Chin Enhancement Surgery (Genioplasty, Mentoplasty) Guide

What can a chin enhancement achieve?

This procedure can alter the chin's shape, size, and position to create a more balanced appearance. The chin is reduced in size if it is overly prominent or enhanced if it is receding or small. Chin enhancement surgery aims to make the patient feel more confident and comfortable by creating a natural-looking, well-proportioned chin.

Chin enhancement technique

The surgeon will discuss all of the available options and tailor their approach around each patient. The choice of technique also depends on whether the patient wishes for their chin to increase or decrease in size. Some of the most common techniques are:

Chin enhancement implant

This is a permanent method of chin enhancement. The surgeon creates a small incision underneath the chin and inserts an implant from either silicone, Porex or Gore-Tex. Silicone implants are the easiest to remove if required and carry a higher risk of movement or buckling as they are less porous than the other types. Despite this, silicone remains the commonest type of implant used for chin enhancement.

Sliding Genioplasty

This permanent method of chin enhancement uses the existing bones to reshape the chin rather than an implant. First, the surgeon makes incisions inside the mouth to reach the lower jaw and chin. This allows the surgeon to cut the bones of the lower jaw and "slide" it into the desired position. Then, they will secure it in place with a small metal plate and screws. Finally, the surgeon stitches the inside of the mouth together using dissolvable stitches.

Chin Fillers

This is a non-surgical procedure, and some surgeons offer it in the clinic. It is not permanent, and results tend to last up to one year. This method involves strategic injections of a material such as hyaluronic acid directly into the chin to alter its shape and size. Fillers only ever increase the size of the chin.

What will a chin enhancement not resolve?

A chin enhancement will only alter the size and shape of the chin. However, often the surgeon can combine a chin enhancement with the following procedures to address other concerns the patient may have:

• Facelift – this can reduce wrinkles and skin sagging.
• Blepharoplasty – this can correct the sagging of the eyelids.
• Rhinoplasty – this alters the size and shape of the nose.

The surgeon may be able to perform these procedures at the same time as the chin enhancement. Please discuss with the surgeon all concerns to suggest the best approach to achieve all surgical goals.

Why choose to have a chin enhancement?

Some patients are more suitable for chin enhancement candidates than others. For example, if patients feel that their chin is either too large or disrupts their face's balance, they may consider having a chin enhancement procedure. The most suitable candidates for a chin enhancement are those who have features and concerns that a BAAPS or BAPRAS approved surgeon can improve through this procedure. In addition, a chin enhancement may be appropriate if:

• The appearance of the chin affects confidence and self-esteem.
• The patient is experiencing significant distress or worry because of the appearance of their chin.
• The chin is disproportionately prominent or receding in comparison to the rest of the face.
• There is a desire to improve the balance of facial features.

Who are the ideal candidates?

This depends on many factors in addition to those outlined above. These include, but are not limited to the following:

Good general health

The patient must be in good general health before the surgery. This may mean stopping smoking before surgery or losing some weight before the procedure. This will reduce the risk of complications and help achieve better results from the surgery. The surgeon will discuss this and will be able to offer support and guidance throughout the process.

Good jaw function

For this procedure to be successful, patients must have healthy jaw and teeth. This includes having a jaw with a full range of movement and no significant under or overbite. Also, patients with some genetic facial abnormalities may not be suitable candidates for a chin enhancement.

A small (receding) or large (prominent) chin

A chin enhancement procedure can correct chins with problems at either end of the scale. However, to achieve the best visible results, patients undergoing this surgery should find themselves in agreement with their surgeon that their chin is either overly large or small when compared to the rest of their face.

What to expect from a chin enhancement consultation?

The chin enhancement consultation is an opportunity for the patient to meet their prospective surgeon to discuss the procedure and what they would like to achieve. This will last between 15 minutes and an hour. The patient will talk with the BAAPS/BAPRAS surgeon about any concerns and assess the patient's face and chin. They can then discuss the best surgical approach to solve the problems the patient may have identified. If appropriate, they may suggest procedures for other parts of the face, such as the nose or eyelids. These can often be performed simultaneously as a chin enhancement, with the aim being to help achieve the aesthetic goal that the patient is looking for.

