Plastic Surgery New Jersey

Facial balance: The face is divided into thirds and these segments should appear relatively equal. The appearance of a short lip to chin distance can be improved with augmentation. Although mentoplasty produces mostly horizontal and very little vertical projection, strengthening the jaw line helps bring the lower third of the face into balance. Conversely, a long chin without a mental sulcus will appear shorter when the straight line is broken by the contour of a chin implant.

Facial symmetry: Facial asymmetry is common and this should be noted preoperatively. Postoperatively, the patient will examine the face closely and may note an asymmetry that was always present.

Lip symmetry: A rare complication of mentoplasty is paralysis of the marginal mandibular nerve. Symmetry of the lower lip, when smiling. should be noted preoperatively.

Jowls: The presence of jowls and a prejowl sulcus can be present as an anatomical feature in the young patient as well as in the aging face. As previously discussed, in these cases a laterally extended or a chin-jowl implant can enhance or, at times, substitute for a facelift (Fig. 17-4).

Neck: The presence and extent of submental fat should be noted. The use of liposuction combined with mentoplasty to improve the submental area will depend on age and skin elasticity. Significant improvement can sometimes be achieved (Fig. 17-5).

FIG 17-4 A, Preoperative view with prominent jowls and prejowl sulcus. B, Improvement following mentoplasty with a laterally extended chin-jowl implant		FIG 17-5 A, Preoperative receding chin with oblique chin-hyoid neck line. B, Postoperative improvement comoining mentoplasty and submental liposuction

Irregular skin lines on the chin are frequently improved with mentoplasty. Marionette lines are usually not improved (Fig. 17-6. p. 194).

Profile

FIG 17-6 Note irregular chin wrinkles (A) preoperatively eliminated by mentoplasty (B) postoperatively		FIG 17-7 A, Preoperative retrognathic patient. B, Postoperative mentoplasty. Chin projection approaches a vertical line dropped from lower lip

Evaluating the amount of augmentation needed: Ideally. the chin should reach a vertical line dropped from the lower lip (Fig. 17-7, p. 194). Males can tolerate some degree of over-correction. Females can have acceptable results with mild under-correction. It should be noted that a slightly, but not excessively overprojecting chin, can be an attractive feature in females. In the patient with a round face. a mild degree of overprojection will be appreciated on frontal view in that it will produce a more angular appearance.

Relation to nasal projection: As previously mentioned. mentoplasty can have a significant role in the patient undergoing rhinoplasty. On occasion proper chin alignment may be more important than nasal reduction in achieving facial balance.

Smiling vs nonsmiling: It is important to evaluate the profile, smiling as well as nonsmiling. In some patients.

Smiling produces a significant increase in chin projection. In the minimally retrognathic patient. the decision as to whether or not to perform mentoplasty can pose a problem. For the most part, we feel that mentoplasty is appropriate in most retrognathic patients and the slight overprojection of the chin, when smiling, is acceptable (Fig. 17-8).

FIG 17-8 A, Preoperative nonsmiling retrognathic patient. B, Chin protrudes significantly with smiling. C, Postoperative mentoplasty not smiling. D, Postoperative mentoplasty smiling with significant but acceptable chin protrusion.

Lip protrusion: The appearance of a protruding lip in the retrognathic patient should be shown to the patient preoperatively. The postoperative improvement should also be indicated. It is helpful to point this out to the patient preoperatively. Most patients are not aware that mentoplasty can improve this appearance and they are delighted to find that they will gain this benefit from surgery (see Figs. 17-3 and 17-19).

FIG 17-3 Preoperative (Al and postoperative (B) rhinoplasty and mentoplasty eliminating the appearance of a protruding lower lip.		FIG 17-19 A, Preoperative retrognathia. B, Accurate correction with a 7 mm implant plus a wafer.

Mental sulcus: A deep mental sulcus can be a limiting factor in chin augmentation. When augmenting such a patient, there may be a limit on chin projection relative to the depth of the sulcus. In some cases, the mental sulcus can be elevated. allowing for increased chin projection

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