Archive for the ‘Chin Surgery’ Category

My chin implant in the spring has made my face look boxy from the oval I used to have. What can I do?

Wednesday, November 17th, 2010

by Bellevue | Seattle’s Dr. Philip Young | Aesthetic Facial Plastic Surgery:

This is a response to a question that I answered for a person who had a procedure by another doctor:

Chin implants can have a tremendous impact on your looks. Because it is placed in the lower third of your face it will have the most impact in this area. But overall, it can change the appearance of your face as a whole to a great degree.  The changes to a box like appearance instead of an oval can definitely happen.  It might improve a little more over the next couple of months since you had it in the spring and right now it is fall going on winter. Your Physician will know the best on what to do.  But you can replace the implant. Work with the implant that you have in there by sculpting it.  It will most likely entail either a smaller implant, a more tapered implant and still you might need further tailoring of the implant to have it fit your face better. During the procedure, I will often assess the appearance of the implant and do contouring of the implant and the bone around the chin to help with this tapered look. Most surgeons just place the implant in and get results that will approximate what you want. Sometimes it takes a little extra time to shape the area and implant to achieve the best results. Here is a link to chin implant videos for you to learn more about this procedure.

chin-implant-before-after

chin-implant-before-after

Cheers!, Dr Young

Dr Young specializes in Facial Plastic and Reconstructive Surgery and is located in Bellevue near Seattle, Washington

Button Chin Implant Can Make Your Chin Look More Prominent and Your Jowls Also More Prominent.

Thursday, July 15th, 2010

I had a patient that had a chin implant (Dr Young is located in Bellevue Washington) placed by another physician near by.  The patient said to me that he felt his chin stuck out too much and that he had indents by his chin.  This was grafted with fat but the fat just couldn’t fill in all of the discrepancy.  We elected to look into his chin implant and replace it with an implant that has more lateral extension.  This was the thought after examining his chin.  When we went into the chin area the implant was indeed a “button” type of implant that just augmented the central part of the chin. This “button” type of chin implant is really rarely used for this reason.  I hardly ever put these in.  They accentuate the chin and make it look too big and also make the prejowl area deeper making the jowls look bigger.  Our answer was to put in a new implant that had more lateral extension and we choose the med por extended chin implant.  Here is a picture of the chin implant that we used:

The chin implant that he had look like this:

What might not be apparent in the picture right above is that the anatomical chin implant lacks the lateral projections for a more even transition to the jawline. The person’s implant that we did surgery however had even less lateral projection.  After removing the implant we tailored the extended chin implant because we thought it was too big and we then screwed in the implant to improve its “take” in this region.  Screwing the implant can decrease unwanted increase in size of the augmentation, prevent fluid accumulating deep to the implant that could cause infection, it also fixes the implant so that the implant doesn’t move.  Here is a video showing this patient’s implant and what we plan on putting in to replace their implant.

Thanks for reading, Dr Young

Dr Young specializes in Facial Plastic and Reconstructive Surgery and is located in Bellevue near Seattle, Washington

Chin implant versus Genioplasty, How does this change the Profile views and Frontal view?

Tuesday, July 13th, 2010

Chin implant’s (Dr Young, Aesthetic Facial Plastic Surgery in Bellevue, near Seattle, WA) can enhance your profile and are much easier to recover from compared to a genioplasty.  A sliding genioplasty involves cutting through your chin bone and advancing it.  This can lead to issues such as longer recovery, nerve injury chances are increased, step off deformities can occur, there is much more pain with it, and the advanced bone segment can loss volume. It is harder to demonstrate the changes from the frontal view.  It requires your doctor changing the way the light hits the chin to show the changes.  For women, the chin implants always need to be done in a conservative way.  Generally, there are many options for augmenting your jaw including where on your jaw (location) and how much. There are many different types of implants that you can choose from. Also, there are different types of material and I generally prefer to implant silicone or medpor (porous polyethylene). Silicone is a the most common option. It is soft, does not get incorporated within your tissues but has a capsule formed around it. The advantage is that it can easily be removed and replaced with a bigger or smaller implant with relative ease. Medpor is stiff, and grainy to the touch and gets incoporated into your tissues. The incorporation makes the medpor implant more resilient to infection. But this incorporation makes it harder to remove the implant if you want to change it. Here is a video on chin implants.

