep apnea. However, if the patient receives Medpor chin insertion, though the aesthetic outcome may be similar but there is no beneficial effect on the opening of airway for sleep apnea. It is recommended that if the recedingness of the chin exceeds 7mm in length, then the consideration for osteotomy or combination of orthognathic surgery will result a more naturally looking outcome than the choice of receiving a Medpor chin insertion that is greater than 7mm in length.
Sometimes, it is necessary to widen the corrected receding chin, under these circumstances, Medpor insertion is recommended for achieving better outcome. On the other hand, it is necessary to combine osteotomy and Medpor chin insertion together for some instances to achieve the best aesthetic look and breathing function.

Correction of Inclination on Chin：
Osteotomy is the best choice of surgical procedure for the correction of an inclined chin. The selection of procedure is important while the best aesthetic outcome may come short if the correction is merely performed on an already deviated chin with the insertion of a contouring implant or bone abrasion in attempts to rectify the condition. Often such corrective attempts may even result a more incline looking chin than before the procedure.
 

Correction for Over Elongated Chin：
It isn't hard to imagine that an over elongated chin may be corrected by receiving osteotomy or combine with orthognathic surgery to shorten its length.
 

Other Considerations:

Consideration for Chin Implant Materials:

Surgeons usually made their selection for chin implantation based on the following characteristics of the materials：

Medpor：
Medpor is made of high density porous polyethylene. Its beneficial characteristics are biocompatible, won't cause chin bone absorption, and there are no soft tissue capsular contraction and disposition problems. However, it is more costly and involves more skilled surgical technique and experience.
 

Silicone Chin：
Silicone has good biocompatibility. It is cheaper with easier surgical insertion and contouring requirements. However, it can cause unpredictable and varying degrees of bone absorption. When bone absorption occurs, it affects the maintenance and the stability of an aesthetic outlook. Moreover, long term capsular contraction may cause silicone implant to disposition from its ideal location so second reposition surgery may be needed to resolve these problems.
 

Recovery:
Irrespectively, both osteotomy and Medpor chin insertion will have similar recovery period. The intraoral incision will leave no scar on the face while the edema will dissipate with 60%~70% of recovery within the first week and 80%~90% of recovery within the second week. It is recommended to have fluid foods for the first 3 days after surgery, soft textured foods for the next 3 to 7 days. Normal foods intake can resume after the first week.

Conclusion:
Dr. Hsieh always believes in forming chief objective for any treatment plan. In fact, every patient is unique and special with different requisites. All patients should not settle for one surgical procedure just because of the surgeon's ability and skill or the clinic's equipments and facilities.

Dr. Hsieh is dedicated in sleep apnea research and found that patient with receding chin often has obstructive sleep apnea, OSA. After receiving advancement sliding Genioplasty, the patient's airway has markedly widened with great improvement on sleep apnea and snoring. Patient has improved stamina for his/her everyday life. Some patients especially the group of men in their mid-years want to have osteotomy to improve their sleep quality and be free of respirator, the concern of aesthetic is minor.

Case 1

Case 2

Case 3

Case 4