Chin augmentation in combination with rhinoplasty can significantly improve a patient's appearance, especially on a profile view.

Patients are often aware of facial disharmony in the upper and midface. However, disharmony in the chin area is frequently overlooked because it is often only detcted in a profile view, which patients don't see as often as a frontal view. Patients frequently seek rhinoplasty when, in fact, a combination of rhinoplasty and chin augmentation or reduction is needed. On the lateral view, with the patient gazing straight ahead in the natural horizontal facial plane, a vertical line dropped from the front border of the lower lip should approximate the projection of the chin in the male; in the female, the chin should lie slightly behind this imaginary line (see drawing below).

This is a rule of thumb, however, because the faces of patients with large noses tend to appear more balanced when the chin is larger and more projecting. Conversely, the faces of patients who have smaller, upturned noses tend to appear more harmonious when the chin is relatively smaller. The plastic surgeon therefore does not consider the chin an isolated unit, but looks at the general profile of the patient and assesses the need for chin reduction or augmentation on the basis of the changes that will occur with rhinoplasty. Frequently, chin augmentation or reduction can provide the finishing touch to facial harmony.

Chin augmentation involves a small incision just behind the lower lip in the crease between the lower lip and gum. Occasionally, the incision is made just beneath the chin in a natural skin crease. An implant, fashioned from medical-grade material, is inserted (see drawing below).

This diagram shows the surgical changes effected with chin implantation. The approach for this implantation can be either intraorally with an incision just inside the lower lip or extraorally with an incision placed in a natural crease below the chin.

Absorbable sutures are used within the mouth, and there is usually relatively little swelling and bruising. A chin reduction involves a similar incision, and a small burr is used to contour the bony aspect of the chin. As with any surgery, chin augmentation or reduction involves certain risks that are present with any type of surgery (infection, rejection, numbness, swelling, asymmetry, discoloration, distortion, scarring, etc.). It is important not to evaluate the results of the surgery during the period of swelling and bruising, because the swelling and bruising always diminish and the chin takes on a more normal profile as time progresses. Generally speaking, about 90 percent of swelling subsides within two months after surgery. Relative numbness after chin augmentation or reduction may persist for as long as 6 to 18 months. Rarely, some diminished sensation is a permanent problem after surgery. Occasionally, patients who have an abnormal chin projection also have abnormal dental occlusion. In these cases, the patient will be evaluated by an oral surgeon to assess the need for possible oral surgery in conjunction with rhinoplasty. In addition, orthodontic evaluation may be considered. These variations will be discussed with each patient individually.