Thanks for reading, Dr Young

Dr Young specializes in Facial Plastic and Reconstructive Surgery and is located in Bellevue near Seattle, Washington

Chin Implant Revision for misplacement and for aesthetic reasons (when the implant is too large)

Friday, June 18th, 2010

There are many times when I get people that come to my office wondering about changing the appearance of a chin implant that they had before.  I have this case of a woman who had a chin implant by another surgeon and she felt that the chin implant was riding too high. She felt that the chin implant was also too large and it made her look a little masculine.  When it comes to revisions, you should not ever just take an implant out unless it is a really small implant.  What happens is that the soft tissue can ball up and contract and create an unfavorable appearance.  What is typically the better thing to do is to replace the large implant with a smaller one.  If the implant is already smaller, then you could make a case to not put any implant in and this is an option only for a small implant.  Generally small implants are the ones that people have an issue with.  Also when you put an implant in, they implant should alwaws ride on the inferior border of the mandible where the bone is hard and less likely to undergo resorption.  I prefer medpor implants for many reasons.  They can get incorporated and vascularized to act like your own tissue much more so than silicone implants.  Silicone implants tend to have a capsule form around it and will not get incorporated. Hence, when you hit your silicone implant there is more likely the chance for complications years after the procedure as opposed to medpor where once it gets incoporated past 12 weeks, it will be more resistant to infection and rejection. Here is a video showing and demonstrating what we are talking about.

Thanks for reading, Dr Young

Dr Young specializes in Facial Plastic and Reconstructive Surgery and is located in Bellevue near Seattle, Washington

Chin reshaping by cutting out a wedge of bone or shaving it down, what is the best approach?

Tuesday, June 1st, 2010

This was the question:

I’d like to get some information on chin shaving. Overall, I’d say that I have a chin that is long (in the vertical direction). I would estimate my reduction would be somewhere around 7-8 mm. I read a blog website that chin reduction in the vertical direction is usually done via removing a wedge between the upper and lower portions of the chin, rather than shaving off the bottom – where a witch’s chin deformity may result. Is this the procedure you would recommend, or it is just one Dr’s preference ? Would this procedure be done under general anesthetic ??

That is one way of doing things.  But if you read more articles on chin shaping (Dr Young is in Bellevue, near Seattle WA), the articles reflect the opinion of many people doing this, is that when you cut a wedge of bone there are other risks.  You are more likely to get nerve damage.  After you remove the middle part of the bone, it usually creates a step off on the sides that makes it more difficult to smooth out.  Also after doing the wedge of bone you need to use plates and screws to fix the bone cuts.  The bone that is left also has the potential to become devascularized and lose volume.  Also this method doesn’t allow you as much room for contouring the soft tissue after the reduction. If you try to contour the soft tissue like skin etc you can further devascularize the bone segment. Also this procedure can be done under local and iv sedation.  Also I would approach this from the outside under your chin.  I would not go through your mouth as this leads to more complications. Here is a video on chin reduction for you to see.

Thanks for reading,

Dr Young

Dr Young specializes in Facial Plastic and Reconstructive Surgery and is located in Bellevue near Seattle, Washington

chin implants and the assesment of the vertical dimension and the possibility of a deficiency.

Saturday, May 15th, 2010

So a common question is would I benefit from a chin augmentation (Dr Philip Young Seattle/ Bellevue Wa)?  I addressed this question in a recent blog but I didn’t talk about the vertical component.  How much vertical augmentation do I need and do I even need to add anything to the vertical dimension of my chin? Firstly, it is good to have some anatomical terms to refer to. In the first picture, the Glabella, labelled “G” is the most projecting point on the lower parto f the forehead and is usually right between the eyebrows. The nasion, labeled “N”, is the most depressed point below G and is usually at the root of the nose.  The Subnasale, labeled “SN”, is the point of transition from the nose to the upper lip.  It is where the nose, columnella, intersects the upper lip.  The upper vermillion is the point of transition from the white part of the upper lip to the red portion of the lip (Called the Vermillion) and is labeled “VU”. The same point coinciding with the lower lip is labeled “VL”. The Pogonion, labeled “PG”, is the point of the chin that is the most projecting anteriorly.  The mentum, labeled “MN”, is the most inferior portion of the chin.  One thing to be careful of is when the patient has a double chin.  The mentum is the part of the chin that is associated with the chin and not the inferior part of the sagging that can occur under the chin and posterior to the chin. The first rule for vertical augmentation is based on three lines drawn through the glabella, subnasale, and mentum.  Each of these distances created by these lines should be equal.  If your chin is making the distance from the mentum to the subnasale shorter than the distance from the subnasale to the glabella, you could benefit from a vertical chin augmentation.  If it is longer than you could benefit from chin reduction. This is shown in the second picture.  Now, if you draw a line through the nasion instead of the glabella the distance from nasion to the subnasale should be 43% and the distance from the subnasale to the mentum should be 57% o the total distance from nasion to mentum.   If the your distance from subnasale to the mentum is less than 57% you could possibly use some vertical enhancement.  the In the third picture, three lines are drawn through the subnasale, stomiom (or the opening between the upper and lower lips), and the mentum. The ratio of the distance from subnasale to the stomiom to the distance from stomiom to the mentum should be 1:2.  If the distance from your stomiom to the mentum is less than this ratio, you could benefit from vertical enhancement or an increase of the vertical dimension of your chin.  Below are some results of chin augmentation for you to see how a chin implant could enhance your appearance.

