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Jump To Chin
Jump to Cheek
Background
A small or recessive chin can make a person look weak and can be the source of ridicule. An
underdeveloped lower jaw, with malocclusion or an overbite requires a combination of orthodontia
and major maxillofacial surgery to move the entire jawbone forward to correct the imbalance.
However, often the teeth are in normal alignment yet the chin itself is underdeveloped. In such an
instance, major surgery is not necessary. Placement of a small prosthetic implant either through an
incision beneath the chin or one inside the mouth, provides a simple yet highly effective correction
of this problem.
Implants are designed from a variety of materials. Dr. Creasman uses a silicone rubber prosthesis with
an anatomical design which wraps around the entire lower edge of the jaw, tapering naturally and avoiding
translation of muscle forces directly over the central prominence of the bony chin. He often modifies the
implant to shape the chin to meet specific patient goals, if possible. Such implants have been in use for
decades, and have a very established safety record.
The Consultation
Dr. Creasman will take a medical history and perform a directed physical examination during your consultation.
Of particular importance is your dental history. If you have dental occlusion (bite) problems, a referral to either
an orthodontist or a maxillofacial surgeon may be indicated. The general health of your gum tissue as well as your
teeth are important in deciding whether you are a candidate for a chin implant.
One primary aesthetic landmark is the profile view of your chin as it relates to you lips and other facial features.
After examining you, digital images will be taken of you both in profile and in frontal views. Dr. Creasman can then
manipulate those images using sophisticated medical imaging software to show you how your appearance might change with
placement of a chin implant. Together, you can decide to what extent you want your chin enhanced, so that you minimize
aesthetic differences in judgment, and thus optimize your chances for a result that pleases you.
Not infrequently, those individuals who have underdeveloped chins also have significant accumulations of fat in the
neck that respond well to liposuction. Chin implants are used not
infrequently in the course of performing a facelift.
Many patients seeking nasal reshaping are also candidates for chin enhancement as well. Dr. Creasman will evaluate these
related issues, and if relevant in your case, can demonstrate what other related procedures might do for you, if you
wish.
Risks of Chin Implant Surgery
Chin augmentation enjoys a very low risk profile, but there are nevertheless complications that can occur. These would
include bleeding, infection, malposition (crookedness of the implant requiring reoperation), loss of sensation to the lower
lip, weakness of the muscles which depress the lower lip, over- or underaugmentation, palpability of the implant, and general
dissatisfaction. Implants left in place for many years may slip as one ages, due to the tendency for the jawbone to get
smaller, particularly if the teeth are extracted. Rarely, the implant can erode into tooth roots, causing problems with
lower dentition, but this should not occur if the implant is placed properly just at the lower edge of the jawbone. Delayed
infections of the implant can occur, and may result in the need to remove the implant many years later, but this is very
unusual.
Before Your Procedure
It is imperative that patients refrain from ingesting any medications or other substances that could potentially be the
cause of surgical complications. A list of medications should be reviewed
and discontinued at least two weeks prior to operation.
Patients are seen just prior to their surgery date for a general physical examination to ensure that no underlying medical problems
exist that may interfere with the safety of their surgery. Specifically, any infections that arise prior to operation, however
seemingly trivial, should be reported to our office. Even an otherwise innocent infection can result in a surgical wound infection,
and must be treated prior to surgery
Prophylactic antibiotics are given intravenously just prior to surgery to reduce the risk of surgical wound infection. A
prescription for pain medication is written at the time of your preoperative visit, so that you have your pain pills when you
return home from the operation. Dr. Creasman recommends the use of homeopathic pills to minimize swelling and bruising. This is
available for purchase in our office. Pre-operative photographs are taken so that you can see the improvement from your surgery
afterwards. We generally take the post-operative photographs at 3 months after your procedure.
You will be asked to sign a surgical consent which enumerates the risks of the procedure in detail. These risks have been
described herein and are also discussed at the consultation.
This is a preoperative checklist to follow prior to your chin implant procedure:
- Please pick up liquid Ivory hand soap and cleanse the skin of your face with it for the three days prior to your operation.
- Pick up an infant toothbrush and Listerine Mouthwash for use after surgery. If Dr. Creasman is using an incision in your
mouth to place the implant, prepare a solution of one tbsp. table salt in one quart of water and chill in refrigerator. This is
to rinse your mouth out after surgery.
- Stock up on Coca Cola Classic. It may help with any nausea you might feel after your anesthetic.
- Please remove any artificial nail material from both of your index fingers. We monitor your oxygen levels through your nail
beds, and artificial nail products interfere with this.
- Avoid alcohol for 48 hours prior to surgery. It can lead to dehydration and can interfere with clearance of your
anesthetic medications.
- Report any signs or symptoms of infection, such as fever, inflamed body parts, burning with urination, cough, diarrhea,
or flu symptoms.
- Wear a non-pullover shirt to your operation. We suggest a zipper front sweatshirt. Wear slip on shoes with smooth soles
for ease of ambulation. Wear cotton underwear and clean white socks. Do not wear makeup.
