Facial Implants

Chin Implant

Many patients desire facial balance and request chin augmentation without having to “cut the chin bone.” This procedure is often combined with other procedures or may be performed as a simple out-patient procedure. Chin augmentation is available to accomplish chin advancement and accentuation of the jaw line with the placement of custom-contoured chin implants. Support of the soft tissues of the lip, jaw line and neck is the foundation that prevents or delays aging of this area of the face.

Method of Surgery

Chin implants can be placed through an incision in the mouth or through an incision underneath the chin. Dr. Vigliante is skilled in both techniques. There are advantages and disadvantages to both approaches, which he will discuss with you at your consultation visit.

Both techniques can achieve predictable results with successful outcomes. A discussion with your surgeon will determine which technique best fits your needs.

Recovery

The recovery for this minor, isolated procedure is rapid. Following the resolution of majority of swelling in 72 hours, most patients are able to return to work or school. A decrease in lower lip sensation is temporary and normal sensation usually returns in 14 days. Within 2 weeks, the sutures will have dissolved and the incision will begin to disappear. For the intra-oral approach, excellent oral hygiene is essential with the use of an antibiotic mouth rinse (Peridex) and tooth-brushing three times per day. The patient is placed on post-operative antibiotics and anti-inflammatory medication. The results speak for themselves!

Genioplasty

Genioplasty, or bony chin advancement or reduction, is a procedure that evolved from the techniques of Orthognathic (Jaw) surgery. Prior to the development of silicone chin implants, it was the only option available for chin recontouring.

However, this technique is still readily used today, and for many patients, provides a distinct advantage to chin implants. The technique is very versatile. It can be used to reduce the length, overall size or set back the prominent chin. With chin advancement, it allows the advancement of the suprahyoid musculature (muscles of the neck) for patients with weak chin/neck angles and definition. It also allows the use of the patient’s own tissue without implantation of a silicone implant. Finally, it permits the correction of both horizontal and vertical asymmetries of the chin.

Preoperative preparation is key to successful genioplasty. Dr. Vigliante is well-trained in reading lateral cephalometric xrays. He will accurately treatment plan your chin surgery by taking one of these xrays in his office. This helps the doctor and patient decide how much chin projection is necessary to accomplish facial harmony. Some surgeons do not use this tool, which can result in a chin that is too large or too small for the person’s face.

Method of Surgery

Because of his extensive training in skeletal surgery, Dr. Vigliante uses an intra-oral approach which allows a camouflage of the incision, recontouring of the bony chin asymmetry if present, assessment of facial midline by viewing the chin from top-side down, and then a bone cut (osteotomy) of the chin itself. The bony chin is then positioned as planned pre-operatively with the accuracy of 0.5 mm, and then the segment is positioned with a small titanium plate. The oral incision is closed with resorbable sutures (melt away on their own) and there is no increase in the rate of infection. The bone heals rapidly over the course of 6 weeks.

Recovery

The recovery for this minor, isolated procedure is rapid. Following the resolution of majority of swelling in 7-10 days, most patients are able to return to work or school. A decrease in lower lip sensation is temporary and normal sensation returns in 10-14 days in most patients. Within 2 weeks, the sutures will have dissolved and the incision will begin to disappear. Excellent oral hygiene is essential with the use of an antibiotic mouth rinse (Peridex) and tooth-brushing three times per day. The patient is placed on post-operative antibiotics and anti-inflammatory medication. The results speak for themselves!

Cheek Implants

The technique of The Four Dimensional Facelift often includes enhancement of the facial skeleton. Some patients age prematurely because of a lack of support of the soft tissues of the face by the facial skeleton. Early aging in this regard is analogous to the collapse of a roof in a rainstorm that has insufficient beams to support the structure. As we age and the effect of gravity causes a forward and down migration of soft tissues on the face, distinct lines, or rhytids, form. If a patient is born without prominent cheek bones, they tend to lack the taper of facial form of an upside-down triangle. In youth, they may appear to be flat in the tissues lateral to the nose and slightly hollow underneath the eyes. However as the individual ages, the cheek fat pad which initially sat over the prominence of the cheek bone tends to fall into an area forward, down and close to the nose. This phenomenon causes the classic aging characteristic of the “nasolabial fold,” or the line that patients call their “marionette line.”

For the treatment of a patient with adequate size and shape of the cheek bones, the treatment of this condition involves precise repositioning of their cheek fat pad in the vector, or direction, from which it migrated over the years.

However, in patients with inadequate cheek bone size and position, “pulling” the cheek pad up and back will shortly result in relapse. As the analogy continues, reinforcing the shingling on the roof will not help support the weight of the rain. Rather, we recommend that we enhance the facial skeleton (a.k.a. support the roof) by augmenting the cheek bones. This is simply done by placing precisely sized and positioned cheek implants.

Method of Surgery

There are many techniques for the placement of facial implants, however most lack the ability to precisely examine the native underlying bone, alter asymmetry and carefully position both cheek implants under direct vision to achieve symmetry of size and position. Dr. Vigliante’s technique is to create a small access opening to the cheek bones from inside the upper lip. The tremendous advantage to this access point is that it is painless to the patient, it does not leave a noticeable scar and it allows direct visualization of the patient’s cheek bone structure, alteration of asymmetry and precise positioning and fixation (with bone tacks) of the implant.

Recovery

Once healed, the implants look and feel like the patients NORMAL bone structure. The oral incision is closed with sutures (stitches) that are resorbable (melt away on their own). For patients undergoing a simultaneous facelift, this allows phenomenal support of the cheek fat pad and not only enhances the initial result, but more importantly, enhances the longevity of the result. Results simply last longer.

For more information, please visit www.cosmeticsurgery.org/Patients/malaraugmentation.asp.