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Please help! Surgeon recommendation for chin reduction surgery

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Linda91:
Hi there,

I am looking for a surgeon who specializes in chin reduction surgery.
I would like to have some excess height (4mm) removed.
Can anyone recommend a surgeon who is great at chin reduction surgery and has a good aesthetic eye?
I am open to surgeons worldwide.
Any recommendation is more than welcome :)

GJ:
4mm is a lot. What happened to cause that much excess height?

I'm not sure on a surgeon who specializes in that...I think any good surgeon should be able to handle it. The big risk is cutting the mentalis a 2nd time. You could get droop, damage the muscle, erratic scar tissue that causes strange sensations, etc, so make sure to ask about all that.

kavan:
Chin reduction isn't really an isolated type specialty. It's in the venue of procedures many max fax docs do along with double jaw surgery when chin reduction is needed in addition. Often done by removing a midsection of the chin and getting the bottom section to close the gap removed from the mid section.

It would need to be established IF in fact your candidacy was isolated ONLY to a chin reduction (and no jaw surgery) and what the millimeter excess was, something that would be established by going on consults.

I would not advise seeking out doctors who do only chin reduction, claim as a specialty. It is preferable to consult with surgeons who do chin reduction ALONG with the rest of the jaw surgery who can tell you if your issue is 'only' isolated to chin reduction.

Linda91:
Thank you so much for your replies GJ and Kavan!

I always had excessive chin bone height. In 2021, I had Lefort1 + BSSO + sliding genioplasty. The surgeon attempted to shorten the chin by the sliding genioplasty. It has become a few mm shorter but still I have an excess of 4 mm*.

In the attachment you find:
- CBCT (post op)
- Measurement of vertical proportions (post op).

*I think lower subvisions should be 1:2 (upper lid 1/3, lower lip 2/3). My lip subdivion display a ratio of 1:2.2 (20mm:44mm) indicating 4 mm excess height in the chin.


--- Quote from: GJ on March 23, 2024, 08:50:03 AM ---4mm is a lot. What happened to cause that much excess height?

I'm not sure on a surgeon who specializes in that...I think any good surgeon should be able to handle it. The big risk is cutting the mentalis a 2nd time. You could get droop, damage the muscle, erratic scar tissue that causes strange sensations, etc, so make sure to ask about all that.

--- End quote ---

@GJ: Thank you so much for warning me about the big risk of cutting the mentalis a 2nd time. I had a consultation with Dr Jeffrey Spiegel. He suggested shaving the chin bone a few mm shorter through an incision inside the mouth instead of removing a midsection. Does this technique also pose a risk of drooping or damaging the muscle?



--- Quote from: kavan on March 23, 2024, 04:35:56 PM ---Chin reduction isn't really an isolated type specialty. It's in the venue of procedures many max fax docs do along with double jaw surgery when chin reduction is needed in addition. Often done by removing a midsection of the chin and getting the bottom section to close the gap removed from the mid section.

It would need to be established IF in fact your candidacy was isolated ONLY to a chin reduction (and no jaw surgery) and what the millimeter excess was, something that would be established by going on consults.

I would not advise seeking out doctors who do only chin reduction, claim as a specialty. It is preferable to consult with surgeons who do chin reduction ALONG with the rest of the jaw surgery who can tell you if your issue is 'only' isolated to chin reduction.

--- End quote ---

@Kavan: Thank you for explaining that chin reduction is not a standalone specialty. I reasoned I should look for a max fac doc who specializes in FFS or V line surgery. I reasoned that they have more experience with chin reduction than most max fax docs. Could you please share your thoughts on that? Does my reasoning make sense or should I rather look for a general max fac?

Many thanks in advance!

kavan:

--- Quote from: Linda91 on March 24, 2024, 03:39:41 AM ---Thank you so much for your replies GJ and Kavan!

I always had excessive chin bone height. In 2021, I had Lefort1 + BSSO + sliding genioplasty. The surgeon attempted to shorten the chin by the sliding genioplasty. It has become a few mm shorter but still I have an excess of 4 mm*.

In the attachment you find:
- CBCT (post op)
- Measurement of vertical proportions (post op).

*I think lower subvisions should be 1:2 (upper lid 1/3, lower lip 2/3). My lip subdivion display a ratio of 1:2.2 (20mm:44mm) indicating 4 mm excess height in the chin.

@GJ: Thank you so much for warning me about the big risk of cutting the mentalis a 2nd time. I had a consultation with Dr Jeffrey Spiegel. He suggested shaving the chin bone a few mm shorter through an incision inside the mouth instead of removing a midsection. Does this technique also pose a risk of drooping or damaging the muscle?


@Kavan: Thank you for explaining that chin reduction is not a standalone specialty. I reasoned I should look for a max fac doc who specializes in FFS or V line surgery. I reasoned that they have more experience with chin reduction than most max fax docs. Could you please share your thoughts on that? Does my reasoning make sense or should I rather look for a general max fac?

Many thanks in advance!

