INDICATIONS

Mentoplasty benefits facial aesthetics in a number of ways:

Profile alignment: The profile is most balanced when the forehead, lips, and chin are aligned in the same perpendicular plane. As the chin recedes from this plane, the nose and lower lips appear to protrude more. At times it is the chin recession which is the major problem, even in some patients who present solely for rhinoplasty. In the retrognathic patient, chin augmentation often allows the surgeon to create a better profile with a modest but appropriate nasal reduction. In the markedly retrognathic individual, even after reduction rhinoplasty, the nose may appear to project excessively on profile, unless accompanied by mentoplasty.

Mentoplasty as an adjunct to facelift: A strong jaw line can assist in facial rejuvenation. The retrognathic individual who is being considered for a facelift will have consider-ably better results if this procedure is associated with augmentation mentoplasty as shown in (Fig. 17-1).

FIG 17-1 Preoperative (A and C) and postoperative (B and D) views of patient who underwent facelift and mentoplasty. Note chin projection contributes to to better chin-neck alignment. Extended implant eliminates prejowl sulcus.

Facial rejuvenation without a facelift: In some younger retrognathic individuals, mentoplasty alone, or in combination with liposuction of the submental and jowl region, can produce a very satisfactory result, eliminating or delaying the need for a facelift. In these cases, implant selection is most important and laterally extended implants with or without pre-jowl augmentation are essential (Fig. 17-2).

FIG 17-2 Pre-operative (A and C) and postoperative (B and D) profile and three-quarters view. Note elimination of redundant submental skin and improved mandibular contour with extended chin implant.

	FIG 17-3 Preoperative (Al and postoperative (B) rhinoplasty and mentoplasty eliminating the appearance of a protruding lower lip

Facial contour can be improved with mentoplasty: In the individual who is round-faced and retrognathic. mentoplasty can produce a more attractive angular-shaped face. In these patients. a mild profile over-correction, even in the female, is warranted to produce the appropriate narrowing on front view. The retrognathic patient who has an extremely narrow face and is undergoing mentoplasty will be best served utilizing a laterally extended implant. This will help to fill out the lateral mandibular region and prevent the appearance of increased narrowing with mentoplasty.

Correction of the overly prominent or protruding lower lip: In some cases the lower lip in the retrognathic patient can appear to project excessively. There is often a bulky appearance to the lip and the area between the vermillion and the mental sulcus. Mentoplasty can significantly improve this and eliminate the bulky look of the lip by balancing the lower third of the face with the lip line (Fig. 17-3: see Fig. 17-19, p. 199).

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