Chin Microgenia: An Anthropometric Analysis on the Prevalence and Severity in a Chinese Population.

BACKGROUND: The chin is an important component of facial harmony, and deficient chins are associated with unattractiveness. Previous studies have reported microgenia as the most common subtype of chin deformities. OBJECTIVE: To investigate the prevalence and severity of microgenia in a Chinese population through facial anthropometric analysis. METHODS: A total of 800 Han Chinese adults from various age groups of both sexes were recruited for facial anthropometric measurements and photographic analysis. Chin deficiencies in both sagittal and vertical dimensions were evaluated using G-S-P angle, chin retrusion distance, and Sn-Vl/Sn-Me ratio criteria. RESULTS: In the sagittal dimension, microgenia was present in 60.7% of men and 68.6% of women according to the G-S-P angle criterion, and the angle significantly decreased with age in women (p < .05). According to the chin retrusion criterion, microgenia was present in 38.7% of men and 32.3% of women, and the retrusion distance significantly increased with age in both sexes (p < .05). Vertical microgenia was present in 69.6% of men and 81.9% of women according to the Sn-Vl/Sn-Me criterion, and the ratio gradually increased with age in both sexes (p < .05). CONCLUSION: Microgenia is common among Chinese, particularly in women, and the prevalence and severity increase with age.

Hyaluronic Acid Soft Tissue Filler for the Treatment of The Hypoplastic Chin: An Observational Study.

BACKGROUND: The hypoplastic chin is associated with facial unattractiveness. OBJECTIVE: To evaluate safety and efficacy of JUVÉDERM Voluma XC Injectable Gel (hyaluronic acid filler, HAF) for treatment of hypoplastic chin. METHODS: This was a one-year, open-label, single-center study. RESULTS: Thirty subjects received HAF injections of which 24 subjects (80%) completed the study. Mean facial angle significantly improved at all time points compared with baseline, improving by 1.83° (95% confidence interval, 0.91, 2.75; p < .001) at 12 months. Subject satisfaction with lower face and jawline increased significantly for all FACE-Q questions and time points compared with baseline (p < .05). Subject satisfaction with overall facial appearance, and percentage of subjects "not bothered" by area under chin increased significantly for most FACE-Q questions and time points compared with baseline (p < .05). CONCLUSION: In this completed one-year study, HAF injection for hypoplastic chin was safe and accompanied by significant improvement in facial angle, measures of subject satisfaction, and GAIS.

Wedge Osteotomy for Correction of Chin Asymmetry.

Chin deviation is generally the visible reflex of a mandibular asymmetry. The difficulty in obtaining a symmetrical result exists, but it can be minimized with the appropriate surgical technique. This article reports the mentoplasty technique with wedge osteotomy performed in an individual with a right-sided chin deviation. Three osteotomies were performed vertically and equidistantly, forming a bone wedge on the contralateral side of the deviation. Horizontal repositioning associated with the rotation caused by the vertical impaction of the chin after bone wedge removal was effective in solving esthetic problems of facial asymmetry, meeting the patient's main complaint.

Intraoral Prosthetic Chin Augmentation With Vertical Incisions.

To explore a new surgical approach for chin augmentation using a prosthesis with 3 intraoral vertical incisions whereby placement of the prosthesis is more convenient and accurate, with fewer postoperative complications. Following the anatomic characteristics of the chin, a bilateral mucosal vertical incision and a median observation incision are made. The V-shaped mark on the upper side of the prosthesis can be seen through the observation incision after it is placed from the lateral incision into the predesigned compartment. The incision can be sutured if there is no bleeding in the operation area. Surgery performed in all 19 patients with mild microgenia with 6 to 12 months of follow-up resulted in satisfactory chin and face shape without any complications. The application of this novel method can correct McCarthy type I microgenia with more accurate positioning, less possibility of bilateral sideways and/or up/down movement, and fewer complications.

Treatment Approach to Severe Microgenia Cases: Combined Use of Osseous and Implant Genioplasty.

