Reshaping Chins and Cheeks

When we talk of 'normal' facial appearance, we imply that there is a 'normal' balance to the features of the face- particularly the nose, the chin and the check-bones. If one of these features is out of proportion with the others, a face can look out unusual or maybe 'abnormal' especially to someone who is aesthetically sensitive. As it is instinctive for most of us to want to look normal, it is understandable that a person can feel self-conscious if a feature of his or her face is out of proportion; either too large or too small. Disproportion of the nose is covered in other sections entitled; 'Reduction Rhinoplasty' and 'Augmentation Rhinoplasty'. It may be possible that the position of your chin is wrong because the jaw as a whole is too large or too small so that your teeth do not meet properly. If so, you would need to get advice from your dental surgeon, as you would probably need a major operation by a maxillo- facial surgeon to reposition the whole of your jaw rather than a type of treatment which is described here.

What can be done?

A jutting chin can be reduced by removing some of the chin-bone and recessive chin can be built out either by sliding the chin forwards or by inserting an implant on the bone. Each of these operations is carried out through a cut made in the grove between the lower lip and the gum though if an implant is used, the surgeon may advise that the cut is made in the natural crease under the chin.

Flat cheek- bones can be built out by inserting implants over the cheek bones usually through cuts that are made inside the mouth where the cheek joins the upper gum.

The implants which are used are manufactured usually from silicone or other non- biological materials and are safe and well- tolerated by the body. Sometimes it is necessary to use a bone graft, which would probably be taken from the crest of the hip and leave a noticeable scar.

These operations can usually be done at the same time as other facial cosmetic surgery, such as a face lift or an operation to reshape the nose.

What are the consequences?

If the cut is made inside the mouth, there will be no visible scar. If made the chin, the scar should be inconspicuous in the line of the natural crease.

There is always some swelling and sometimes bruising which settles within three weeks.

Temporary numbness of the lower lip after chin surgery and of the upper lip and the side of the nose after surgery on the cheeks is common. It usually disappears within a few days though you may have a period of pins-and-needles discomfort during recovery.

An implant, particularly when it used to build out the chin, may not become firmly fixed to the underlying bone and fell a bit unstable. However, this is unlikely to have any effect on your appearance. Sometimes though, the outline of the implant's shape can be visible under the skin. Because there may be some scarring in the muscles of the chin as a result of surgery, you may find that your chin creases unnaturally when you smile.

What are the limitations?

It is usually possible to harmonize the facial features with one or more of these operations. However, as the outcome of treatment must be an appearance with which you feel happy, it is essential that you have a clear idea in your mind about what is wrong with your present appearance and that you can explain this to us. We will be able to give a personal opinion about the changes that could be made for the better but, in the end, it is your face and how you see it that is important. Once you have established the ideal, we will be in the position to advise you on the possibilities of achieving it.

What are the risks?

We will require a general anaesthetic, and there is a small risk of chest infection, especially among smokers.

There is a small risk that part or all of lip may be permently numb and there is an equally small risk of some weakness in one or more muscles around the mouth.

Occasionally, the pressure of an implant can thin the underlying bone and, if roots of teeth are nearby, they may be weakened.

Sometimes an implant can slip out of place and require a further operation to reposition it.

Occasionally, these operations are complicated by infection which shows up as painful, red swelling and it may be necessary to remove an implant in order to clear it up. Should this be necessary the implant can usually be replaced once the infection has cleared.

What should you do before the operation?

Because of the risk of infection, it is most important that your mouth is healthy and that there is no infection in your teeth. You are strongly advised to visit your dental practioner for a cheek-up if you have any doubts.

What can you expect at the time of your operation?

These operations are usually done under a general anaesthetic for which you would need to be in hospital at least overnight. You can expect a moderate amount of pain for the first two days and some soreness inside your mouth where the stitches lie. if you have had surgery to your chin, you are likely to have it strapped for a few days. It is sometimes necessary to stabilize a cheek implant with an out side stitch for the first 4 days.

What you should do after the operation?

The most important thing to do is to treat your face gently and avoid disturbing an implant by feeling it or, worse still, trying to feel if it will move. Don't rest your chin on your hand. Keep your mouth clean and have a mouthwash after meals whilst your stitches are dissolving. When brushing your teeth, you should take care not to damage your scars with the toothbrush. You will need at least a week off work.

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