The Problem With Chin Implants

October 18, 2017

Chin implants may be a popular choice for chin surgery but removing them is also one of the most popular revision surgeries that we perform.

Chin implants are typically used in chin surgery (genioplasty) to improve a “weak” or nonexistent chin, or within the context of Asian V-Line surgery. The popularity of chin implants has grown over the last few years and has become one of the fastest growing procedures in plastic surgery. Unfortunately, chin revision surgery (revision genioplasty) is also one of the most popular revision surgeries we perform due to the often unsatisfactory results or resultant medical complications of using chin implants.

Chin implants are problematic and often cause complications.

Although chin implants are an option in some cases, and occasionally used, we believe that placing a foreign object (an implant) into your own body is counterintuitive and often problematic when there are much better ways to reshape and augment the chin.

Often chin implants are placed by inexperienced or unskilled surgeons and sold to the patient as an “inexpensive” or simple solution. This, of course, is so often untrue, due to the frequency of need for chin surgery revision procedures! Instead of one operation, the patient needs another one — often at an increased cost because a secondary procedure is always more complex than a primary one — not to mention the suffering, stress and mental anguish over the first, failed procedure.

Chin implants often cause complications, with the most common being:

  • The implant shifting from its original location,
  • The implant eroding into the roots of the anterior teeth,
  • And, most commonly a squaring of the chin which in females, in particular, can have an undesired masculinizing effect that is altogether unsatisfactory.

It is our belief, that a far better option in our experience, is to reshape the underlying skeleton or foundation of the chin by altering or repositioning the bone. In fact, there are several non-implant options for genioplasty surgery: the chin may be moved forward, down, centered, widened, or narrowed — depending on the desired outcome. In these cases, outcomes are improved because there are more “degrees of freedom” for the surgeon to reshape the chin into an aesthetically pleasing shape that is in harmony with other facial features.

The risks, complications and side effects of chin implants.

Apart from the obvious risk of choosing an unskilled or inexperienced surgeon to insert a chin implant – that the aesthetic result will not be a satisfactory one – there are several other serious medical complications and side effects to be aware of:

  • Damage to the marginal mandibular nerve — leading to permanent loss of movement in the lower lip
  • Damage to the mental nerve (a sensory nerve which provides sensation to the front of the chin and lower lip as well as the buccal gingivae of the mandibular anterior teeth and the premolars)
  • Implant is placed in the superficial tissues — not under the periosteum (the dense layer of vascular connective tissue enveloping the bones) leading to implant movement under the skin
  • The wrong sized chin implant is used resulting in a chin looks out of sync or inharmonious with other facial features
  • Injury or damage to the teeth, gums, or surrounding nerves
  • Permanent loss of sensation, and/or scarring.
  • Slow healing, infection, or internal bleeding leading to removal of implant
  • Inadvertent masculinization of the female chin
  • Unsightly deepening of the labiomental crease (the deep groove underneath the lower lip)

It is critical that when you choose a surgeon for your chin surgery, that you choose a U.S. Board Certified surgeon. The risks of choosing an uncertified, unskilled or inexperienced surgeon are too great and must be avoided at all costs.

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African American Facial Feminization Surgery

September 26, 2017

Feminizing the African American Face

If you are of African American heritage and seeking to have facial feminization surgery (FFS) it’s critical to understand that what constitutes a typically female African American face may be vastly different — aesthetically and structurally — than a typical European, Asian, or even Hawaiian (Polynesian) face.

So before you select a plastic and craniofacial surgeon for your facial feminization surgery, it’s imperative to ensure that they have an in-depth understanding of the differences between the facial structures of people of different ethnic backgrounds, and most importantly proven experience with performing FFS on African Americans.

The forehead is the critical to feminizing the African American face.

The shape and size of the forehead and the brow should be the main focus of facial feminization for those of African American heritage. Typically the forehead will project a little further outwards than that of a person of Asian descent, but not as far as that of a person of European descent.

Forehead feminization typically includes forehead reduction and contouring to create a smoother, rounder, and more feminine forehead. Also, a feminizing brow lift and/or brow shaping procedure is recommended to reduce the distinctly ‘heavy’ African American male brow bossing and to “open up” the eyes to create a more feminine and rejuvenated appearance.