- Do not wear jewelry or bring other valuables to the office on the day of your surgery. Pierced body parts need to be
free of jewelry for your safety.
- Take any prescribed medications as directed.
- DO NOT EAT OR DRINK ANYTHING FOR SIX HOURS PRIOR TO YOUR ARRIVAL.
- Avoid smoking for six hours prior to surgery.
- Shampoo the morning of surgery and dry your hair well. Do not apply any hair care products afterwards. Floss and brush your
teeth thoroughly the morning of surgery, and rinse with Listerine Mouth Wash.
Pre-operative photographs are taken so that you can see the improvement from your surgery afterwards. We generally take
post-operative photographs at 3 months after your procedure.
You will be asked to pay your surgical fee at your pre-operative visit. The current fee for chin augmentation available
by calling our office (408-369-9300), and includes the costs of surgeon, operating room, and follow-up visits. There may an
additional cost to you for you prescription medication, depending on your health insurance coverage. The procedure is not
typically covered under any insurance plan because of its cosmetic nature.
You will need to arrange for an escort to drive you to and from our office operating suite. Patients cannot operate motor
vehicles after surgery, and we will not place recently sedated patients into taxis for transport home. We can arrange for medical
transport in the event you cannot find an escort. It is a good idea to have someone stay with you for at least 24 hours after
surgery, for your comfort and safety. You should be able to drive yourself to the first follow up visit, which is typically 2-3
days after your operation.
The Operation
As an isolated procedure, chin enhancement is done under a local anesthetic and intravenous sedation. It is not uncommon for
this procedure to be done at the time of a rhinoplasty (nasal surgery), or a facelift. As mentioned, after the area is
anesthetized with a local anesthetic, a small incision is placed through the lining of the mouth near the lower gum line, or
alternatively through a small incision under your chin. A space is developed just large enough to admit the implant that was
decided upon during the preoperative evaluation. The space is made right down to the lower border of the jawbone, so the
implant does not ride up to put pressure on the tooth roots. Large sensory nerves are easily identified and avoided. After
confirming the choice of implant by trying sizer implants, the implant to be implanted is placed in an antibiotic solution to
lessen the risk of contamination and infection. Frequently, Dr. Creasman sculpts the implant to make adjustments to its shape
or size. The implant is positioned and secured in position with sutures. Incisions on the skin are closed with sutures that need
to be removed in 4-5 days; the oral incision is closed with self-absorbing sutures. A small dressing to immobilize the area is
applied. The procedure typically takes about 30 minutes.
The Recovery Period
The chin and lower lip are numb from the local anesthetic, much in the same way one feels after a trip to the dentist. This
usually lasts for a couple of hours after you leave the office. You should take a pain pill as soon as you arrive home, and you
should try to eat with the medication to avoid nausea. You should take a “dental soft” diet, which avoids excessive chewing. Jaw
movement will tend to increase swelling of the chin and lips. It is helpful to apply cold compresses to the area to reduce swelling
and bruising. One needs to be very careful not to ingest hot liquids so as to avoid burns until the sensation returns. Frequent
mouth washing with cold salt water and meticulous dental care are important also in preventing infection.
Mild to moderate swelling is to be anticipated, which usually takes a week or so to subside. Pain is typically mild, and is well
controlled with pain medication prescribed by Dr. Creasman. The oral stitches dissolve without intervention, and this usually takes
about 10 - 14 days to reach completion. When skin stitches are used, they need to be removed in 4-5 days. Patients usually express
that they “feel different” with their new chin and it sometimes takes several weeks to months to adapt to the presence of the implant,
particularly with smiling and speaking. Once the swelling and normal wound healing near completion in about six weeks, most people have
adapted to their new chin, and begin to appreciate the improved balance and strength of their profile. Often, when reviewing pre-operative
photographs, patients express surprise at how different they used to look, and how much better they feel about themselves.
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Background
A cheek enhancement is a cosmetic surgical procedure used to build up a person’s cheekbones and thus bring a more desired balance to
the face. A relatively flat cheekbone area can be enhanced or made more prominent with the insertion of a silicone rubber cheek implant.
The implants may be inserted in conjunction with other procedures, like a facelift, or they may be inserted as a separate procedure.
They can be placed either through an incision in the mouth, through a lower eyelid incision if eyelid surgery is being performed, or
through a facelift incision.
The Consultation
Dr. Creasman will take a medical history, including any history of congenital or developmental abnormalities, as well as any history
of facial bone fractures. After this, a thorough physical examination of the face is carried out and digital images are taken. Using
sophisticated medical imaging software, a computer image of the appearance of your face with enhancement of your cheekbones can be generated,
which helps you decide with Dr. Creasman if this is an operation which will meet your expectations. Different sizes of implants are available,
and these can be held up to your face to show you how they are positioned and give you an estimate of the effect of various sized implants on
your appearance.