INTRODUCTION: As well as the chin is an important esthetic unit of the facial structure, it is also the region having a key role in the appearance of the face. Correction of cosmetic and functional deformities that may occur in this region because of serious hypoplasia (microgenia) is performed by chin augmentation. Chin augmentation is most frequently performed via implant or osseous genioplasty in the literature. Both 2 techniques have their own advantages and disadvantages. In the literature, various studies comparing these 2 techniques and their long-term results are present, but in some severe microgenia cases, these techniques can be insufficient only for augmentation. In such cases, combined use of implant and osseous genioplasty techniques can come up and data and experiences regarding such combined uses are limited in the literature. In our study, we aim to report our experiences and long-term results regarding 3 cases to whom chin augmentation combined with implant and osseous method is applied because of serious chin hypoplasia (microgenia). METHOD: Three patients to whom chin augmentation combined with osseous and implant genioplasty was applied because of severe microgenia between 2011 and 2016 are included in our study. Before the chin restoration, orthognathic surgery or maxillomandibular distraction applications owing to existing obstructive sleep apnea, malocclusion, or facial asymmetry, are performed in the patients. In preoperative period, chin augmentation amount required is planned for all the patients via cephalometric analysis and the operations of all the patients are performed under general anesthesia via intraoral access. RESULTS: Among 3 patients, 2 were male and 1 was female and their mean age was 27.3 years (22-33). In all the patients, primarily horizontal subapical sliding osteotomy was performed and advancement was performed. After osteotomy, mean 8-mm osseous advancement was obtained and Medpor implant was placed in the chin at the same session for additional augmentation. Mean advancement amount obtained by the Medpor implants was 9 mm. A total average of 17-mm augmentation was obtained in the patients via osseous and implant genioplasty. The reflection of this advancement amount on the soft tissue was measured as 13 mm. Mean follow-up period is 24 months and the patients did not encounter with a major complication in the postoperative period. In the postoperative period, early-period band application was performed at the chin of the patients to reduce edema and to support immobilization. CONCLUSIONS: Chin contour is an important part of facial aesthetics and osseous genioplasty is the ideal treatment option for the correction of most chin deformities. However, in some serious microgenia cases, osseous genioplasty may be insufficient to correct the existing deformity. In such cases, it is seen that the combined correction procedures to be applied together with the implant use can be applicable in terms of the safety and its long-term results.

Early Orthognathic Surgery: A Review.

INTRODUCTION: Management of growing patients with severe developmental jaw abnormalities can be very difficult. Early surgical intervention may be warranted in situations where function (e.g., mastication, swallowing, breathing, or speech) and/or psychological well-being could be negatively affected. Many surgeons and orthodontists are reluctant to recommend a surgical treatment option for growing patients with severe developmental jaw abnormalities because of their age. Specific surgical procedures can be performed during growth to correct developmental jaw abnormalities with predictable results. A sound understanding of the facial growth and the effects of the surgical procedures on subsequent growth is essential when managing growing patients with severe developmental jaw abnormalities. Children with severely progressive congenital deficiencies affecting function/health should be distinguished from ones with severe developmental jaw abnormalities that can be managed later in life. In this review, we will focus on the management of growing patients with developmental jaw abnormalities who seek orthodontic treatment, rather than patients with progressive congenital deformities affecting function and/or health.

Development and Validation of a Photonumeric Scale for Assessment of Chin Retrusion.

BACKGROUND: A validated scale is needed for objective and reproducible comparisons of chin appearance before and after chin augmentation in practice and clinical studies. OBJECTIVE: To describe the development and validation of the 5-point photonumeric Allergan Chin Retrusion Scale. METHODS: The Allergan Chin Retrusion Scale was developed to include an assessment guide, verbal descriptors, morphed images, and real subject images for each scale grade. The clinical significance of a 1-point score difference was evaluated in a review of multiple image pairs representing varying differences in severity. Interrater and intrarater reliability was evaluated in a live-subject validation study (N = 298) completed during 2 sessions occurring 3 weeks apart. RESULTS: A difference of ≥1 point on the scale was shown to reflect a clinically meaningful difference (mean [95% confidence interval] absolute score difference, 1.07 [0.94-1.20] for clinically different image pairs and 0.51 [0.39-0.63] for not clinically different pairs). Intrarater agreement between the 2 live-subject validation sessions was substantial (mean weighted kappa = 0.79). Interrater agreement was substantial during the second rating session (0.68, primary end point). CONCLUSION: The Allergan Chin Retrusion Scale is a validated and reliable scale for physician rating of severity of chin retrusion.

Not by the Red on My Chinny Chin Chin: A Case of Mandibular Osteomyelitis in a 5-Year-Old Girl.