The surgeon will also discuss the potential risks and complications that come with a chin enhancement procedure. The patient needs to be aware of these to make an informed decision on whether or not they wish to go ahead with the operation.

To assess suitability for surgery, the surgeon may ask about the following:

• Any current medical conditions
• Past medical history
• Any previous surgeries
• Medications use (including over-the-counter and herbal remedies)
• Intake of alcohol
• Smoking history
• Any allergies

During the consultation, it is recommended that patients are as open as possible with the surgeon. Be honest about expectations and desired outcome. The surgeon is there to listen carefully and to help achieve the goals the patient wants. This also means letting the patient know if their expectations are not realistic. In this case, they may suggest better alternatives.

Questions to ask during the chin enhancement consultation

Patients can ask the surgeon any questions they have about the procedure during the consultation. The following are some examples of questions that patients may consider asking:

• Will a chin enhancement correct the concerns I have expressed?
• What scars will I be left with?
• What other options are available for me?
• Will I benefit from a facelift/rhinoplasty/eyelid lift too?
• Do you think that my goals would be better achieved with a non-surgical procedure?
• Do you have any before and after pictures of previous chin enhancement procedures you have performed?
• Will I be in pain after the surgery?
• How soon after a chin enhancement can I return to work?

How to prepare for chin enhancement surgery

Preparation is key for a smooth and speedy recovery. Doing some household chores and planning will make life easier after the surgery. During this time, patients will need to take things slowly as the wounds heal. Below are some simple chin enhancement preparation tips that can help make a smoother recovery:

Household work

Patients might want to do certain tasks like cleaning the house, taking the bins out, or washing before the day of the operation. This way, patients won’t have to do these chores when they get home from the surgery. In addition, coming home to a clean and tidy house is sure to make the patient feel more comfortable and at ease whilst they recover.

Shopping

It’s good to stock up on some key food items that can be kept in the cupboard or fridge. Patients may not feel like leaving the house for a couple of days after the surgery, which will save them from going to the supermarket upon returning home. Preparing some meals in advance may also be a useful way of minimising stress after the operation as they can be kept in the freezer. Patients can then easily defrost these on days they don’t feel like cooking.

Children and pets

Looking after pets and young children can often be a handful. After a surgical procedure such as a chin enhancement, it is understandable to be tired and lack usual energy. Asking friends or family to mind children or pets can help make recovery less stressful.

Driving

After the surgery, patients will not be able to drive as the effects of the anaesthesia wear off. be sure to have organised for someone to do the pick-up and drop off.

Diet

A healthy diet is an important factor in helping healing and recovery after a chin enhancement. Eat lots of healthy green vegetables, fresh fruit, and high-protein foods such as chicken, fish and legumes. In addition, drink plenty of fluids - water is best. Tea and coffee are high in caffeine, so it's advised to keep those to a minimum as well as avoiding alcohol. Also, try to avoid foods that are high in sugar and salt as much as possible.

Clothing

Be sure to have clothing that fastens in the front or the back. Clothes that have to be pulled over the head will make contact with the treated area of the face and might cause pain or irritation of the incisions.

Sleeping

The face might feel delicate the first few days after surgery, so that patients may find it uncomfortable sleeping face down. Additionally, sleeping face down can cause a chin implant to move from its desired position and so is not recommended. Patients may, therefore, want to have some extra pillows for after the surgery so they can sleep propped up on their back. Resting in an inclined position on pillows also has the benefit of reducing swelling around the treated area.

Medications

Before the surgery, please discuss any medicines in use with the surgeon and/or anaesthetist. This includes over the counter medications, herbal remedies and any other drugs not prescribed by the doctor. In addition, it is important to follow any instructions about adjustments to medications or medications you have been told to stop before your surgery. This is particularly important if patients take any blood-thinning medications such as warfarin or clopidogrel and/or any oral diabetes medications.

How is a chin enhancement performed?