Thanks for reading, Dr Young

Dr Young specializes in Facial Plastic and Reconstructive Surgery and is located in Bellevue near Seattle, Washington

Profile Landmarks

Facial Thirds

Mouth Ratios

Before Chin Augmentation

After Chin Augmentation

Before Chin Augmentation

After Chin Augmentation

Custom Chin Implants are a good option for chin augmentation and how much anterior projections should I have.

Saturday, May 15th, 2010

Chin implants (Dr Young specializes in plastic surgery in the Face and Neck in Bellevue Washington) come in many shapes and sizes.  Sometimes, even with the many variations there  might not be one that fits all of your needs.  This is when a custom implant may be the perfect choice for you.  One of the first questions you should ask is whether or not a chin implant would work for you.  There are multiple ways of assessing whether you could benefit from enhancing your chin.  The first thing to do is to understand the various landmarks. In the first picture, the Glabella, labelled “G” is the most projecting point on the lower parto f the forehead and is usually right between the eyebrows. The nasion, labeled “N”, is the most depressed point below G and is usually at the root of the nose.  The Subnasale, labeled “SN”, is the point of transition from the nose to the upper lip.  It is where the nose, columnella, intersects the upper lip.  The upper vermillion is the point of transition from the white part of the upper lip to the red portion of the lip (Called the Vermillion) and is labeled “VU”. The same point coinciding with the lower lip is labeled “VL”. The Pogonion, labeled “PG”, is the point of the chin that is the most projecting anteriorly.  The mentum, labeled “MN”, is the most inferior portion of the chin.  One thing to be careful of is when the patient has a double chin.  The mentum is the part of the chin that is associated with the chin and not the inferior part of the sagging that can occur under the chin and posterior to the chin. One rule was developed by Gonzalez-Ulloa shown in the second picture.  The horizontal line you see will be refered to a lot by surgeons. It is called the frankfort horizontal.  It travels from the top of the ear canal and through the top of the inferior orbital rim.  The vertical line you see is part of there interpretation of where the chin should be.  The vertical line should travel through the Nasion and the the Pogonion should approximate this line. Some feel that the augmentation based on this rule would lead to too much projection. A similar rule places the vertical line of the Gonzalez-Ulloa line more posteriorly at the subnasale, although sometimes it is very close as in this picture, called the Epker and Fish Rule.  Based on this rule, the vertical line should travel from the subnasale and through the upper vermillion “VU” and the lower vermillion should be 2mm behind, and the pogonion should be 4mm behind. The third really common rule is based on the Nasal Chin Lip Line.  It is based on the ideal nasal length measure from the root of the nose at the level between the upper eyelid crease and the upper eyelid margin to the nasal tip.  From the half point distance, a line is drawn through the upper lip vermillion.  From this point, the pogonion should be be 3mm behind this line.  The last two rules are my most preferred ways to assess how much chin augmentation to do.  In another blog, I will address the vertical dimensional analysis.

Thanks for reading, Dr Young

Dr Young specializes in Facial Plastic and Reconstructive Surgery and is located in Bellevue near Seattle, Washington

Profile Landmarks

Nasal Chin Lip Plane / Line

Reoccuring Jowls 3 years after facelift and what is a Thread Lift By Dr. Philip Young Bellevue | Seattle:

Thursday, February 25th, 2010

Reoccuring Jowls 3 years after facelift and what is a Thread Lift By Dr. Philip Young Bellevue | Seattle:

Question: What can be done for reoccuring jowls after having a facelift 3 years ago? What about the thread lift?