BACKGROUND: Osteomyelitis is not an uncommon emergency department diagnosis in pediatric patients, and most cases are in the lower extremities. Children can present with acute, subacute, or chronic erythema, pain, swelling, or decreased use of the extremity; some patients will also have fever or elevated serum inflammatory markers, or both. CASE REPORT: We present the case of a healthy 5-year-old girl who presented to the emergency department with 3 weeks of painless chin swelling and 2 days of erythema and pain. While laboratory testing was normal, magnetic resonance imaging demonstrated osteomyelitis of the mandible, later confirmed by biopsy. After 4 weeks of intravenous antibiotics and an additional 2 weeks of oral antibiotics, the patient recovered completely without any residual findings. WHY SHOULD AN EMERGENCY PHYSICIAN BE AWARE OF THIS?: This case demonstrates that osteomyelitis can develop in previously healthy, fully vaccinated children with competent immune systems. Systemic findings (ie, fever and elevated serum inflammatory markers) may be absent, and osteomyelitis should always be considered in the differential diagnosis for a child presenting with subacute to chronic cutaneous findings without other clear explanation.

Computer Image-Guided Template for Horizontal Advancement Genioplasty.

BACKGROUND: Horizontal advancement genioplasty can be extremely rewarding for microgenia. However, it is challenging for even very experienced surgeon to determine the three-dimensional position of the distant bone fragment during the operation. This study aimed to apply and evaluate computer-aided design (CAD) and computer-aided manufacturing techniques for horizontal advancement genioplasty to improve surgical accuracy. METHODS: Seven patients with microgenia were prospectively enrolled in the study. Preoperative and postoperative computed tomography (CT), photographs, and lateral cephalograms were performed. Computer-aided design was done based on preoperative CT data, and then surgical templates (cutting guide templates and fixation templates) were designed accordingly to guide horizontal advancement genioplasty. All surgeries were performed by junior surgeons. The accuracy of the authors' method was evaluated by the relative error (the mean value of discrepancy between postoperative CT and preoperative design at 6 points selected randomly/preoperative design movement × 100%), Pg position error (postoperative Pg Advancement - preoperative CAD Pg Advancement)/preoperative CAD Pg Advancement × 100%), and Me position error (postoperative Me downward movement - preoperative CAD Me downward movement)/preoperative CAD Me downward movement × 100%). They are all calculated by Geomagic automatically. RESULTS: All 7 patients were satisfied with their aesthetic outcomes. The average absolute relative error is 1.8%. The average absolute Pg position error is 1.9% and the average absolute Me position error value is 1.3%. CONCLUSIONS: The authors' study showed that applying computer-assisted techniques for horizontal advancement genioplasty provided accurate surgical result. With this technique, best result for horizontal advancement genioplasty could be achieved by even inexperienced surgeons.

Autogenous Fat Grafting for Chin Augmentation: A Preliminarily Clinical Study of Cosmetic Outcome.

Preoperative evaluation and surgical details of chin fat augmentation aiming at increasing the projection of the original mentum are scarcely reported. Herein, the authors systematically reviewed the application of fat grafting for chin augmentation in our institution from 2010 to 2014. This percutaneously multilayered fat-injection technology can be applied for chin augmentation for a subset of patients after strict selection, and the details of lipofilling technology and fat distribution vary depending on each individual patient's condition. Mentum can be augmented in the sagittal plane in different degrees, whereas the chin height seems unable to be effectively prolonged by lipofilling.

Chin Microgenia: A Clinical Comparative Study.