There are several different techniques the surgeon can use for a chin enhancement procedure. Patients will have met with their BAAPS/BAPRAS surgeon for a consultation before the surgery to discuss the different options and the most suitable technique to achieve their goals. A chin enhancement usually takes around 1 hour to perform. However, this also depends on whether patients have additional procedures, such as a rhinoplasty performed simultaneously. Below is an overview of what will happen on the day of the procedure.

Consent

Patients will have to sign a consent form before having surgery. Patients will sign this either on the day of the surgery or during the pre-operative assessment a week before.

After signing the consent form, the surgeon may want to look inside the mouth or draw some lines on the face. They will also discuss the goals of the procedure and what they will be doing.

Anaesthesia

Patients will be walked to the anaesthetic room, where they will meet their anaesthetist. This is the doctor who will be responsible for giving an anaesthetic. The surgeon will have discussed what type of anaesthetic the patient will have during the operation. This will either be a general or a local anaesthetic. A general anaesthetic will put the patient safely to sleep throughout the entire procedure. A local anaesthetic will numb the surgical area, and the anaesthetist will also give a sedative medication at the same time. This will help to keep the patient relaxed throughout the operation.

Incisions

In the operating theatre, the surgeon will prepare for the operation by cleaning the chin area and draping over a sterile sheet. The surgeon will then make an incision. The incisions will vary slightly in size and location according to the technique used. However, they are generally located under the chin or inside the mouth. The general technique involves the surgeon gaining access to the jaw bone and placing an implant or cutting and manipulating the existing jaw bone to enhance the chin. The surgeon will then use stitches to fix the chin in its new position.

There are also different techniques that the surgeon may use, which include the following:

Chin implant

This is a permanent method of chin enhancement. The surgeon creates a small incision underneath the chin and inserts an implant from either silicone, Porex or Gore-Tex. Silicone implants are the easiest to remove if required and carry a higher risk of movement or buckling as they are less porous than the other types.

Here are some examples of silicone chin implants in the photo below.

Despite this, silicone remains the commonest type of implant used for chin enhancement because it is robust and well established.

Sliding genioplasty

This permanent method of chin enhancement uses the existing bones to reshape the chin without an implant. First, the surgeon makes incisions inside the mouth to reach the lower jaw and chin. This allows the surgeon to cut the bones of the lower jaw and reposition them with small metal plates and screws. Finally, the surgeon stitches the inside of your mouth together using dissolvable stitches.

Closing of incisions

The surgeon will stitch the incisions closed. They will usually use absorbable stitches to close the incision. Afterwards, they will apply a light dressing to the face to help minimise bruising and swelling. These bandages will come off after a couple of days. In addition, the surgeon may encourage patients to wear a support bandage around the chin for the first week after the surgery to ensure that the chin settles in its new position.

Return to the ward

At the end of the surgery, the nurses will move the patient to a recovery room. Here, the patient will gradually wake up from the anaesthetic under close supervision.

What to expect after a chin enhancement

Knowing what sort of things to expect after a chin enhancement operation can help make the patient feel more comfortable and at ease in the lead-up and on the day of the surgery. Chin enhancement aftercare is an important part of the road to a balanced and cosmetically pleasing chin. The BAAPS/BAPRAS surgeon will discuss the details of the chin enhancement aftercare process during the consultation. In addition, the surgeon will provide the patient with information on how best to take care of themselves during recovery. This includes advising on:

• Going back to work
• Resuming sport and exercise
• Caring for wounds

A key element of chin enhancement aftercare is a follow-up appointment which the surgeon will also organise. This often takes place within two weeks of surgery. During this appointment, the surgeon will check the wounds to see how they are healing, remove any non-dissolvable stitches, and remove or replace any dressings if necessary. They will also address any complications and make an initial assessment of the results of the procedure.

Waking up after surgery

If the patient were put to sleep with a general anaesthetic, they would gradually wake up following surgery under close supervision. They will have dressings around the chin, and they may also have a drainage tube in place. The nurses will remove any drainage tubes before they go home unless the surgeon advises otherwise. The bandages will normally stay in place for up to a week, after which time chin support can be worn. If a local anaesthetic was used, patients might feel a change in sensation in the treated area of the face. This will eventually wear off. The chin area may also feel slightly tight and tender. The surgeon or the nurses in the recovery room will offer painkillers that patients can take if necessary.