--- End quote ---

OBSERVATIONS:

Scull scan reveals a 'tall' face which is consistent with the longish periform aperture (pear shaped hole of the nose area). Jaw balance and bite are great. Step off seen to the chin is well masked by the SOFT TISSUE envelope when looking at the frontal full FLESH photo. So, the outcome of the genio shortening the chin and advancing it forward was that your soft tissue HID visibility of the bone step off from the genio AND the genio (upward displacement of it) SUPPORTED the soft tissue of the chin area=GOOD OUTCOME.

DIVISION OF '1/3rds':

As someone who studied Fine Arts/Art History at Harvard, I will tell you that the division of 3rds arises from Leonardo and Durer. But as a basic guideline for DRAWING a face. However, it, in itself was not meant to DEFINE 'perfection'. In fact, Leonardo WARPED the ratios to draw hideous faces (as to demonstrate extreme deviations) and did not stick to that ratio when painting the Mona Lisa's face. I will also add that forensic studies of distance relationships inherent in normal to attractive faces reveal division ratios that DIFFER from equal thirds for normal to attractive faces. The point I'm making here is that you need to be cautious about using that as some kind of 'directive' to ALTER your own face via surgery. As to the division of thirds, as it can apply to an attractive face, art students are often encouraged to use different ratios that deviate somewhat from exact division of thirds to draw an aesthetically pleasing face.

YOUR DIVISION OF '1/3rds':

You got the lines right as to hairline, nasal base and chin. But the glabella line was too high. When I lowered this line to be approx at the 'root' of the nose, between the the medial brows, your upper 'third' was equal to the middle 'third'. Now as to the lower 'third' it was longer than upper and midface 'thirds'. For example my RELATIVE measures were 5 'units' for upper, 5 units for middle and 5.9 units for lower 'third'. HOWEVER, there is some leeway one can divide the lower 'third' into thirds in your case. For example, the division line is usually through the oral commissures (corners of mouth). You took some leeway in this because your line passes through where the lips part at CENTER of lips. Through the lower corners of mouth the dividing line would be LOWER than your dividing line. So, the corners of the mouth being LOWER than the parting of the central lip area allows some leeway to use a line lower than your division line but higher than a division line above the corners of the mouth. When I used such a line, I got a division of 3rds for the lower 3rd of face. So, there are some artistic 'liberties' one can take here as to the glabella line and the division at the LIP area and they bear out that the upper and middle areas equal each other and although the lower area is longer, the division of that can be seen as 1/3rd upper and 2/3 lower. So, the division I came up with is that of a TALL yet attractive face in terms of facial ratios. That is to say, it does NOT call for shortening the chin.

SOFT TISSUE OBSERVATIONS.

It looks like you may have had a rhino (if so, it looks good and well sculpted). It also looks like you may have had a lip lift. Perhaps the kind where they hide the scars INSIDE the nostrils. It looks that way because you don't have sills at nostril (little ledges) and the philtral ledges appear to be sucked into your nostrils. So, it looks characteristic of a type of lip lift that lifts the CENTRAL part of the lips where hiding the incision inside the nostrils involves cutting into the little ledges (sills) at nostril nose base. Also, the fact that the corners of your mouth are lower than the central area of where the lips part, that is also consistent with a lip lift. Now, the overall aesthetic GESTALT of the short upper lip area looks GOOD and as I said prior, there is some leeway as to where to set the dividing line to get a 1/3rd to 2/3 division of the lower 'third' of the face. But when you set the lip divide line where you did through central parting of the lips in a circumstance when the corners of the mouth are down lower, leeway has it that the divide line can be set lower than where you placed it but higher than the corners of the mouth to get a 1/3rd to 2/3rds division.

CONCLUSION:

You have a very attractive 'tall' face and although the tallness comes from the chin area, it's NOT a 'long' chin. Also, the contour curve of the lower face is a nice streamline curve (no scalloping) to it. So, there is excellent SOFT TISSUE to BONE STRUCTURE BALANCE to the lower face. The PREDICTIVE aesthetic risks that I see IF you shorten the chin to fit into 'equal division of 3rds' OR 'more feminized shorter chin' would tend to be similar to what I see in other people who pursue the chin shortening as to fit into some ratio they tell themselves they need to fit into. They end up losing soft tissue support. For example there is no guarantee that if you shorten your chin BONE that the soft tissue is going to hug that tightly for a stream line contour curve. The outcome could give appearance that the chin might not look shorter due to the soft tissue envelope surrounding the bone NOT getting shorter and if the soft tissue starts to 'hang' or droop around the bone removal, the chin would still look long to you. Hence your aesthetic risk is losing some of the present stream line contour curve you now have which is a good BALANCE of bone support and soft tissue contour. Basically, if you shorten the chin bone, your central chin BONE goes UP. So, you can be sure the chin BONE would be shorter (on an X ray). But you can't be sure that the SOFT TISSUE of the chin would go up along with it (or not droop down). Personally, I think the potential aesthetic loss of good soft tissue coverage (and good bone support of it) risk outweighs any aesthetic gain to be had from shortening the chin bone. I don't envision an aesthetic gain from shortening the chin bone.

Enclosed is an illustration.

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