Chin Augmentation Only

When people hear the words “cosmetic surgery” and “implants” used in the same sentence, they usually think of buxom Hollywood movie stars and models who sometimes overdo it while going for a more feminine figure.

But implants are not just for bosoms, any more. Some are used in facial cosmetic surgery. Solid silicone facial implants are perfectly safe; in fact, the same material is routinely used in artificial joints and heart valves.

Probably the most common are the implants that augment a weak profile when a patient is having rhinoplasty or a revision nose job.

Other facial implants include those for:

• Jaw
• Cheek
• Chin

Unlike breast implants which come with a choice of saline or silicone fillings, facial implants are made from a solid medical grade silicone.

A soft but solid implant – for the lips – came into the world of cosmetic and plastic surgery in 2007 but did not go over big with patients because time and many flapping jaws showed the kisser augmentations made quite a few unkissable due to:

• Hardness
• Scar tissue
• Infections
• An unnatural appearance
• Breaking back through the skin

According to the American Society of Plastic Surgeons (ASPS) 17,143 lip augmentations – not involving injections – were done in 2010. But that was a 21 percent reduction from those done in 2009.

Consequently, most patients who want fuller lips now choose injections of Restylane, Juvederm and other facial fillers.

In about 20 percent of rhinoplasty cases, a chin implant is also used due to the patients’ receding chin lines. Rhinoplasty done alone in such cases usually does not improve patients’ facial appearances because the profile isn’t balanced.

Jaw and chin implants are often placed from inside the mouth while cheek implants can be inserted through the lower eyelid, leaving no scars whateve on the facial skin.

Nasal implants are small and can be inserted from inside of the nose, again leaving no surgical marks on the facial skin.

Patients should select their cosmetic plastic surgeons with great care because facial implants require a perfectly sized pocket which can’t be too large or too small or problems with the implant will show up later. For instance, the implant could slip out of its chamber.

Top facial plastic surgeons make sure some implants last by stitching the implant to the fascia, a tough sheet of tissue that covers the facial bone. Sometimes, surgical screws fasten implants down.

After Chin Augmentation

When people hear the word “implants” they usually think of breast implants. But there are many inserts for the face, too.

One of the most recently invented was a lip implant that worked like a breast implant; the insert was placed in the lips and then filled with saline to pump up the kissers. But the mouth is in motion far too much, causing some lip implants to break through the skin.

Commonly used facial implants are solid silicone with no filling required. Moreover, solid silicone has been proven safe and is routinely used to make artificial joints and heart valves. Facial implants are used for:

• The nose
• Jaw
• Chin
• Cheek

In about 20 percent of nose jobs, a chin implant is added to offset a receding chin. If a rhinoplasty is done without adding to a receding chin, the patient’s profile will be unbalanced and the new appearance of the nose less attractive. (In fact, you can’t really judge the results of a nose job unless you include the chin within the after rhinoplasty picture — like at the bottom of this post.)

Along with jaw implants, a chin implant can be inserted through the mouth while cheek implants are placed through the patient’s lower eyelids. Thus, no facial scars show.

But it’s not just a matter of opening the skin and plunking in an insert. The facial plastic surgeon must first craft pockets that hold the implants just so. Otherwise, the implant can slip out of place.

We prefer to stitch implants to internal facial structures for added stability. One of our favorites is the fascia, a tough lining covering the bone of the face. Sometimes, tiny surgical screws are used to more firmly attach facial implants to bone.

Nose implants are often donated cartiledge from the patient’s own ear or from a small piece of his rib, and most often used to raise the bridge of the nose.

An older use for lip augmentation is with PTFE, a material which is about the same as Gortex. But PTFE tends to harden over time.

Infection is always a concern while placing implants. To start, the surgical area skin is painted with strong germ killers. Implants come packaged in sterile materials and are soaked again in sterile agents after opening while the pocket is irrigated with an antibacterial solution before closing.

That’s why we see patients the morning after procedures. An experienced cosmetic plastic surgeon can see the start of an infection even before the patient is aware of it.

Rhinoplasty with chin Augmentation

CONSIDERING RHINOPLASTY?  BE SURE TO CHECK OUT YOUR CHIN ALSO.

Many people have rhinoplasty because they are not satisfied with their profile.  There might be a hump or the nose may project too far from the face.  The nose may be too long ; even  “so long” that it nearly touches your lip when you smile.  Most people do not see their profile and, rarely, can make the same objective judgment about their nose that they can about the width, which is visible from the front.  Often, photographs are what drive people to see us for consultation concerning their nose because, “Whoa, I saw what I look like from a side view, and I sure don’t like what I see.”

A complete consultation will include evaluation of the appearance of your nose in all views.  The wise cosmetic surgeon, or plastic surgeon, or facial plastic surgeon will also take into account the dimensions and position of the chin.  It is very important because often the nose appears unduly large because the rest of the face is not large enough.  In other words, there is a disproportion between the nose and the face based on how the other facial structures are formed and what their dimensions are.