The first 24 hours after surgery

Patients must have a responsible adult to stay with them for at least 24 hours after the surgery. This is because, after a general anaesthetic, the patient will feel tired and groggy. The anaesthetic can also affect memory and concentration and affects everybody differently. This can last from anywhere between a few hours and up to 2 days. It is good to have someone there to help if, at any point, the patient feels dizzy or unsteady as they get up from a seated position. Therefore, it is recommended that patients ask a friend or relative in advance if they can stay over during this period.

Returning to work

The recovery period may depend on the surgeon's surgical technique and how extensive the chin enhancement procedure is. In general, patients will need to take around a week off work. Patients may need longer if their job is more active or they are not comfortable enough to return. Patients should therefore listen to the exact time frames that the surgeon provides. Whether patients have an office job or a physical job, be sure not to lift anything heavy for at least 4 weeks post-op.

Sports and exercise

Patients should avoid any strenuous activity and contact sports for at least 4 to 6 weeks after the chin enhancement surgery. However, it should be fine to resume some light physical activity after 1 to 2 weeks. But, again, start gently, with light aerobic activity such as walking on a treadmill or a short walk outside.

Scarring

For the first few weeks, scars typically appear raised. They will eventually fade to faint lines. Avoid too much sun exposure to the chin area as this can cause permanent darkening of the area.

Saunas and heat

Avoid anything that may promote facial flushing for 4 to 6 weeks. This includes saunas, steam rooms, and steam face masks.

Compression bandage

The surgeon may advise that the patient wears a compression bandage around the face for the first couple of weeks after the operation. The length of time they will need to wear this bandage will depend on the individual surgeon’s specific advice. The surgeon will also advise on the type of bandage that they need and will be able to recommend some suitable options.

Final results

There will, of course, be a noticeable difference to the face immediately after surgery. Still, it is important to remember that patients may not appreciate the final cosmetic results until up to 6 months after surgery. This is because there is some residual swelling, some scarring may take longer to fade, and it may take a while for the area to heal fully. In addition, immediately after the surgery, the chin may look larger than anticipated due to the swelling. This will gradually settle within 2 weeks.

What are the main chin enhancement risks and complications?

As with any surgical procedure, some risks and complications can occur. Patients must be fully informed of these and weigh up these risks before choosing to go ahead with chin enhancement surgery. This page outlines the main chin enhancement risks and complications.

Bruising & bleeding

Some bruising of the treated area is common after surgery. This should resolve over the first couple of weeks. Patients may also experience slight bleeding from the incision site. This typically occurs right after surgery but may occur a few weeks later. However, please inform the surgeon immediately if patients notice significant bruising, pain, and facial swelling. They may have a haematoma, which is a solid collection of blood under the skin. These usually occur within 24 hours of surgery and require medical attention to treat.

Infection

Although every effort is made to minimise the risk of infection during surgery, it is still possible for an infection to occur in the treated area. Therefore, patients must be aware of the signs of infection. Make the surgeon aware immediately there are any of the following signs after the chin enhancement:

1. Feeling feverish with a temperature over 38° C.
2. Redness at the incision site is spreading after the first 48 hours.
3. Yellow pus-like or foul-smelling fluid seeping from the incision.
4. Increased pain or discomfort that your pain medication does not resolve.

Scarring

Unfortunately, it is not always possible to avoid scarring where the surgeon has made incisions. The size and location of the scars will vary according to the technique used. Be sure to have discussed with the surgeon what scarring is expected. Most scars will be minimal, and the surgeon will make them as discreet as possible, often placing the incisions either inside the mouth or underneath the chin, so they are as unobtrusive as possible. Remember that scars will also fade with time. How much they fade will depend on the healing ability of the skin. The surgeon can also give you some tips on caring for the wounds and minimising the scarring.