BACKGROUND: The aesthetic relevance of the chin and its relatively simple correction through different approaches make genioplasty one of the most performed aesthetic procedures of the face. Sliding genioplasty is extremely rewarding, particularly when performed as an adjunction to rhinoplasty, rhytidectomy, or jaw surgery. In the scientific literature, many different surgical techniques are described, but the biological implications and the economical impact can shape the surgeon's decision on which can be the best treatment: surgical correction with osteotomy, chin implants, or with fillers. OBJECTIVE: The authors propose a decision making protocol for correcting chin microgenia based on a revision of 345 treated cases. METHODS: A retrospective review of 345 cases of chin microgenia was undertaken to understand the proper preoperative assessment and therapeutic planning. A total of 135 patients were treated with surgical sliding genioplasty (group A): 60 patients (group B) have been grafted with alloplastic implants and the remaining 150 patients (group C) with hyaluronic acid. We recorded clinical indications, complications, and long-term aesthetic results at 3-year follow-up. RESULTS: The analysis of the results based on the entity of the chin's sagittal defect, the chin soft-tissue thickness, the patient's age, and self-judgment allows for simplified treatment planning for sagittal chin deformities showing a greater predictability and a more stable long-term aesthetic result regarding sliding genioplasty compared to alloplastic implant placement and fillers. CONCLUSIONS: Our proposal for a simple and versatile protocol of chin microgenia aims to simplify the therapeutic indications for a predictable and a stable long-term aesthetic result. LEVEL OF EVIDENCE II: This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to Table of Contents or the online Instructions to Authors www.springer.com/00266 .

Adult patient with hemifacial microsomia treated with combined orthodontics and distraction osteogenesis.

Distraction osteogenesis is an alternative treatment option for patients with facial asymmetry and mandibular hypoplasia. New bone is formed between bone segment surfaces that are gradually separated by incremental traction. The purpose of this article is to report the treatment of a 22-year-old man with hemifacial microsomia, facial asymmetry, and a skeletal Class II profile. The patient's left mandibular ramus was lengthened with distraction osteogenesis, and miniscrew-assisted rapid palatal expansion was used to correct the maxillary transverse deficiency. Postoperative orthodontic treatment achieved tooth alignment and closure of the posterior open bite. The total treatment period was 27 months. These therapeutic treatments improved the patient's facial appearance.

The need for mentoplasty following rhinoplasty.

OBJECTIVE: Rhinoplasty is the most common facial plastic surgery procedure. The appearance of the face must be considered as a whole to achieve the best results, but assessment of the chin is often overlooked. The aim of this paper was to determine the need for mentoplasty after rhinoplasty. METHODS: Adobe Photoshop CS6 (Adobe Systems, San Jose, CA) was used to analyze 200 consecutive rhinoplasty patients, 170 of whom were included in this study. We used Silver and Agarwal's method for assessment of the chin. RESULTS: A total of 170 profile photographs were analyzed. Of these patients, 58.2% (n = 99) had normal chins, 40% (n = 68) had small chins (microgenia), and 1.8% (n = 3) had over-projection. There were no statistically significant differences between men and women. CONCLUSION: Chin projection is an important component of facial euphony. Approximately half of the rhinoplasty patients we assessed would also benefit from mentoplasty. Surgeons that perform rhinoplasty should discuss mentoplasty with their patients to achieve the best results.

[Morphological evaluation of genioplasty associated with orthognathic surgery]. / Évaluation morphologique des génioplasties associées à la chirurgie orthognathique.

INTRODUCTION: The maxillo-mandibulary dysphormias are frequently associated with morphological abnormalities of the chin. Their correction in the sagittal and transverse planes can benefit both morphologically and functionally. The purpose of this study was to evaluate the morphological benefit of the osseous genioplasty associated with orthognathic surgery depending on the type of technique used, as well as complications occurred. PATIENTS AND METHODS: We identified patients who underwent osseous genioplasty associated with orthognathic surgery in our department between 2004 and 2010. For each patient Angle class, type of osteotomy, genioplasty and postoperative complications were recorded. The morphological results were evaluated by a group of surgeons and a group of observers using standardized photographs. RESULTS: Of the 203 facial osteotomies performed during this period, 101 osseous genioplasties were made. In most cases, there was a height reduction associated with advancement of the chin. The morphological results were considered as satisfactory all evaluators alike (3.92). The best results were obtained in height reductions with advancement techniques as sliding genioplasty (4.03) and jumping divided genioplasty (4.19). Five patients (5.9%) had a postoperative complication. This was especially one mental nerve injury and two dental mortifications. No default of consolidation or necrosis or hematoma of mouth floor have been reported. CONCLUSION: Osseous genioplasty is a safe, reliable procedure with morphological satisfactory outcome, in combination with orthognathic surgery. The best results were obtained with cases of height reduction with advancement of the chin, especially the original technique of the jumping divided genioplasty.

Comprehensive consideration and design for treatment of square face.

