The lower face
Mentoplasty or Genioplasty (Chin Enhancement)
A balanced facial appearance depends on the shape and size of one’s chin in relationship to one’s nose. Chin surgery can reduce or augment the chin to give the face a more proportional appearance. A prominent chin can be modified via a hidden incision in the mouth. A less prominent chin can be augmented by placing an implant either in an incision hidden in the mouth, or hidden in the crease below the chin. Patients are normally able to return to work and other normal activities in less than a week depending on the size and surgical approach for placement. There are times when a chin implant is preferred and other times when a moving the bones of the chin is a better option.
Is your chin in the right position?
If you make a line from the top of your ear canal to the boney rim of your eye socket, then drop a line perpendicular (90 degrees) down touching where your two lips meet, this is your reference line. A woman is typically on that line or 2 mm behind it. Men are usually on that line or slightly in front of it. This facial balance has impact on your entire face, most notably the nose.
Whenever evaluating the neck, it is most important to first diagnose the problem. Doing the wrong procedure will result in an unhappy patient.
There are 5 things I look for when looking at the neck:
1. Is there loose excessive skin?
2. Is there platymal banding (muscle laxity- see photo)?
3. Is there extra fat?
4. Is the chin in the correct position
5. Where is the hyoid bone?
This is the one factor that cannot be altered. The hyoid bone is a free floating bone of the neck and cannot be maniupulated. If the hyoid bone is position back, the patient will have an 'acute angle' or a well definied neck line. If it is more forward, they will have and 'obtuse angle' and the patient will not have a chiseled neckline. Oftentimes advancing the chin can compensate for a poorly positioned hyoid bone.
Check out Dr. Blyer featured in livestrong magazine offering his insight on neck enhancement.
A neck lift can be performed as an isolated procedure or together with a facelift. Patients who are candidates for a neck lift include those who have excess skin under the chin, referred to by patients as “turkey neck”, or bands of muscle that create an older appearance. A neck lift creates a refined, smooth, youthful appearance to the neck. The incision is hidden behind the hairline, and a small incision hidden in a natural crease under the chin.
The procedure is often performed in conjunction with liposuction of the neck.
Although liposuction was initially designed for contouring the body, it can now be used to enhance the facial features. Facial liposuction can make a dramatic change in the way one looks by removing the excess fat from cheeks, chin and neck. The incisions are very small and hidden in discrete areas like behing the earlobes. The result is a more striking and youthful facial silhouette. The fat removed from the neck can be injected elsewhere to enhance other features. (please see the fat transfer section)
Orthognathic “Jaw Alignment” Surgery
Orthognathic surgery corrects an improper bite or jaws that are positioned incorrectly. Corrective jaw surgery repositions misaligned jaws. This not only improves facial appearance, but also ensures that teeth meet correctly and function properly. The affect of surgically moving the jaws will have an impact on the nose, cheek bones, neck line, and chin. These patients often are perceived as having a very gummy smile, a large lower jaw or receded jawline. The incisions are made inside the mouth so there are no visible scars. Oftentimes this procedure is covered by medical insurance.