The shape and proportion of the bones of the face are important in achieving a pleasing overall facial harmony. In balancing the proportions, particularly of the nose, cheeks, chin and forehead can lead to a disharmony of facial appearance that some people find aesthetically unattractive. Perhaps the most common disproportion is in the size and shape of noses, which is dealt with in a separate section.
Under or over development chin and flat or overly prominent cheek bones can also result in disharmonies of facial proportion.
Many procedures are available to change the shape of the chin and cheeks and brow. In order to decide on the best treatment it is usually necessary to perform an analysis of facial proportion. Often this involves simply an analysis and morphing of digital photographs of the face which can be undertaken at your consultation. Occasionally more complex bony disproportions require an x-ray or CT scan to show the shape of the underlying facial bones.Procedures
The ideal procedure to correct these problems depends on the position and severity of the disproportion of the underlying bone.Chin
An overly prominent chin can often be reduced by removing some of the chin bone in a procedure called a reduction genioplasty. A recessive or underdeveloped chin can be built out either by inserting an implant or performing a sliding genioplasty to advance the existing bone of the chin. Each of these operations is carried out through an incision inside the mouth between the lower lip and gum.
More severe chin or jaw disproportions may require more complicated treatment and may involve orthodontics and surgery to re-align the teeth and jaws.
Flat cheekbones can be treated in a number of ways. Very mild flatness can be addressed by simply augmenting the soft tissue of the cheeks by fat transfer. This is discussed in a separate section on this website. More marked flatness requires the insertion of a cheek implant or occasionally bone grafts. Generally I favour the use of Medpore implants which have a similar texture to bone and can be fixed rigidly to the cheekbones so that they do not move about underneath the skin.
Overly prominent cheekbones can be reduced through an incision inside the mouth.Consequences of surgery
Surgery to the bones of the face usually produces some swelling and bruising which may take several weeks to settle. Temporary numbness of the chin, lips and cheeks can occur following surgery to these areas. It usually disappears within a few days but occasionally prolonged numbness can occur.
Insertion of bone grafts and implants inevitably carries a small risk of infection, although happily this is uncommon. Very occasionally chin augmentation can cause an unnatural crease when smiling.Limitations of surgery
It is usually possible to harmonise facial features with one or more of these operations, however, there are some limitations to the way in which the shape of the bones of the face can be changed. The use of computer prediction software and alteration of digital photographs will help in the planning and explanation of the expectations of surgery.Risks of surgery
Surgery is usually performed under general anaesthetic and there is a small risk of chest infection, especially among smokers. Numbness of the lower lip or cheeks may occur depending on the area operated on and there is a very small risk of weakness of some of the muscles of the mouth. There is also a small risk that an implant or genioplasty can damage the roots of nearby teeth. Occasionally implants can become displaced, but fixing implants with small titanium screws reduces the risk of this. All operations carry a small risk of infection. If there is a significant infection the implant will need to be removed by surgery.Preparation for surgery
If the operation involves incisions within the mouth, it is important to have a dental check-up before surgery and often a visit to the dental hygienist is advisable.
You should not take aspirin or non steroidal anti-inflammatory drugs such as Brufen or Nurofen for two weeks before your surgery. These drugs increase the risk of post operative bleeding and have an adverse effect on bruising.
If you smoke, you will need to stop smoking for two weeks before surgery and a week afterwards. Smoking reduces the blood flow to the skin and can prevent healing.The operation
These operations are almost always undertaken under general anaesthetic and usually require an overnight stay. You can expect a moderate amount of soreness and discomfort in the first two days.After the operation
After the operation it is usually necessary to sleep for the first night with the head of the bed raised to reduce the swelling. It is important to keep your mouth clean. Mouthwashes will be provided and it is important to take care not to manage the stitch lines whilst brushing teeth.