The hairline position on the forehead will also be different because African American women tend to have naturally higher hairlines than European women. Therefore, when we perform feminizing hairline lowering we make allowance for the fact that African American women have slightly higher hairlines to begin with, so we may not lower the hairline as significantly as we might in others. Ultimately, it all depends on your newly feminized facial features to ensure aesthetic balance and a natural looking result.

Feminizing the lower half of the African American face.

Typically, feminization of the nose via feminizing rhinoplasty is recommended for those of African American heritage. Often gender transition patients are seeking a narrower, more streamlined female nose. However, we also want to make sure that your nose will maintain a size and shape that is in harmony with your natural African American facial features, so that you still look like you.

Feminizing jaw surgery is also recommended because often the male African American jawline is quite broad and angular – often wider and squarer than what we see in other ethnicities. The jaw will often need to be narrowed and softened via feminizing jaw contouring or reshaping.

Read more about the cluster of surgical and non-surgical procedures that comprise facial feminization.

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Women With Masculine Looking Faces

September 18, 2017

Facial Feminization Surgery for Women

Often when we talk about facial feminization we are referring to the surgery within the context of transgender individuals. However, there is another set of circumstances wherein facial feminization surgical procedures may be incredibly useful: for cis-gendered women (female assigned female at birth) who are born with “masculine”-looking features and who are want to appear more feminine.

What features make a woman’s face appear “masculine”?

The most common complaint we hear from our female patients who are seeking facial feminization is either the forehead and brow and/or the jawline and chin is too prominent or too “bold”. These two features — more than any others — contribute to a masculine-looking appearance.

The good news is that a plastic surgeon, such as Dr. Deschamps-Braly, who also has extensive craniofacial and jaw surgery expertise can help to feminize these features while still ensuring that you still look like you. And herein lies the true skill of any form of gender-related facial surgery: along with excellent surgical skills, your surgeon must also possess a deep understanding of gender-related aesthetic differences in terms of male/female facial proportions, and an appreciation for what constitutes “beauty” in the feminine face to ensure an optimum outcome.

Recommended surgical procedures to create a more feminine appearance:

There are many ways you can make your face appear more feminine. After an in depth consultation, your surgeon may recommend one or more of the following procedures, depending on your circumstances and desired results:

  • Feminizing Forehead Reduction and Contouring: to create a more feminine, softer appearance of the forehead, and reduce the heavy appearance of the male brow.
  • Feminizing Brow lift (Browplasty) – raises the eyebrows into a higher, more feminine position on the face. Also helps to reduce common telltale signs of aging such as forehead wrinkles, crow’s feet, horizontal or vertical lines such as frown lines and furrows between the eyebrows.
  • Feminizing Rhinoplasty (nasal surgery) – some women may have a very prominent or ‘masculine’ looking nose. In such cases, feminizing rhinoplasty may help.
  • Feminizing Cheek Enhancement – gives the cheeks a rounder and smoother feminine appearance. Depending on your existing features and the desired effect, the procedure includes either cheek augmentation or cheek reduction.
  • Feminizing Chin Recontouring (Genioplasty) – alters the shape of the male chin by reducing, reshaping, or augmenting (making the chin larger). Most often the male chin is reduced in size and reshaped to be less angular, creating a smoother and more feminine aesthetic.
  • “Asian” V-Line surgery – suitable for all ethnicities: this surgery works to contour and slim the lower jaw, creating a more slender jaw line while at the same time reducing jaw width and a producing a sharper, better-defined chin profile.
  • Jaw Contouring – The male jaw is usually wider and more angular than the female jaw. Men tend also to have a sharp back “corner” to the jaw, which can be made to appear rounder and smoother through jaw contouring resulting in a more feminine look. The bone of the jaw can also be shaved along its lower edge and chewing muscles reduced to make the jaw more slender.

Ultimately, the decision with regards to which surgical procedures will suit your circumstances is one that will be made in consultation with you and your surgeon.

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