Facial Implants

Chin Implant

Many patients desire facial balance and request chin augmentation without having to "cut the chin bone." This procedure is often combined with other procedures or may be performed as a simple out-patient procedure. Chin augmentation is available to accomplish chin advancement and accentuation of the jaw line with the placement of custom-contoured chin implants. Support of the soft tissues of the lip, jaw line and neck is the foundation that prevents or delays aging of this area of the face.

Method of Surgery

Many surgeons place chin implants by making an incision underneath the chin. The greatest flaw with this technique is that they are unable to alter the common bony asymmetry of the chin bone itself which often results in a post-surgical asymmetry. Secondly, it is very difficult to assess facial midline and place the implant on facial midline. Right-handed surgeons viewing the chin from below with this technique will often place the implant improperly off midline to the right. Finally, in isolated chin implant placement, the technique requires a skin incision on the facial skin of the neck.

Dr. Watson, having trained extensively in skeletal surgery, uses an intra-oral approach which allows a camouflage of the incision, recontouring of the bony chin asymmetry if needed, assessment of facial midline by viewing the chin from top-side down, placement of the chin implant on facial midline and fixation (stabilization) of the implant with small, non-palpable, titanium screws assuring that the implant will not move. The oral incision is closed with resorbable sutures (melt away on their own) and there is no increase in the rate of infection.

Recovery

The recovery for this minor, isolated procedure is rapid. Following the resolution of the majority of swelling in 72 hours, most patients are able to return to work or school. A decrease in lower lip sensation is temporary and normal sensation will return in 10-14 days. Within 2 weeks, the sutures will have dissolved and the incision will begin to disappear. Excellent oral hygiene is essential with the use of an antibiotic mouth rinse (Peridex) and tooth-brushing three times per day. The patient is placed on post-operative antibiotics and anti-inflammatory medication. The results speak for themselves!

Genioplasty

Genioplasty, or bony chin advancement or reduction, is a procedure that evolved from the techniques of Orthognathic (Jaw) surgery. Prior to the development of silicone chin implants, it was the only option available for chin recontouring.

However, this technique is still readily used today, and for many patients, provides a distinct advantage to chin implants. First, the technique can be used to reduce the length, overall size or set back the prominent chin. Second, with chin advancement, it allows the advancement of the suprahyoid musculature (muscles of the neck) for patients with weak chin/neck angles and definition. Third, it allows the use of the patient's own tissue without implantation of a silicone implant. Finally, it permits the correction of horizontal or vertical asymmetries of the chin.

Method of Surgery

Because of his extensive training in skeletal surgery, Dr. Watson uses an intra-oral approach which allows a camouflage of the incision, recontouring of the chin bone asymmetry if needed, assessment of facial midline by viewing the chin from top-side down, and then a bone cut (osteotomy) of the chin itself. The chin bone is then positioned as planned pre-operatively with the accuracy of 0.5 mm, and then the segment is positioned with a small, non-palpable titanium plate. The oral incision is closed with resorbable sutures (melt away on their own) and there is no increase in the rate of infection. The bone heals rapidly over the course of 6 weeks.

Recovery

The recovery for this minor, isolated procedure is rapid. Following the resolution of the majority of swelling in 7-10 days, most patients are able to return to work or school. A decrease in lower lip sensation is temporary and normal sensation will return in 10-14 days. Within 2 weeks, the sutures will have dissolved and the incision will begin to disappear. Excellent oral hygiene is essential with the use of an antibiotic mouth rinse (Peridex) and tooth-brushing three times per day. The patient is placed on post-operative antibiotics and anti-inflammatory medication. The results speak for themselves!

Cheek Implants

The technique of The Four Dimensional Facelift often includes enhancement of the facial skeleton. Some patients age prematurely because of a lack of support of the soft tissues by the facial skeleton. Early aging in this regard is analogous to the collapse of a roof in a rainstorm that has insufficient beams to support the structure. As we age and the effect of gravity causes a forward and down migration of soft tissues on the face, distinct lines, or rhytids, form. If a patient is born without prominent cheek bones, they tend to lack the taper of the facial form like an upside-down triangle. In youth, patients may appear to be flat in the tissues lateral to the nose and slightly hollow underneath the eyes. However as the individual ages, the cheek fat pad which initially sat over the prominence of the cheek bone tends to fall into an area forward, down and close to the nose. This phenomenon causes the classic aging characteristic of the "nasolabial fold," or the line that patients call their "marionette line."

For the treatment of patients with adequate size and shape of cheek bones, the treatment of this condition involves precise repositioning of their cheek fat pad in the vector, or direction, from which it migrated over the years.

However, in patients with inadequate cheek bone size and position, "pulling" the cheek pad up and back will shortly result in relapse. As the analogy continues, reinforcing the shingling on the roof will not help support the weight of the rain. Rather, we recommend that we enhance the facial skeleton (a.k.a. support the roof) by augmenting the cheek bones. This is simply done by placing precisely sized and positioned cheek implants.

Method of Surgery

There are many techniques for the placement of facial implants, however most lack the ability to precisely examine the native underlying bone, alter asymmetry and carefully position both cheek implants under direct vision to achieve symmetry of size and position. Dr. Watson’s technique is to create a small access opening to the cheek bones from inside the upper lip. The tremendous advantage to this access point is that it is painless to the patient, it does not leave a noticeable scar and it allows direct visualization of the patient's cheek bone structure, alteration of asymmetry and precise positioning and fixation (with bone tacks) of the implant.

Recovery

Once healed, the implants look and feel like the patients NORMAL bone structure. The oral incision is closed with sutures (stitches) that are resorbable (melt away on their own). For patients undergoing a simultaneous facelift, this allows phenomenal support of the cheek fat pad and not only enhances the initial result, but more importantly, enhances the longevity of the result. Results simply last longer.

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