Our brains are hard wired to perform pattern recognition. We subconsciously analyze faces for proportionality of the vertical facial thirds and right and left axial symmetry and then attach an aesthetic value based on the harmony. Without even contemplating this, a person’s bias to say one face is more pleasing than another occurs almost instantaneously. Men are routinely viewed as more masculine and stronger in appearance if they possess a symmetric lower jaw in harmony with the middle facial third or conversely they may appear weaker or less vital if they portray a retruded jaw with an obtuse chin-neck angle. Additionally, having a stronger skeletal support of the soft tissues of the face and neck will lead to less of an aged appearance compared to a less prominent skeletal relationship. People with under-bites and small lower jaws having fuller, less defined neck lines look older or even appear more overweight compared to an individual with a normal jaw line. Therefore, correction of this anomaly of the jaw and neck makes sense for projecting a powerful image and to offset an premature aged appearance.
The treatment for this condition is heavily dependent upon a three dimensional facial analysis. If the lower jaw is retruded with a steep mandibular plain angle and a vertically elongated chin with lip strain, without question, the best approach is to perform a sliding, vertically reducing and forwardly advancing osteotomy of the chin with skeletal fixation. This allows the projecting chin point to move forward while shortening the chin and reducing the lip strain. In conjunction with this approach additional soft tissue support just under the lip and above the chin is required with fat grafting to soften the labiomental crease which increases as the chin is moved further forward than the teeth. Fat is an easy approach with less cost than a bone graft which can provide the same results. Lastly to tone the skin under the jaw and to crisp the chin-neck angle, liposuction is performed to remove unwanted fat but more importantly to induce scar contracture of the overlying skin to allow for neck retraction and an improved jaw line.
If the chin is retruded and has a normal proportion to that of the middle third of the face, I prefer a Medpor chin implant which can provide skeletal enhancement without the need for an osteotomy. Unlike a silicone gel implant it can be carved and customized to meet the exact needs of the patient. I then perform bone screw fixation so the implant is not free floating like other implants and becomes the normal extension of the bone. Just as in the previous scenario soft tissue support of the lower lip is required to avoid accentuating the labiomental fold as the chin point is increased over the dental support elements of the lower lip. I also generally utilize liposuction as described above.
The last case type is a patient with a short, vertically deficient chin with respect to the middle facial third. This requires an osteotomy (moving the chin forward) and necessitates an inter-positional bone graft from a bone bank to make the vertical facial thirds the same.
Skeletal enhancement with fat grafting and neck liposuction can produce a very powerful outcome without changing the overall identity of the patient and generally makes the person appear to lose weight and demonstrates a more youthful neck line.
If you are interested in being evaluated for these procedures please contact The Lucas Center, Plastic Surgery, www.thelucascenter.com. 865 218 6210.