Esthetic Surgery of the Chin in Cis- and Transgender Patients-Application of T-Genioplasty vs. Single-Piece Segment Lateralization.

Background and Objectives: Correction of lower face asymmetry still remains challenging in maxillofacial surgery. This report describes techniques for the lateral transposition of the symphyseal segment to restore lower face symmetry while maintaining gender-related features in cis- and transgender patients. Materials and Methods: A retrospective review of medical records of 31 patients who attended for esthetic corrective surgery after orthodontic camouflage or orthognathic treatment, or during facial feminization of the lower face between June 2021 and June 2023 was performed. Result: All patients underwent lateralization genioplasty (with or without advancement or setback), either with or without narrowing T-osteotomy supplemented with necessary procedures in order to obtain proper facial balance and desired esthetical effects, such as bichectomy, liposuction, and face and neck lift. The mean asymmetry of the chin was 5.15 mm and was surgically corrected either by single segment lateralization or T-shape narrowing genioplasty depending on the gender and esthetical requirements. No complications were reported. Conclusions: Lateral shift genioplasty serves as a powerful tool in primary and secondary corrective surgery for lower face asymmetry that maintains gender-specific facial features. It may serve either as an additive to orthodontic camouflage or a way to correct previous orthognathic surgery pitfalls. The surgeon performing esthetic genioplasty associated with gender-specific expectations must be trained in facelift and facial liposculpting techniques in order to provide the best results and properly choose the right procedures for the right patients.

A prospective, randomized, double-blind, placebo-controlled clinical trial comparing the efficacy of systemic enzyme therapy for edema control in orthognathic surgery using ultrasound scan to measure facial swelling.

PURPOSE: To evaluate the effectiveness of systemic enzyme therapy for the control of edema in patients who undergo bimaxillary orthognathic surgery. MATERIALS AND METHODS: Thirty patients were included in this double-blinded, randomized, control trial. Before surgery, each patient was allotted a code (study or control group). Nine anthropometric points were selected. Thickness of the soft tissue at each of these points was measured using an ultrasound device. These measurements were performed on the day before surgery and 1, 5, and 15 days after surgery. The study group was given a twice-daily dose of systemic enzyme therapy from the first postoperative day for 5 days; the control group was given placebo. The percentage of difference in the thickness of the soft tissue was calculated at each of the 9 points on postoperative days 1, 5, and 15. These data were analyzed and compared using the Mann-Whitney test. RESULTS: The statistical evaluation showed a significant difference in soft tissue thickness between the 2 groups, especially on days 5 and 15, at most assessed points. CONCLUSION: The results of this study suggest that systemic enzyme therapy significantly decreases postoperative edema in orthognathic surgery, precluding long-term corticosteroid use.

Silicone implant for chin augmentation mimicking a low-grade liposarcoma.

The silicone implant has been widely used in facial aesthetic surgery for chin augmentation. A case of a 71-year-old woman with a lesion in the anterior mandibular region detected by radiographies and suggestive of benign soft tissue tumor is presented. The patient denied previous surgical intervention in the mental area. A biopsy was performed and initially interpreted as low-grade liposarcoma. After an immunohistochemistry study showing CD-68-positive cells and complementary information regarding a silicone implant for chin augmentation, the definitive diagnosis was silicone granuloma. This case reinforces that silicone implant in the mandibular region can be misdiagnosed as malignant tumor and the correct diagnosis is heavily dependent on close collaboration between clinician and pathologist in order to avoid unnecessary surgical intervention.

Combining chin-jowl implants with local anesthesia facial rejuvenation.

Mandibular implantation is an outpatient procedure that can be used in combination with other minimally invasive cosmetic interventions. Specifically, silastic chin implants can help create a strong chin and smooth the jaw-line in carefully selected patients. A standard surgical excision tray plus a few additional simple instruments are required, and a variety of commercially available implants are available for placement via an intraoral or submental approach. Meticulous technique minimizes the small risk of nerve injury and numbness. Chin-jowl implants may be preceded by neck liposuction and immediately followed by a face-lift to achieve overall facial enhancement.

