CHIN AUGMENTATION Deficiencies of the chin may be corrected by using a silicone implant or bone from other sites in the body. In addition, the bone of the chin may be advanced or the entire jaw can be advanced. The latter is quite complex and must be coordinated with orthodontia (dental braces). The choice of technique is dictated by the clinical presentation and the need for augmentation in each particular case. The most direct and commonly used chin reconstruction involves placement of a silicone implant over the existing chin prominence under the skin. This can be accomplished by one of two approaches. One is to go through the mouth. The incision is made just below the gum line but over the prominence of the chin. The other approach is to make the incision underneath the chin. The resulting scar is hidden under the fold of the chin and jaw. In the immediate postoperative period, the chin will be taped to maintain position of the implant. Patients are to eat clear liquid diet for the first five to seven days after surgery, particularly when using intra-oral approach. Whichever approach is taken, patients will have some numbness over the chin prominence and will require a period of weeks or months to have such feelings restored. In very rare cases will the numbness in the chin be permanent. This is some swelling and possibly some black and blue from the procedure, but this usually resolves within seven to ten days. There is some chance of bleeding and the possibility of infection. Despite which surgical route is chosen, the incidence of infection is equal. Patients are placed on prophylactic antibiotics prior to and during the immediate postoperative phase of their surgery. In the event of infection, the patient will be placed on an appropriate antibiotic following a culture of the infection. The chin implant will also have to be removed and then allow for a healing over several months before reimplanting. There can occasionally be the slight erosion of bone from a chin implant but this is very subtle and usually not noticeable. With the intraoral incision, there will be a scar on the inside of the mouth, which is usually quite tolerable. When the incision is made under the chin, the scar may become thickened and require either a cortisone injection or re-excision.
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