A woman in her late 30’s who is bothered by a weak chin as well as submental fullness. She is shown 3 ½ months after a chin implant and 2 months after the placement of 4 vials of Kybella to the submental area. She has gained 4 lbs since the Kybella treatment but the submental area is more refined and gives her the appearance of having lost weight. We can typically expect the area of Kybella treatment to continue to improve over the next 2 months.
A woman in her early 20’s who was interested in chin augmentation and rhinoplasty. She did not like the overall shape of her nose and the dorsal hump, and also feels that her chin is too small for her face. She also had a history of nasal obstruction and would snore at night and wake up with a dry mouth in the morning. She is shown before and again, 6 weeks after an open rhinoplasty with straightening of her septum and placement of spreader grafts to correct collapse of the internal nasal valve. She had a solid silicone anatomic chin implant placed through an incision under the chin at the same time. Her nasal obstruction is improved, and she is thrilled with her natural appearing improvement. The nose looks better already at the 6 week mark but will typically continue to improve in the tip area over the next 3 years as swelling gradually resolves.
A woman in her late 40’s who is bothered by an aged appearance of the face. She has a weak chin which worsens the appearance of her neck and jowl laxity. She is shown before and again, 6 months after a Lateral SMAS facelift combined with fat grafting to the midface (to replace volume lost through the aging process) and placement of a solid silicone anatomic chin implant through a submental (below the chin) incision. The scars in front of her ears are beveled around the sideburns to prevent over elevation of the sideburns. The beveling allows the hairs to grow up through and hide the scar.
A woman in her late 60’s who did not want a face lift but wished to have a simpler surgery that would still improve her chin balance. She is shown 3 months after the placement of a medium Flowers Mandibular glove implant through a submental incision. Even though she did not have a facelift, her neck is also improved by treating her weak chin. A quick test to see if a chin implant will be helpful is to draw a line connecting the upper and lower lips. The chin should come out close to this line (“Riedel’s line”). As in everything is plastic surgery it is always better to under correct it slightly so that it does not look too prominent.
A woman in her mid 20’s who was bothered by the appearance of her nose as well as having difficulty breathing. On examination she was noted to have a weak chin as well. Whenever someone is considering rhinoplasty we are taught to always look at the chin. If it falls behind a line that connects the lips, it is usually”weak” or too small, and a chin implant or advancement of the chin can dramatically improve the results. She is shown before and again, just 6 weeks after an open rhinoplasty along with placement of a medium chin implant. It is better to under correct the chin slightly rather than having it appear too “strong” or masculine in appearance. She is already thrilled with her new look. The tip will typically continue to appear more refined over the next 3 years as the swelling diminishes. We also corrected deviation of the septum and vestibular stenosis at the same time- her breathing was obstructed by deviation of her septum but also collapsed inside at the “nasal valve”area when she inhaled- the area that is improved with BreathRite type strips. We corrected this with “spreader grafts”,a strip of her septal cartilage that sits up high on the inside along the top edge of the septum and prevents the collapse. Her breathing is corrected now, and she is very happy to have a beautiful and refined look to her nose and face.
A professional in her mid 30’s who is bothered by a crooked nose, dorsal hump, difficulty breathing. On examination she was noted to have significant deviation of the septum as well as vestibular stenosis. Vestibular stenosis is the collapse of the nose when someone breathes in that takes place at the “nasal valve” area and is often temporarily improved with “Breath rite” strips. She was also noted on exam to have a “weak chin”. The chin falls behind an imaginary line that touches the upper and lower lips. She is shown before and again,4 months after an open rhinoplasty with correction of the vestibular stenosis by placing “spreader grafts”, a match stick shaped piece of the septal cartilage. She also had a medium chin implant placed. She is thrilled with her early improvement, and no longer has obstruction of her breathing. Her husband notes that she no longer snores at night. The nasal tip will continue to gain refinement over the next 2 1/2 years. The slight pinkness of her nose is a sunburn from the weekend.
The same patient is now shown in her mid-50’s. Her upper face has held up well following her brow lift and blepharoplasties from 10 years before. She has some slight “weakness” of the chin and elected to have a small chin implant placed at the same time. She is shown before and again, 5 months after a short scar MACS face lift combined with a chin implant and micro fat grafting. Facial aging is mainly due to volume loss as we age. Although lifting the tissues improves the appearance, filling the tissues at the time of lifting gives a more natural appearance. When a patient has a second facelift they are at risk for descent of the skin at the sides of the mouth, sometimes called “jokers’ lines” and it is important to support this area with additional volume at the time of surgery. She also had Sharp needle intradermal fat grafting (SNIF) (link here for the utube video)as described by Dr’s Zeltzer, Tonnard and Verpaele in 2012 to improve the deep line between her lower lip and chin. She did not require further surgery to her eyes, brow and mid face at this time. In addition to improving her facial balance and making her nose appear smaller, the chin implant also improves the appearance of the neck after surgery.
A young man in his early 20’s who comes in concerned with a “hump” on his nose and trouble breathing after an old fracture of his nose from high school. He was noted to have a “weak” chin (“hypogenia”) which made his nose appear larger. When he breathed in quickly, his nose collapses in the mid portion a condition known as “vestibular stenosis”. This is typically improved with commercially available external tape strips but can be improved at the time of surgery with an internal graft, called a “spreader” graft. Plans were made to correct his weak chin with a small chin implant at the time of his nasal surgery to lower his dorsal hump by 3 mm, shorten the nose by 3 mm and elevate the tip to sit just higher than the new dorsal line. The tip cartilages were also reshaped with a “non destructive tip rhinoplasty” with shaping of the cartilages with internal sutures and a cartilage strut to add additional strength to the nose and resist the forces of healing which would tend to pull the tip back down. Although the nose will continue to improve in appearance for 2-3 years after surgery, he already has a marked improvement. His breathing is also improved.
A woman in her late 40’s complained of her nose being “too large”. Her nose has excellent aesthetics however, and after analysis it became clear that her chin is too small (“hypogenia”). She is shown before and again 6 weeks after chin augmentation with a solid silicone implant placed through an incision under her chin. Although no surgery was performed on her nose, it appears proportionally smaller and in better balance with her face in the after photograph.