The chin often needs to be augmented.  In other words, the profile is improved if the nose is made smaller, and the chin is made larger on the profile.  I am not talking about looking like Jay Leno.   But, I am suggesting, and in some people, just a very small increase in the forward projection of their chin will compliment the improvement in the nose and make the profile as good as possible.  At consultation, it is very important that all aspects of your appearance be considered.  Do not go in with a narrow-minded view of “I need a rhinoplasty.”  The point of consultation is for you to learn and understand what the anatomic issues are.  If the surgeon suggests that you consider a chin implant, do not take it as an insult, but, rather, that the surgeon is thinking about your entire face, and that is exactly what his mission should be.

Cosmetic Surgery For An 11-Year-Old?

Recently on the Fox News channel was one of their occasional investigative reporting series entitled “From the Fox Files.”  This project was called “Operation Teen.”

The reporter and producer called the office of a non-board certified plastic surgeon in a large metropolitan city in the south and made an appointment ostensibly for their 11-year-old child.  All this was somewhat of a ruse:  the point of the consultation was to determine what the doctor’s attitude and disposition would be with respect to the requested cosmetic surgery for an 11-year old.

The 11-year-old patient said that she wanted a chin augmentation, nasal cosmetic surgery and lip enhancement. 

With hidden cameras, the child and ostensibly the mother (in reality, the segment producer), came to the office and first visited with the doctor’s wife who is the “consultant”.  The consultant spent much more time with the patient than the doctor would subsequently.  The consultant recommended that indeed the patient have a chin implant and nose surgery and lip augmentation and said that she would “take care of everything”. 

Then, the “patient” and “mother” were escorted in to see the doctor.  His examination took 52 seconds, according to the voiceover.  He said, “Yes,” and noted that she would be scheduled for surgery the next day.  Interestingly, the program did not raise this issue but I was shocked that there were no provisions made for this patient to have a pre-operative history and physical and appropriate laboratory testing. 

The doctor’s wife had given patient and mother the quotation and all was seemingly well. 

The next day, the “patient” and “mother” plus the segment’s reporter presented themselves at the appointed time for surgery and then revealed to the doctor who they were and asked how and why he could possibly make these recommendations for an 11-year-old. Frankly, it was one of the saddest and poorest commentaries on professional conduct I have ever seen as the doctor tried to weasel out of having blessed the surgical undertaking the day before.  On this visit under tough questioning, he attempted to back pedal in saying something to the effect of “. . . well, we really make the final decision right before surgery.”

What a poor quality professional this doctor was. 

I thought it important to share this with you because, unfortunately, particularly because of the changes in the health care delivery system, many doctors are migrating into cosmetic surgery who neither have the training and background nor the proper ethics.  I am not happy about this; the medical profession at large is not happy with this but we have no control over how an individual doctor conducts his practice and how he may or may not breach the high standards we would like to see in force.

Computer Imaging and Hollywood

There is something magical about computer imaging.  The uniqueness is that the prospective patient can see their predicted result on a computer screen and immediately understand “what it is all about.”

The discussion of cosmetic procedures is often very abstract without some visuals.  The most powerful graphic they can have would be a computerized prediction of the outcome of whatever procedure they are considering, whether it is rhinoplasty, blepharoplasty, face and neck lift, chemical skin peel or neck sculpturing with or without chin augmentation. 

Previously all we had available to demonstrate to patients would be a magic marker to “erase” the bump on the nose.  We have used computer imaging in our practice since 1989.  Today’s technology, of course, is far advanced over those rudimentary computer systems we had and patients very much appreciate the chance to have that as an important part of their consultation.

In Hollywood, the home of the stars, we sometimes kid our patients who come from out of state to see us that “Welcome to Hollywood, now we will show your transformation to a Hollywood star!”

Rhinoplasty Costs in Hollywood

Do rhinoplasties cost more in Hollywood than in other parts of the country?  I suspect they do.  There are several reasons for this.  One is that we do have more superspecialists here performing cosmetic procedures, including rhinoplasty.  Superspecialists tend to command slightly greater fees because of their prominence, their excellence lower rate of re-do or revision surgery.

The cost of doing business is higher in Hollywood than it is in Lincoln, Nebraska or Appleton, Wisconsin.  The labor costs are higher; nurses and surgical assistants command higher wages, all of which are a factor of the higher cost of living in California. Ditto for New York and other centers of excellence.

If one had blepharoplasty and chin augmentation he or she would expect to pay a bit more than you would elsewhere, although not greatly more than in other large cities that have very sophisticated practitioners of cosmetic plastic surgery including New York City, Miami and Houston.

When looking at costs in Hollywood or anywhere else, always be mindful to ask about “the entire cost.”  You need to know what additional costs there would be for the outpatient surgery center, and anesthesia specialists, medications and perhaps even a postoperative recovery facility in which to stay for one or two nights.