[-Ulloa] line is probably the most utilized; it extends from the nasion and perpendicular to the Frankfort plane. Typically, the chin should lie along that line,” Dr. Funk said. “But I have not found that to be an aesthetically pleasing line. I’ve found that it frequently creates too strong of a jaw.”
Explore This IssueAugust 2012
Part of the problem with many published formulas is that they are Euro-centric, Dr. Dayan said. “Most of these ideal measurements are based on Da Vinci’s drawings from the fifteenth century, on the European Caucasian face,” he said. “But today in America, almost half of our population is not Caucasian. If I use those measurements to create a chin for an African-American or Asian patient, the result is not going to look right.”
Taking a few basic measurements and combining them with an awareness of the general constructs of beauty often leads to the best outcomes. “I draw a line from the upper lip through the lower lip on profile. The chin on females should lie anywhere between one millimeter and two millimeters behind that line and in males, it should lie right along that line,” Dr. Funk said.
The ideal proportions of male and female faces underlie surgical planning. “In a female, you want a thinner, smaller, one-third of the face,” Dr. Dayan said. Males, on the other hand, typically have a squared-off, stronger jaw line. That’s why some physicians use different techniques to augment male and female jaws. “We don’t want to masculinize a female jaw line by placing too large of a chin implant,” Dr. Funk said. “So I typically won’t use an extended implant with female patients, whereas with male patients, I favor extended implants because they create a stronger jaw.”
Another element to take into consideration is the patient’s dental alignment. “A deficient chin can be an aesthetic problem or a sign of a dental relationship problem,” Dr. Kaufman said. “When in doubt, the patient should be evaluated by a surgical specialist with expertise in maxillofacial surgery, because if patients require treatment to correct dental relationships after a chin augmentation, it could affect the results of the augmentation.” It’s usually better, he said, to wait until all orthodontic work or dental surgery is completed.
Chin augmentation is most frequently achieved through the use of chin implants. While implants can be placed either intra- or extra-orally, most facial plastic surgeons prefer the extra-oral option due to a theoretical decrease in the risk of infection. “I use a small incision in the cervicomental crease underneath the chin,” Dr. Funk said. “I find that the incision, if placed correctly and closed meticulously, heals beautifully.” The cervicomental approach is the approach of choice when a chin implant is being combined with a neck lift, face lift or facial liposuction, because the same incision can be used for all procedures.