PURPOSE: From an East Asian traditional esthetic viewpoint, a soft facial appearance seems to be more attractive. A prominent mandibular angle, a high zygomatic bone, and an inharmonious chin strongly lessen the attributes of femininity. Attention should be paid to the zygomatic projection and square mandible from the frontal view and the gonial angle and mental region configuration from the lateral view to obtain a slender oval face (melon seed face). PATIENTS AND METHODS: From January 2005 through December 2010, 47 patients underwent a combination of 4 operative techniques to reshape a square face: L-shaped osteotomy, V-line osteotomy, mandibular outer cortex splitting ostectomy, and sliding genioplasty. RESULTS: Outcomes in and feedback information from patients showed that these methods made the square face look more harmonious, with significant improvement of the middle and lower facial contours. CONCLUSIONS: Asians with a square face have different combinations of facial features; thus, surgeries should be customized and designed comprehensively to achieve optimal results.

Treatment protocol and surgical techniques for macrogenia.

BACKGROUND: This study focused on the treatment protocol for macrogenia and surgical techniques of the semicircular ostectomy of the mandibular inferior border. METHODS: Seven patients with macrogenia were treated following our treatment protocol including a preoperative assessment (the Delaire analysis), an operative design (three-dimensional reconstruction and simulation), operation techniques (semicircular ostectomy of the mandibular inferior border), and a postoperative evaluation. RESULTS: Our treatment procedure provided an overall harmonizing effect on the lower facial contour. All 7 patients were satisfied with their aesthetic results. A few complications such as numbness and submental soft-tissue excess were observed, but they improved to different extent as time went by. CONCLUSIONS: Our treatment protocol for macrogenia is of great use to make the surgeries to be precisely and safely done with satisfactory results.

Combined multisegmental surgical-orthodontic treatment of bialveolar protrusion and chin retrusion with severe facial asymmetry.

LeFort I osteotomy, anterior segmental osteotomy, bilateral sagittal split ramus osteotomy, and genioplasty are frequently used methods for correcting facial deformities. However, in patients with an abnormally shaped maxilla or mandible, more complex surgical techniques or multiple combinations must be considered for improved esthetic results. This article presents a patient with bialveolar protrusion, mandibular prognathism, chin retrusion, a long face, and severe facial asymmetry. A combination of LeFort I asymmetric impaction, anterior segmental osteotomy, and 3-piece segmentation of the maxilla, and bilateral sagittal split ramus osteotomy, anterior segmental osteotomy, genioplasty advancement, and angle shaving in the mandible were conducted simultaneously. In patients with complicated deformities that cannot be classified by simple conventional classification methods, multisegmental osteotomy can be an option for improved esthetic results.

Reconstruction of lower face defect or deformity with submental artery perforator flaps.

BACKGROUND: Reconstruction of lower face defects or deformity often presents as a challenge for plastic surgeons. Many methods, including skin graft, tissue expander, or free flap are introduced. Submental artery perforator flaps have been used in the reconstruction of defects or deformities of the lower face. METHODS: Between August 2006 and December 2008, 22 patients with lower face defects or deformity underwent reconstruction with pedicled submental artery perforator flaps. Their age ranged between 14 and 36 years. The perforator arteries were detected and labeled with a hand-held Doppler flowmeter. The size of flaps ranged from 4 × 6 to 6 × 7 cm, and the designed flaps included the perforator artery. RESULTS: All the flaps survived well, except 1 flap which resulted in partial necrosis in distal region and healed after conservative therapy. No other complication occurred with satisfactory aesthetic appearance of the donor site. CONCLUSIONS: The submental artery perforator flap is a thin and reliable flap with robust blood supply. This flap can reduce donor-site morbidity significantly and is a good choice for reconstructive surgery of lower face.

Orthognathic surgery for obstructive sleep apnea: applying the principles to new horizons in craniofacial surgery.

This article is dedicated to the senior author Dr. Henry K. Kawamoto, Jr, who pioneered the use of orthognathic surgery to treat severe obstructive sleep apnea in 1981. Since that time, his techniques for maxillomandibular advancement have been revised and expanded for improved surgical success. Obstructive sleep apnea is a growing public health concern because it can cause hypertension, cardiac arrhythmias, heart attack, stroke, and, in rare circumstances, sudden death if untreated. When less invasive options fail such as weight loss or dental devices for mandibular repositioning, maxillomandibular advancement is a valuable treatment option for severe obstructive sleep apnea.