Chin and prejowl augmentation in the management of the aging jawline.

The effects of aging in the lower face and neck are reflected in the contour of the jawline. Soft tissue atrophy, the formation of jowls, and retrusion of the chin are all age-associated changes that contrast starkly with the smooth harmony of a young lower face. These soft tissue changes in the jawline are exacerbated by the effects of aging on the bony portion of the mandible. Bone resorption of the mandible seen with aging can lead to the development of a hypoplastic mentum and the formation of an anterior mandibular groove. Rhytidectomy serves to address the soft tissue changes from aging but cannot counter the effects of aging on the bony mandible itself. Understanding the effects of bone resorption on the aging mandible allows the facial plastic surgeon to augment the mandible appropriately to achieve a more effective rejuvenation of the lower face. The aging process in the mandible and the development of the prejowl sulcus are reviewed. The use of chin and prejowl augmentation as a valuable adjuvant to facelift surgery is discussed.

"Cook Weekend Alternative to the Facelift". Liposculpture of the face, neck, and jowls with laser dermal resurfacing and platysmal plication.

The "Cook Weekend Alternative to the Facelift" is a combined liposculpture and laser surgical procedure which produces excellent cosmetic results, in many cases comparable to the results of traditional surgical rhytidectomy, without the extensive surgical intervention and prolonged recovery time needed for rhytidectomy. The procedure consists of liposculpture of the face, neck, and jowls; laser resurfacing of the platysma and underside of the dermis; vaporization of subcutaneous fat; resection of a small ellipse of excess submental skin; separation of the neck septa; and plication of the platysma, with or without chin augmentation. Cosmetic results can be dramatic, and most patients return to normal activities approximately three days postoperatively.

The free revascularized rectus abdominis myocutaneous flap for the repair of tumour related defects in the head and neck area.

The present work reviews a series of 11 consecutive patients who have received free revascularized rectus abdominis myocutaneous flaps for primary reconstruction of soft tissues after ablative tumour surgery in the head and neck area. In 10 patients, a total or subtotal glossectomy had been performed and the flap was used to replace the resected tongue volume. In 5 of these cases, extensive perforating defects had resulted after additional resection of large portions of the chin and the cheek. Mandibular continuity was restored by a metal plate and the flap was divided into an intraoral and extraoral portion in these patients. In one patient, the flap had been used for closure of a full thickness defect of the calvarium. 9 of the 11 flaps healed uneventfully. In one case, a partial flap loss was encountered after thrombosis of the venous pedicle due to compression as a result of an unfavourable defect anatomy and flap positioning. Primary closure of the abdominal wall was achieved in all cases. A subcutaneous hematoma occurred at the donor site in one patient. According to our present experience, the rectus abdominis free flap may serve as an alternative to the frequently employed latissimus dorsi flap in maxillofacial reconstructions while it offers the possibility for flap elevation simultaneously to the surgical procedures in the head and neck area.

Cost of a genioplasty under deep intravenous sedation in a private office versus general anesthesia in an outpatient surgical center.

The cases of twenty-four patients who underwent genioplasties either under deep intravenous (IV) sedation in a dental office or under general anesthesia in a surgical center were reviewed. A cost comparison of this operation in these two environments showed that it was twice as expensive to have the same procedure done in an outpatient surgical suite under general anesthesia as it was in a private office under IV sedation.

Augmentation genioplasty: when bone is not enough.

PURPOSE: Augmentation genioplasty is indicated to correct microgenia. When a large defect must be corrected, the additional use of a soft alloplastic implant may be indicated. METHODS: A 22-year-old patient is presented who required correction of microgenia. A 15-mm advancement of the chin was required to obtain an acceptable cosmetic result. RESULTS: An augmentation genioplasty achieved an 8-mm correction. This was supplemented by a silicone gel-filled implant inserted subperiosteally. This resulted in an outstanding cosmetic result. CONCLUSIONS: Chin contour is an important aspect of facial aesthetics. The sliding genioplasty is ideally suited for correcting most chin deformities; however, the insertion of an alloplast may augment patients with severe microgenia. Avoidance of the donor-site morbidity associated with the use of autogenous bone is a major benefit of this procedure.

