Trans - World Med

As Published in TGForum

TG Medical:
Putting Your Best Chin Forward

f you are blessed with a broad masculine facial profile and a desire to look more feminine, Facial Feminization may involve more than superficial skin augmentation. But now beauty becomes more than skin deep and some serious realignment of the facial bones may be the answer. We are aware of the differences in the appearance of a "fixed" nose, but rarely can we detect the "fixed" chin or forehead or cheekbones because the changes are more peripheral on the face and less obvious. But these shapes all contribute to the overall cosmetic appearance of the female face. This is the beginning of a series of three articles describing facial reconstruction, when the previously described superficial procedures won't do the trick.
Chin Profile

The chin sits in relationship to the lower lip, the draping of skin below it and the angle of the lower jaw with the neck. If the angle of your profile drawn from the forehead to the chin and then to the neck is less that 75 degrees or greater than 90 degrees you may want some revision. It is easier to add length to a receding chin than to decrease a protruding chin or add height below the lip, but today all is possible using a procedure know as the sliding medial genioplasty. Prior to the introduction of this procedure, alloplastic grafts of synthetic materials as solid Silicone, Gore-tex and Mersilene mesh have been shaped and added to the chin. These are still inserted with ease by most Plastic Surgeons. In about 2% of the cases these have been removed because of infection, displacement, extrusion, capsular contraction or bony erosion.

Meticulous measurements of the face are first made and compared with skull x-rays taken in different views to attain proportionate facial features. A dental panoramic x-ray is usually made to look for occlusion abnormalites which can be corrected simultaneously with the procedure.

Under local or general anesthesia an incision is made inside the lower lip to dissect the muscles and nerves away from the jaw bone allowing a horizontal incision to be performed on the lower jaw just above the chin. If your dental occlusion is already perfect there is no need to change the alignment of the teeth. Small vertical incisions on each side at the midpoint of the jaw allow the chin to become mobile. The bony chin then may be moved forward or backward, side to side if there is facial asymmetry or upward or downward using bone grafts. Forward displacement is never more than 8 mm. and backward displacement is up to 4mm. With the attainment of the proper position, the bone then is screwed in place using a titanium plate in the shape of a stairstep or fixed with wires to immobilize the chin. Fusion with the jaw will then take place with rare exception. With the use of perioperative antibiotics, graft infection is very rare. Postoperative bleeding may require some aspiration in the office.

Chin Profile

This procedure is usually done in combination with other plastic surgery such as neck lipoplasty (fat removal), rhinoplasty (a nose job) or a face lift. Total operating time for the genioplasty is around one hour depending on what has to be done. The result is usually a lengthening of the jaw line, resulting in a narrow chin with stretching and elevation of the muscles and skin below the jaw. The soft chin pad can then be sculpted to fit the new protuberance. This is usually an outpatient procedure with moderate postop pain and swelling.

In general there may be many Plastic surgeons who are not as experienced with facial bone surgery as Dr. Ousterhout, but may have done a dozen or more genioplasties qualifying their expertise in this procedure. One of the more serious complications is injury to the mental (chin) nerve which supplies sensation to the lower lip and chin. With proper knowledge and dissection this can easily be avoided. In reading a paper of Dr. O's describing how to avoid damaging the sensory mental nerves, I noted that Dr. O delivered the paper in St. Tropez, France. And all I really wanted to know, "Was it in a one-piece or two piece bathing suit?"

Tune in next month to learn about rhinoplasty or "How they really can fix your nose."

Best Wishes in Your New Future,
Cerise Richards, M.D.