Chin augmentation in the microgenic patient is a valuable adjunct to improving the outcome of rhytidectomy, further reducing the cervicomental angle. However, does a chin implant in isolation of rhytidectomy or submentoplasty also influence the cervicomental angle? Although the symbiotic relationship between chin augmentation and rhytidectomy and between chin augmentation and rhinoplasty is well known, little is known with regard to how chin augmentation may alter other facial relationships, in particular, the cervicomental angle.
A retrospective study was performed of 76 patients who underwent a chin implant from 1999 to 2007. Of these, 17 patients did not have a face-lifting or submental liposuction procedure and met the inclusionary requirements for photographic analysis. In all cases, the chin implants were placed subperiosteally through a submental skin incision and were performed in the operating room under sterile conditions using Mersilene (Ethicon, Inc., Somerville, N.J.) mesh (polyester fiber sheeting) implants.
All photographs included met standardization criteria, including a consistency of the Frankfort horizontal in the preoperative and postoperative photographs, and lack of animation. Preoperative and postoperative profile views were evaluated by identifying the glabella, pogonion, menton, gonion-gnathion, and cervical point (Fig. 1). The anthropometric tangents of pogonion to gonion-gnathion and cervical point through the menton were then drawn. The cervicomental angle was then measured by forming a line tangent to the submentum (from the menton to the subcervicale) and a line tangent to the neck intersecting at the subcervicale.1 A protractor was then used to measure the cervicomental angle.
Comparison of postoperative photographs revealed that the insertion of a chin implant caused the cervicomental angle to decrease 2 to 12 degrees (mean, 5.35 ± 3.88 degrees). Preoperative cervicomental angles measured 121 to 142 degrees (mean, 133 ± 7.61 degrees). Postoperative angles ranged from 113 to 143 degrees (mean, 128.06 ± 8.47 degrees). These numbers indicate a significant decrease in the cervicomental angle after chin implantation (Table 1).
Although the mean angle of 128.06 degrees is higher than the ideal cervicomental angle as reported by Sommerville et al.,2 it is important that the decrease in cervicomental angle was the direct result of the chin implant and not any lifting procedure. Thus, a significant correction toward the ideal of the cervicomental angle can be achieved through a chin implant alone.
It is the natural subtleties that create the harmony and balance of the face, and often they are not recognized by the patient preoperatively. Computer imaging software designed to morph facial features can visually present the benefits of increasing chin projection on overall facial harmony. We have found this to be an invaluable tool for gently demonstrating the benefits of increased chin projection. Before our evaluation, we would just alter the chin projection. However, after the results of our study, we now also reduce the cervicomental angle on the imaged photograph approximately 5 degrees, consistent with our evaluation.
Placement of a chin implant in a microgenic face will result in a more youthful appearance by reducing the cervicomental angle, in addition to adding balance to a face with a prominently projected nose, lips, and forehead. Although chin augmentation is a seemingly minor addendum, its impact on facial proportion and appearance is substantial.
Steven H. Dayan, M.D.
Department of Otolaryngology
Division of Facial Plastic and Reconstructive Surgery
University of Illinois Medical Center at Chicago
John P. Arkins, B.S.
Cristina Antonucci, B.A.
Selika Borst, M.S., R.N.
Division of Aesthetic Medicine
Office of Steven H. Dayan, M.D.
The patient provided written consent for the use of her image.
1.Tollefson TT, Sykes JM. Computer imaging software for profile photograph analysis. Arch Facial Plast Surg
2.Sommerville JM, Sperry TP, BeGole EA. Morphology of the submental and neck region. Int J Adult Orthodon Orthognath Surg
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