Grafts and implants in nasal and chin augmentation. A rational approach to material selection.

Two major factors are involved in choosing augmentation materials: (1) the specific properties and limitations of the materials themselves (Table 2) and (2) the characteristics of the site for implantation. A wide variety of materials are currently available and these vary in density, ability to be sculpted, tissue reaction, resorption, migration, incidence of infection, extrusion rate, and ease of removal. Some of these characteristics are self-evident. For example, materials with high infection or extrusion rates (such as Silastic in nasal reconstruction) are clearly not useful in most instances. Likewise, materials that tend to migrate, such as tiny bits of cartilage, can lead to unacceptable results, but cartilage is such a generally good augmentation material in the nose that the measures to ensure stability are worth the additional time required for implantation. Resorption is a potential problem with all the biologic grafts and possibly with Supramid. Again, in certain situations in which alloplasts are unacceptable, such as infected areas, biologicals must be used and the consequences of resorption accepted. Density and ease of sculpting are often a matter of the surgeon's personal choice. As a general rule, bone is best replaced with firm materials and soft tissues are best augmented with soft materials. Should infection or rejection occur, the porous materials are much more difficult to remove; therefore, Silastic or a biological may be the best choice if there is any question about the presence of infection or possible future infection. The effect of the degree of tissue reaction is not well-understood. For example, Supramid elicits a marked tissue response but in general displays high compatibility with the tissues. Further investigation is needed to elucidate the role of tissue reactivity and porosity in the development of infection and extrusion. When choosing the implant material, the specific characteristics of the site for augmentation must be considered. A good example is the nose. Its mobility and thin soft-tissue coverage lead to extrusion of firm implants such as Silastic. By contrast, Silastic works well for chin augmentation. Also, consider present or future bacterial contamination in the area. This is especially important in nasal augmentation, where infection and extrusion can lead to unacceptable deformities. In general, nasal augmentation is best achieved in most circumstances by cartilage. If this is unavailable, then Supramid has a proven record for good tissue compatibility and resistance to infection. For the chin, Silastic (either rubber- or gel-filled prostheses) produces the most pleasing and long-lasting results.

Sliding genioplasty as a local anesthetic outpatient procedure: a prospective two-center trial.

A two-center (U.C.L.A. and Georgetown) prospective trial was planned to examine sliding genioplasty as an outpatient local anesthetic procedure. Thirty-nine patients, 14 male and 25 female, underwent the procedure. Average operating time was 43 minutes (range 15 to 70 minutes). Perioperative pain was remarkably mild, and patient satisfaction was extremely high, even among patients unhappy from previous chin implants. The overall complication rate was 20 percent, including two wound infections and one mental nerve injury. Both wound infections resolved uneventfully without detracting from the final result. Neither bleeding nor airway problems were encountered. An osseus genioplasty is a useful technique for correction of the hypoplastic chin. This technique may be performed as an outpatient procedure under local anesthesia with minimum pain and excellent patient acceptance. In light of the low risk and favorable results from this procedure, we recommend this technique as a practical alternative to alloplastic chin augmentation in selected patients.

Suction lipectomy of the neck.

Suction lipectomy of the neck has been advocated in other reports. However, because of skin laxity, a simultaneous face/neck lift has been performed usually. In this series of 49 patients, ages 18 to 73, removal of submandibular fat was performed by suction lipectomy. A simultaneous face/neck lift was not done. In addition, no skin was excised. On the contrary, the apparent excess skin was found to be required for contouring. Approximately one-third of the patients had a simultaneous chin implant. Others had different aesthetic surgical procedures performed during the same operation. The removal of neck fat by suction has proven to be more efficacious than excisional methods of lipectomy. The risks of operation have been found comparable to suction lipectomy performed in other anatomic locations.