Skin discolouration

Sometimes the skin where the surgeon has operated on can change colour slightly after the surgery. This should settle over a few months. Patients should be able to cover this with makeup easily.

Nerve injury

If, during the surgery, the nerves in the face or jaw are injured, patients may lose some feeling or movement in the face. For most cases, this is temporary. However, rarely, more long-term loss of sensation or movement can occur.

Implant displacement

Rarely, the implant inserted during the surgery can move or become displaced. This may affect the result of the surgery, but fortunately is a rare occurrence. When it does occur, displacement of the implant tends to happen soon after the surgery as it has not had time to settle into position and has not yet grown attached to the surrounding soft tissues. To lower the risk of chin implant displacement, avoid putting any pressure on the chin after surgery, sleep on your back or side and make sure to wear any supports or bandages as advised by the surgeon.

Aesthetic

After cosmetic surgery, there is always the possibility that patients are unhappy with the procedure's results or that they are not exactly as you had expected. To ensure that patients are happy with the final results, it is recommended that patients talk openly with their surgeon during the consultation about all desired outcomes and make sure that they understand all expectations to ensure patient and surgeon are happy with the chin aims enhancement.

General surgical complications

All surgeries carry some common risks. These include the development of a blood clot, nausea and vomiting, and postoperative pain. In addition, as the surgery involves using an anaesthetic agent, it is also possible that patients may develop complications relating to the anaesthetic itself.

A surgical chin enhancement is a permanent procedure. Having said this, no cosmetic procedure can stop the effects of time and ageing and so there may be some changes to the shape of your face and chin as you get older. This means that most patients only undergo one chin enhancement in their lifetime, with the very rare exception of those patients who suffer from surgical complications such as an infected implant. It is recommended that you follow general health advice to get the best long term results from your operation. This includes maintaining a healthy weight and using sunscreen when outside, moisturising regularly and staying healthy and hydrated.

You should not wear makeup until your surgeon gives you approval to do this. Usually it is possible to start wearing makeup again 2 weeks after your procedure. You can then use camouflage cosmetic products if you wish to cover any bruising you may have.

Your surgeon will give you specific advice on how to wash and bathe after the surgery. In general, you may shower and wash your hair 48 hours after a chin enhancement procedure. Use a mild shampoo and be particularly careful around the treatment area. You can also blow dry your hair on a cool setting. Be gentle when brushing or combing your hair so that you do not catch your comb on your chin as it may still be sore. You must follow your surgeon’s specific advice.

It is normal to feel a little self-conscious when you are in public due to the swelling, redness and bruising around the treated area after a chin enhancement. However, the vast majority of bruising and swelling should have settled by around 4 weeks. By this time, most people feel comfortable enough to be seen by friends and colleagues. Full recovery, however, takes several months. It is therefore advised that you plan ahead. If you have a major event coming up such as a wedding or birthday, plan your surgery 2 to 3 months before it.

You should not wear makeup until your surgeon gives you approval to do this. Usually it is possible to start wearing makeup again 2 weeks after your procedure. You can then use camouflage cosmetic products if you wish to cover any bruising you may have.

Generally, you do not need a GP referral to see a cosmetic surgeon for an initial consultation. However, if you decide you want to go ahead with the procedure, your surgeon will require more detailed information on your medical history. In this case, they may contact your GP for this information, with your permission.

Smoking and drinking too much alcohol can increase your risk to a number of complications from surgery. This is why we advise you to cut back on alcohol and stop smoking well in advance of the operation. Six weeks is the least we advise you to be smoke-free before your surgery and to continue this for as long as possible afterwards.

All of the information found on our website is sourced from highly reputable experts, government-approved authorities and is widely used by healthcare professionals.

• https://www.bapras.org.uk/public/patient-information/surgery-guides/craniofacial-surgery British Association of Plastic, Reconstructive and Aesthetic Surgeons
• Understand.com Understand

Our content is written by our Medical Quality Managers and Patient Care Advisers, all of who have medical backgrounds and training. Prior to publishing, all the information is reviewed by a surgeon specialised within the relevant field.