Full Text from Dr. Berman's Book

Chapter 5


Chin augmentation is a frequently performed procedure to help balance a face with a weak or recessive chin. If the occlusion (bite) is properly aligned, but the chin is recessive, then the patient is a good candidate for chin augmentation with a synthetic implant. The procedure can also be done by cutting and repositioning the bone. In my office we most often use a silicone rubber implant coated with Gore-Tex™. It is shaped to wrap around the normal contours of the chin. It can be placed through a small incision under the chin or from within the mouth. While any implant material runs a risk of infection and consequently needs removal, it is very infrequent. Today the emphasis is on anatomical implants that wrap around the chin as opposed to the smaller implants that just sit in front of the chin. There are several different styles and sizes available.

Also, special chin implants are often used to fill out natural defects from aging. The idea of using implants for the aging face is based on the general loss of volume we sustain as we age.

When the chin is excessive in length, or there is significant maloclusion (the teeth do not align properly), then treatment requires resetting the bone. I prefer to refer these patients to an oral surgeon who usually works in conjunction with an orthodontist.

A typical example of a slightly weak chin, coupled with a slight nasal hump. The chin augmentation is probably more important, than the rhinoplasty in balancing out the face.

By performing a chin augmentation, a subtle rhinoplasty, and plumping the pre-maxilla under the upper lip, the patient has a much more pleasing and attractive profile.

A young man with a slightly weak chin and drooping nasal tip has a more harmonious appearance with a chin augmentation and subtle rhinoplasty, mainly tip work.

While cheek augmentation has become increasingly popular, it is still not well appreciated. The cheekbones also help balance the face. While the chin tends to frame the mouth, the cheeks frame the eyes. Full or high cheekbones are not only attractive, augmentation of the cheek area can also help fill the face and reduce changes associated with aging. (I believe we will see significant advances in the development of facial implants to deal with the problems of the aging face.) The implant shape is determined pre-operatively during the consultation. There are several different shapes and sizes which may be utilized depending on what we want to accomplish. Occasionally, this procedure can be combined with fat-grafting to achieve the enhanced results. The cheek implants are the same type of material as used with the chin. The implants are most often placed through a small incision inside the mouth. There can be a considerable amount of swelling associated with cheek augmentation - somewhat like that associated with the removal of wisdom teeth. Most of the swelling subsides during the first week, though there may still be persistent swelling for another week or two. This will subside and the implant will stabilize and fix in place. The sutures that close the incision site inside the mouth are absorbable and do not require removal. It is advisable to be on a liquid diet for the first day and soft, smooth foods for the next day or two to avoid irritation around the incision site.

Once the healing process is completed the new implants should feel like a normal part of the patient. Neither the patient nor anyone else will be able to tell that there is an implant in place. The ultimate result will provide an enhanced facial contour and in appropriate cases a more youthful appearance. It is important to note, that should any problem occur, including dissatisfaction with the appearance, the entire implant is removable as there is no degradation of the materials.

This patient initially thought she needed her nose made smaller, however, cheek augmentation balanced out her face, made her nose fit better, and gave her an overall more glamorous or attractive appearance.

With the slight flatness of the cheeks and general fat loss that comes with age, the face sags and looks older. With cheek augmentation, the face is not only better contoured, it gets a "lift" and the patient looks more youthful, as well as more attractive.

A young patient subtly improves her appearance with cheek and chin augmentation giving a more sophisticated look.

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