The chin, jaw line and upper neck play a vital role in your facial appearance
When we think about what makes an attractive face, we often consider the beauty of the eyes, the curve of the brows, the size and angle of the nose, or the shape of the lips. We may not focus as specifically on the chin and the jaw line, yet these features are, in fact, an important part of the skeletal framework that defines our facial appearance.
For a woman, a well-defined jaw line that is slightly curved contributes to attractive facial proportions. A delicate but adequately projecting chin generally is the ideal of feminine beauty. For a man, somewhat greater chin projection combined with a more angular jaw line is perceived as conveying a strong, masculine appearance.
For both women and men, the transition from the jaw line to the upper neck should be a “clean,” smooth line without excess fat or sagging skin. Unfortunately, the jaw line is one of the first areas to show early signs of aging, losing its youthful angles and definition. Heredity, as well as age, often plays a role in aesthetic problems of the lower face. Younger patients may be dissatisfied with a recessive, or “weak,” chin, a chin that is too long relative to their other facial proportions, or excess fatty tissue underneath the chin. Plastic surgery can help solve all these problems, either by restoring lost facial contours or creating new contours in better harmony with your other facial features.
Reshaping the Chin
Evaluation of your chin first requires careful examination by a qualified plastic surgeon and, in some cases, may involve radiographs or other detailed analysis to determine the true skeletal proportions. A thorough dental examination to evaluate your occlusion, or “bite,” may also be necessary.
The most common technique for increasing the projection of the chin is to insert a small, silicone implant in the space between the chin bone and tissue. The implant can be placed through incisions inside your mouth or on the underside of your chin. If the implant is inserted through an external incision, the remaining scar should be barely visible with your head tipped back and, in most instances, will not be noticed. Some patients may also benefit from augmentation of the jaw bone, or mandible, with specially designed facial implants, but this procedure is much less common than chin augmentation alone.
The chin may be altered, in some instances, by cutting and moving the bone. If the chin is receded, chin augmentation may be achieved by advancing the chin bone to achieve the desired projection. On the other hand, if the chin projects too much, the chin bone can be moved back. In such cases, it may be necessary to perform liposuction in the area beneath the chin to correct any fullness that may result.
If the chin is vertically too long, it can be shortened by removing a wedge of bone and moving the chin bone upward. However, it is more common for the vertical dimension of the chin to be too short, in which case it can be lengthened by moving the bone downward. Whenever the chin bone is cut and moved, the bone is held in its new position by small screws and bone plates during the healing process.
Enhancing the Upper Neck
Many people are bothered by excess fat underneath their chin and jaw line that causes a lack of definition in the transition from the face to the neck. In many instances, liposuction is the answer.
Liposuction requires only very tiny incisions through which excess fat can be removed. As long as the skin has sufficient elasticity, it will conform to the new, improved neck contour. Liposuction of the area beneath the chin, alone or in combination with chin augmentation, often produces dramatic results, especially in younger patients with good skin tone.
If loss of jaw line definition is the result of sagging facial tissues, then a face and neck lift may be recommended to achieve the necessary tightening. Procedures using horizontal sutures that act as a “sling” beneath the chin and jaw line to diminish early sagging of the upper neck have been proposed as a less extensive alternative to a lower facelift. Though some surgeons find these techniques useful, questions remain as to the predictability of long-term results.
Surgery of the chin and upper neck, like all cosmetic surgery, requires an individualized surgical plan. Every patient has unique characteristics, and there is no “one size fits all” solution. For one person, enhancement of the lower face may be as simple as a chin implant, while another patient may require procedures to alter bones and other structural components of the face. A board-certified plastic surgeon who is a member of the American Society for Aesthetic Plastic Surgery (ASAPS) has been trained to analyze and develop surgical solutions for aesthetic problems of the lower face. While every surgeon has his or her preferred techniques, an ASAPS member can always help patients sort out the options and make informed choices about the wide array of cosmetic surgical enhancements that are available today. New procedures are constantly being developed, but often the tried-and-true approaches are the most predictable and achieve a consistently high level of patient satisfaction.