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Improving Aesthetic Outcomes after Alloplastic Chin Augmentation

Yaremchuk, Michael J. M.D.

Plastic and Reconstructive Surgery: October 2003 - Volume 112 - Issue 5 - p 1422-1432
doi: 10.1097/01.PRS.0000081067.90827.C2
COSMETIC SECTION: COSMETIC

A novel approach to increase chin projection with alloplastic material is presented. Key aspects of the technique include the consideration of anthropometric normal values in preoperative assessment and planning, a submental approach with wide subperiosteal exposure of the area to be augmented, the use of two-piece porous polyethylene implants for augmentation, and screw fixation of the implant to the mandible. Screw fixation improves the predictability and precision of reconstruction by preventing implant displacement, by obliterating gaps between the implant and the facial skeleton, and by facilitating final implant contouring. In a series of 46 patients (24 primary and 22 secondary) operated on over a 6-year period, this approach allowed anatomically correct, stable chin contours to be created. Iatrogenic problems with macrogenia, mentalis dysfunction, and soft-tissue distortion resulting from implant migration and capsular contracture have been avoided. There have been no infections. Two patients who had had multiple previous chin operations requested revisional surgery to refine contour.

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Boston, Mass.

From the Division of Plastic Surgery, Department of Surgery, Massachusetts General Hospital and Harvard Medical School.

Received for publication December 9, 2002;

revised February 28, 2003.

Michael J. Yaremchuk, M.D.

Massachusetts General Hospital

15 Parkman Street

WACC Suite 453

Boston, Mass. 02114

myaremchuk@partners.org

©2003American Society of Plastic Surgeons