Answer: A Chin Implant Reshaping or Fillers / Fat injections (Dr Philip Young Seattle Washington)could help the looseness in the jowls.  The jowls occur for a number of different reasons. If you read my other blogs you can find pictures that illustrate jowls.  What happens is that when you lose volume in the face, especially the cheeks and jawline area along with volume around the mouth, the jowls become more prominent.  As an example, pinch the skin by your upper cheeks just inferior and lateral to the eye.  Notice as you do this, that the jowls begin to rise a little bit.  Now in front of your jowls is a depression and volume loss call the prejowl area.  This area along the jawline and closer to the lips and in front of the marionette lines can be filled in as well.  Also along the jaw in front of the ear can also be filled in and this can have an effect on the jowls decreasing.  Sometimes people fill in the prejowl area with fillers and fat injections to reduce the appearance of the jowls through a camouflage type of correction. In terms of volumizing with fillers, you can also use fat injections for the same thing and you can add more volume with fat than you can, a lot of times, than with filler.  Fillers are quite a bit more expensive than fat for filling in volumes.  Sculptra is another option in between fat and fillers. Sculptra can last over 2 years and some are finding more than that.  Other options for the jowls include direct liposuction of the jowl area.  Thread lifts, in my opinion, don’t work. They pull on the skin for a time being but relax and most of the time I don’t think you get any long term improvement.  The only time you get long term improvement is when you turn the thread lift into basically a facelift done in many traditional ways. Here is a facelift consult to help you prepare before a facelift consult:

I hope that helps.

Thanks for reading, Dr Young

Dr Young specializes in Facial Cosmetic and Reconstructive Surgery and is located in Bellevue near Seattle, Washington

Can Facial Nerve Damage occur with Rhinoplasty and Chin Reduction Surgery?

Wednesday, February 24th, 2010

Facial Nerve Damage from Rhinoplasty (Aesthetic Facial Plastic Surgery, Dr Young Bellevue) and Chin Reduction Surgery (Philip Young MD, Bellevue, WA) is extremely rare.  From Rhinoplasty, Facial Nerve Damage would be something that you could report in the literature because it is extremely rare.  I have never heard of that ever.  So you worry about Rhinoplasty causing that should be lessened.  Chin Reduction surgery is a viable concern. When you do this type of surgery, you have to elevate the chin area.  Superficial to this elevation, you do have nerve fibers from the facial nerve that traverse this area.  If one were not in the right plane you could damage this nerve although this is still pretty rare.  Also with Chin reduction surgery, you need to tailor the skin envelope to accomodate the smaller chin after reducing the bone volume.  this tailoring can injure the nerve. One thing to remember is that, at that point you are dealing with end fibers of the facial nerve and likely regeneration will occur without any effects if it were to happen.  But more laterally when you do your reduction you need to be careful to stay in the right planes.  That might be too much information.  In general, the risk of facial nerve damage from either procedure is extremely rare!

I hope that helps.

Thanks for reading, Dr Young

Dr Young specializes in Facial Cosmetic and Reconstructive Surgery and is located in Bellevue near Seattle, Washington

Genioplasty or Chin Implant to move the chin forward without increasing the vertical height.

Tuesday, February 23rd, 2010

Genioplasty or Chin Implant (Dr Philip Young, Seattle) to move the chin forward without increasing the vertical height during chin cosmetic surgery (or chin plastic surgery, chin enhancement surgery).  This can be done but can be tricky.  Anytime you project the chin forward, because the chin is usually angled in a inferior direction and not horizontally straight (you can see this by using two mirrors and looking at your side profile), Any lengthening of the chin will cause some vertical lengthening.  You can avoid this by making some adjustments to the chin implant, by tailoring the bottom of the chin implant.  The other more advanced way is to reduce the vertical chin height by taking the bone down in the vertical dimension and then augmenting it more horizontally.  In general genioplasty is favored among plastic surgeons due to the easier procedural steps, less complications, and less operation time to name just a few reasons.

I hope that is helpful.

Thanks for reading, Dr Young

Dr Young specializes in Facial Cosmetic and Reconstructive Surgery and is located in Bellevue near Seattle, Washington