Author: Dr. Oreste Di Mattei Di Matteo

date: 20/01/2020

 is the aesthetic surgery of the chin.
Mentoplasty can:

  • correct defects
  • improve the aesthetic appearance of the face
  • restore mouth function

Why undergo mentoplasty?
Mentoplasty can be performed for several reasons:

  • To correct malformations of the chin resulting from abnormalities in the development of the jaw bones causing facial asymmetry
  • To reshape a chin that is disproportionate to other parts of the face
  • As part of craniofacial reconstruction following injury or cancer surgery
  • As part of orthognathic surgery. (Orthognathic surgery involves the repositioning of facial bones to correct deformities that affect the patient's ability to speak or chew normally).

Who undergoes menoplasty?
Mentoplasty is performed on adults.
Mentoplasty is not among the most frequently performed procedures in plastic or aesthetic surgery.
Mentoplasty is generally combined with other plastic or aesthetic surgeries, for example:

Women undergo mentoplasty more often than men.
Types of mentoplasty: additive mentoplasty and reductive mentoplasty
Mentoplasty can be classified into 2 categories:

  • Additive mentoplasty. This is surgery that uses procedures to increase a small or receding chin.
  • Reductive mentoplasty. This is surgery that uses procedures to reduce a large, prominent or prognathous chin.

Increasing the size of the chin is more frequent than the reduction of the chin (a receding chin is the most common chin defect).

Additive mentoplasty: chin augmentation
Chin augmentation can be performed with 2 techniques:

  • by inserting an implant under the skin of the chin
  • by performing a sliding mentoplasty (in cases where it is not possible to insert a prosthetic implant)

The duration of additive mentoplasty surgery varies according to the type of procedure:

  • Implant insertion takes between 30–60 minutes
  • Sliding genioplasty (sliding mentoplasty) takes slightly longer, between 45–90 minutes.
  • Combined with orthognathic surgery, the procedure can take up to 3 hours.

Additive mentoplasty: implant
In patients 
with mild or moderate microgenia (small chin). These implants are nothing more than biocompatible synthetic materials (they are organic materials so as to reduce the risk of infection).
To insert the implant, the surgeon can choose to make the incision:

  • under the chin (submental)
  • inside the mouth (intraoral)

The surgeon makes a pocket in the connective tissue inside the chin where the sterilised implant is inserted and positioned correctly.
The incision is closed and the wound covered with sterile gauze.

Additive mentoplasty: the sliding surgery technique
A sliding mentoplasty can be performed if the patient's chin is too small for chin augmentation with an implant, or if the deformity is more complex.
With this procedure, the surgeon cuts the jaw and removes part of the bone.
The bone segment is moved forward
and held in place with metal plates and screws.
After fixing the bone segment in position, the incision is closed and the patient's head is bandaged with a dressing that exerts some pressure on the treated area.

Reductive mentoplasty
The reduction of an excessively large, protruding or prognathous chin can be performed in 2 different ways:

  • direct reduction
  • sliding reduction

In a direct reduction, the surgeon performs the operation either by cutting under the chin or making an intraoral incision and removes excess bone from the chin with a surgical burr.
A sliding reductionis a technique similar to that used in chin augmentation (sliding genioplasty or sliding mentoplasty), except for the repositioning of the bone segment in this case is moved backwards rather than forward.

Mentoplasty: diagnosis
The diagnostic evaluation consists of:

  • facial analysis
  • dental history
  • complete medical history

In facial analysis, the face is divided into 3 parts.  
The surgeon compares the proportions in order to determine the most suitable procedure for rebalancing the appearance of the face.
Dental history. Dental history and X-rays of the teeth, skull and jaw are required to determine whether the disproportion of the face can be corrected by an implant (if aesthetic surgery is required), or whether orthognathic surgery or a combination of operations is necessary.
Patients with severe malocclusion (irregular contact between the teeth of the upper and lower jaws) or facial bone deformities should consult a maxillo-facial specialist for reconstructive surgery.
Assessment of expectations. Finally, the surgeon will assess the patient to detect any signs of psychological instability, including unrealistic expectations of the results of the surgery.

Mentoplasty: preparation for surgery
The most common indications to follow before surgery are:

  • quit smoking
  • discontinue all drugs containing aspirin or NSAIDs for 2 weeks prior to menthoplasty.
  • use an antibacterial facial cleanser
  • use a mouthwash 3 times a day for 2 days before intraoral surgery
  • do not eat or drink within 8 hours before surgery

Mentoplasty: after surgery
Patients will require assistance after the procedure.
Pain medications and antibiotics are prescribed to reduce the risk of infection.
Most patients can return to work within 7 to 10 days.
Other aspects of post-surgery include:

  • a liquid diet or semi-liquid foods
  • raising your head with pillows
  • rinsing your mouth
  • avoiding exercise for about 2 weeks

Mentoplasty: the risks

  • Infections
  • Bleeding
  • Allergic reaction to anaesthesia
  • Chin deformity
  • Chin nerve damage
  • Erosion of the bone under the implant
  • Displacement of the implant
  • Implant extrusion
  • Over or under-correction of the defect
  • The bone segment is not correctly repositioned with the other parts of the jaw
  • Damage to the roots of the teeth
  • Haematoma (may damage overall results due to the pressure distorting the final shape of the chin)

Mentoplasty: results
Results of additive mentoplasty (augmentation) or reductive mentoplasty (reduction) include:

  • Correction of facial asymmetries and disproportions
  • Improved jaw function

Patients are usually very satisfied with the results.

Mentoplasty: minimally invasive alternatives
Some patients prefer to reshape their chin with a temporary or minimally invasive procedure and then decide whether to undergo mentoplasty.

Fillers, hyaluronic acid
In certain cases it is possible to augment the chin by inserting hyaluronic acid.  The substance injected is resorbable and therefore the procedure is reversible.

Lipofilling, injecting fat.
In some cases, autologous fat (fat taken from the same patient, treated and purified) can be injected into the area under the chin.
This technique has limits in its applications, as it is aimed at cases of small chin sizes.
In addition, fat injections 
must be repeated periodically, as the fat is gradually absorbed by the body.

Facial liposuction can be used in combination or instead of mentoplasty to improve the patient's profile. In particular, removing fatty tissue from under the chin can make the chin appear larger and more prominent.

Mentoplasty makes it possible to restore the aesthetic harmony and proportions of the face; in addition, mentoplasty also corrects deformities that can negatively affect one's quality of life.

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