BEFORE AND AFTER PHOTOS
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A balanced facial profile is desirable. In fact, it is difficult to look very attractive without jawline definition and adequate chin projection. Almost all popular movie stars or models, past or present, have a well-defined jawline, whether natural or enhanced. A few examples—Michelle Pfeiffer, Angelina Jolie, Rob Lowe, Cary Grant, any actor who’s played James Bond and any actress who’s played a Bond girl.
The face can be divided into thirds (See photo). The lower third balances the upper and middle thirds. For a pleasing profile, the chin should fall into alignment with the most projecting points on the upper and lower lips, called Reidel’s plane.
(Left) The face may be divided into thirds. (Right) Ideally, the chin is aligned along a plane that connects the upper and lower lips.
Unfairly, a strong chin is thought to be associated with strong character. The chairman of the board, the warrior-king, and the quarterback hero are all portrayed by men with strong chins in movies. Look at an ad for any branch of the U.S. military and you will see a strong chin. The same is true for superheroes. Idealized portraits of Napoleon in battle take almost cartoonish liberties in exaggerating his chin.
Many people inherit a recessed chin. Sometimes a small chin may be associated with improper alignment of the teeth (“malocclusion”), in which case orthodontic treatment is needed to adjust their position. If an overbite cannot be corrected with braces, orthognathic surgery is needed, which involves breaking the jaw bone and advancing it forward. However, patients with cosmetic concerns who have a normal occlusion do not need jaw-breaking surgery. A chin implant is used to augment the lower third of the face, balancing the lower third with the upper and middle thirds, and improving facial proportions. It is a procedure that plastic surgeons can usually do well and reliably, and without a difficult recovery.
I commonly point out any deficiency of the lower face in patients inquiring about other cosmetic procedures. I am not hesitant to do so because of the profound benefit that this procedure can give to facial balance. A chin augmentation and submental lipectomy complement each other in defining the jawline.
Chin implants used in the 1980s were often quite short, limited to the chin, and tended to produce a pointy chin. They also were prone to moving around. Modern implants wrap around the jawline, helping define the jawline along the sides, and do not move after healing. They are made of solid silicone, a material that is inert and safe to implant. The procedure is also reversible. If a patient decides later that he or she does not want the implant, it is easy to remove. This rarely happens because patients prefer their appearance with the implant. It feels totally natural and is not fixed with screws. It is placed in a pocket made under the lining of the mandible, the periosteum. Scar tissue forms and holds the implant securely in place. Because the implant is flexible, the incision does not need to be any longer than the incision used to perform a submental lipectomy.
Absorption of the bone under implants has been reported, but this does not seem to present a practical problem. I’ve followed patients with chin implants for over a decade with no noticeable changes on their profile views (See B.W., Patient Photographs).
The jawline may be augmented with or without augmentation of the chin. When done on its own, this implant has been called a jowl implant, describing augmentation of the jawline on either side of the chin. However, the term “jowl” implant is an unfortunate name because the word “jowl” commonly refers to the undesirable soft tissue hanging over the edge of the jaw. No one would want to augment this problem, which is treated with a facelift. Instead, in this context, “jowl” refers to the bony jawline itself on either side of the chin (anatomically, the “body” of the mandible). To avoid confusion, I prefer the description “jawline” augmentation.
The aesthetic importance of an unbroken jawline is increasingly being recognized. Commonly, there is a depression called a prejowl depression or a prejowl sulcus on either side of the chin that seems to become more pronounced with aging. If this depression is filled in, the chin tends to blend in with the jawline, which is appealing to the eye. Implants manufactured today are longer than ones used in the past, wrapping around the jaw to help achieve jawline continuity. Jawline augmentation can also serve to camouflage soft-tissue jowls by filling in the valley between the jowl and the chin on either side. This effect can be a temporary measure for those patients who are not yet ready for a facelift (See S.H., Patient Photographs).