Risks of Cheek Implant Surgery
The risks of this procedure are very low, but any operation carries with it some element of risk. In the case of cheek implant
surgery, risks include bleeding, infection, malposition or crookedness of the implants leading to (or stemming from) facial asymmetry,
palpability, numbness, weakness of facial muscles, over- or under-augmentation, pulling down of the lower eyelid when combined with
eyelid surgery, internal scarring possibly resulting in chronic pain; many of these complications may require additional surgery for
correction or improvement.
The Pre-operative Period
It is imperative that patients refrain from ingesting any medications or other substances which could potentially be the cause of
surgical complications. A list of medications should be reviewed and
discontinued at least two weeks prior to operation. Patients are
seen two weeks prior to their surgery date for a general physical examination to ensure that no underlying medical problems exist which
may interfere with the safety of their surgery. Specifically, any infections which arise prior to operation, however seemingly trivial,
should be reported to our office. Even an otherwise innocent infection can result in a surgical wound infection, and must be treated
prior to surgery.
Prophylactic antibiotics are administered intravenously just prior to surgery to reduce the risk of surgical wound infection. A
prescription for pain medication is written at your preoperative visit, so that you have your pain pills when you return home from
the operation. Dr. Creasman recommends the use of homeopathic pills to minimize swelling and bruising. This is available for purchase
in our office.
Pre-operative photographs are taken so that you can see the improvement from your surgery afterwards. We generally take post-operative
photographs at 3 months after your procedure.
You will be asked to sign a surgical consent which enumerates the risks of the procedure in detail. These risks have been described
herein and are also discussed at the consultation.
This is a preoperative checklist to follow prior to your cheek implant procedure:
- Please pick up liquid Ivory hand soap and cleanse the skin of your face with it for the three days prior to your operation.
- Pick up an infant toothbrush and Listerine Mouthwash for use after surgery. If Dr. Creasman is using an incision in your
mouth to place the implant, prepare a solution of one tbsp. table salt in one quart of water and chill in refrigerator. This is
to rinse your mouth out after surgery.
- Stock up on Coca Cola Classic. It may help with any nausea you might feel after your anesthetic.
- Please remove any artificial nail material from both of your index fingers. We monitor your oxygen levels through your nail beds,
and artificial nail products interfere with this.
- Avoid alcohol for 48 hours prior to surgery. It can lead to dehydration and can interfere with clearance of your anesthetic
medications.
- Report any signs or symptoms of infection, such as fever, inflamed body parts, burning with urination, cough, diarrhea, or flu
symptoms.
- Wear a non-pullover shirt to your operation. We suggest a zipper front sweatshirt. Wear slip on shoes with smooth soles for ease of
ambulation. Wear cotton underwear and clean white socks. Do not wear makeup.
- Do not wear jewelry or bring other valuables to the office on the day of your surgery. Pierced body parts need to be free of
jewelry for your safety.
- Take any prescribed medications as directed.
- DO NOT EAT OR DRINK ANYTHING FOR SIX HOURS PRIOR TO YOUR ARRIVAL.
- Avoid smoking for six hours prior to surgery.
- Shampoo the morning of surgery and dry your hair well. Do not apply any hair care products afterwards. Floss and brush your teeth
thoroughly the morning of surgery, and rinse with Listerine Mouth Wash.
You will be asked to pay your surgical fee at your pre-operative visit. The fee for cheek enhancement with implants is available
by calling our office (408-369-9300), and includes the costs of surgeon, operating room, and follow-up visits. There may an additional
cost to you for you prescription medication, depending on your health insurance coverage. The procedure is not typically covered under
any insurance plan because of its cosmetic nature.
You will need to arrange for an escort to drive you to and from our office operating suite. Patients cannot operate motor vehicles
after surgery, and we will not place recently sedated patients into taxis for transport home. We can arrange for medical transport in
the event you cannot find an escort. It is a good idea to have someone stay with you for at least 24 hours after surgery, for you comfort
and safety.
The Operation
The procedure takes approximately an hour and is done under a local anesthetic with intravenous sedation. Dr. Creasman carefully
marks the outline on your cheek skin where the implant will be placed. The incision is made usually inside the mouth and the tissues
lifted off of the bone, creating a space just large enough to accommodate the implant. The implants are then placed and secured with
temporary stitches passed through your skin. These are removed a few days after surgery. The incision is closed with self-absorbing
sutures, which dissolve in a week to ten days.
After your procedure, you will spend a short time of observation in our recovery room, after which you will be discharged into the
company of an adult escort.
The Post-operative Period
Minimal to moderate pain and swelling should be expected, but is usually well controlled with the pain medication prescribed by
the doctor. Ice compresses applied to the face in the first few days help to minimize swelling. You should avoid excessive talking
and chewing. Frequent iced saltwater rinses of the mouth help to keep the incision clear of any food debris, and minimize the risk of
infection. You will be seen after a couple of days at which time the positioning sutures will be removed.
Most patients return to work in a few days, but swelling continues for a week to ten days, but is not as noticeable to those around
you as it will be to you. It takes about six weeks for all of the swelling to settle down so that you are stable with regard to the
amount of augmentation.
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