The chin is an important visual feature distinguishing between the male and female genders. The male chin is typically broader, and is more projected in the forward direction than in females. Cleft chins are acceptable, and sometimes desirable in men, whereas it is generally undesired in women.
In men, augmentation of a deficient chin confers the image of masculinity and authority. In women, correction of a deficient chin helps to restore the ideal facial proportions, viz. the midface-to-lower face and the upper lip-to-lower lip ratios.
In appropriate individuals, vertical lengthening of the chin helps one to achieve an aesthetically pleasing V-shaped face, and helps to visually distinguish the lower face from the neck.
Small chins are clinically divided into three large groups. Individuals with microgenia have a reduced lower lip height and a reduction of the normal upper lip-to-lower lip height ratio of 1:2. Individuals with retrogenia have inadequate forward projection of the chin. This is assessed from the side view, where an imaginary line is drawn from the tip of the nose to the chin point. The lower lip usually lies 2 mm behind this line, and individuals with retrogenia present with lips that lie in front of the line due to the recessed chin.
Individuals with retrognathia have generalized undergrowth of the lower jaw and have associated overbite, snoring and sleep-related problems as well. Individuals may have combinations of these conditions, which makes accurate clinical assessment critical to determining appropriate treatment and attaining optimal results.
Microgenia, retrogenia and retrognathia have hereditary genetic components and result in insufficient growth of the chin bone at the completion of facial skeletal maturity. Some individuals with retrognathia may have underlying congenital syndromes predisposing to the undergrowth of the entire lower jaw.
Men generally have thicker and heavier soft tissue (skin, fat and muscle) overlying the chin area and treatments aimed at altering the chin contour will require additional consideration. Men also often prefer chins that are broader and more projected than in women and affect the surgical planning and execution.
Small chins may be due to microgenia, retrogenia or retrognathia. Accurate clinical assessment is critical to determining appropriate treatment and attaining optimal results. Microgenia may be treated with filler injection or genioplasty (chin bone surgery). Retrogenia may be managed with filler injection, insertion of chin implant or genioplasty. Retrognathia requires further investigation with X-rays and scans, and management with partnering maxillofacial surgeons to restore optimal bite and appearance.
Microgenia and retrogenia are reliably treated with filler injection and attain a high degree of satisfaction in many cases. Filler injection is a popular ambulatory procedure and may be used to augment facial skeletal deficiencies. Firmer fillers are used to simulate bone and fill the area of bony deficiency and support the overlying muscle and skin. This creates the appropriate chin contour and improves the overall aesthetic appearance. A detailed explanation of filler injection may be found here.
Filler injection to the chin may be performed using calcium hydroxylapatite (CaHA) or hyaluronic acid (HA) fillers. A detailed description of the different filler materials may be found here.
Mild degrees of microgenia and retrogenia are often successfully managed with fillers.
Obtaining an optimal result for chin filler injection requires appreciation of the dimensions and proportions of the ideal chin. Administration of filler has to be performed with care and skill to achieve these ideal dimensions. Attaining beautiful and bespoke results is frequently possible and requires a combination of appropriate product choice, precise technical execution and an experienced practitioner.
Preprocedural assessment identifies the existing and ideal chin dimensions to be achieved. The filler material is injected at various points on the chin bone to create the desired length, projection and shape. The choice of filler material, volume administered, and injection points are tailored to each individual for optimal results.
The effects of filler injection may be observed almost immediately following the procedure. Most of the filler will be resorbed in 6 to 9 months and repeat treatment is required to maintain the result.
Individuals are advised to avoid vigorous massage or rubbing of the treatment area for 2 hours following filler injection to minimize the potential for bruising. Individuals may resume their usual activities immediately following the procedure.
Dr Yeo is experienced in filler injections in Singapore and is a trainer for several filler product lines. He frequently delivers lectures and conducts workshops on effective and safe filler administration in the Asia Pacific region. Injection site pain is significantly reduced with the use of a pain distraction device at Picasso Plastic Surgery.
Insertion of chin implants are an effective and popular method of achieving long-term correction of retrogenia. A variety of implant sizes and implant materials are available to suit each individual’s unique anatomy and help to achieve their aesthetic goals. This is an ambulatory procedure performed under intravenous sedation.
Individuals with retrogenia seeking long-term improvement may consider chin implant insertion.
Individuals are advised to stop herbal supplements and traditional medicine and start special medications 7 days prior to surgery to minimize bruising and swelling.
There are two possible approaches: the intraoral (“scarless”) and the transcutaneous approach where the incision is made on the skin of the back of the chin. The approach selected is dependent on the individual’s aesthetic goals and the underlying chin anatomy.
Local anaesthesia is infused for optimal intra- and post-operative analgesia. The incision is performed and the muscle is elevated off the chin bone to create a precise pocket for the insertion of the implant. The wound is then closed meticulously to ensure the optimal postoperative outcome.
Minor swelling and bruising is expected after surgery, and will mostly resolve by the 7th postoperative day. The intraoral approach does not require removal of stitches; the transcutaneous approach will require removal of stitches on the 5th postoperative day. Most individuals are able to return to work following removal of stitches.
Specific post-operative compressive bandaging is performed for the first 5 postoperative days to maintain the position of the chin implant. Postoperative swelling is reduced by remaining upright during the daytime and by elevating the head of the bed with extra pillows when asleep at night. Strenuous activity should be avoided for the first two weeks to minimize bruising.
Genioplasty surgery uses the individual’s native chin bone to lengthen or increase the forward projection of the chin. It produces a natural-looking and long-lasting contour change and restores one’s aesthetic facial proportions. Genioplasty is an ambulatory surgical procedure that is performed under intravenous sedation.
Individuals with microgenia, retrogenia, or combination both, and seeking long-term improvement may consider genioplasty.
Individuals are advised to stop herbal supplements and traditional medicine and start special medications 7 days prior to surgery to minimize bruising and swelling. Preoperative X-rays or CT scans are required for planning for this surgery.
Local anesthesia is infused for optimal intra- and post- operative analgesia. The incision is made at the back of the chin and results in a well-concealed scar when healed. The incision is performed and the muscle is elevated off the chin bone to provide good exposure. The chin bone is cut and advanced accordingly to achieve the desired result. Permanent titanium implants are used to fix the bone in its new position. The wound is then closed meticulously to ensure optimal postoperative outcome.
Minor swelling and bruising is expected after surgery, and will mostly resolve by the 7th postoperative day. Stitches are removed on the 5th postoperative day. Most individuals are able to return to work following removal of stitches.
Specific post- operative compressive bandaging is performed for the first 5 postoperative days to reduce swelling. Swelling is further reduced by remaining upright during the daytime and by elevating the head of the bed with extra pillows when asleep at night. Strenuous activity should be avoided for the first two weeks to minimize bruising.