Chin and Malar Augmentation

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Chin and Malar Augmentation

• Ravi Pachigolla, MD
• Karen Calhoun, MD

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Introduction

• Chin augmentation
• Malar augmentation
• Chin augmentation more developed

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Chin projection

• Line perpendicular to the frankfurt horizontal at
  lower vermilion
• Legan Angle
• Merrifield Z angle
• Gonzales-Ulloa
• Line from lips to chin

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Frankfurt horizontal line
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Other methods of chin projection
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Quick chin projection
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Occlusal Relationship

• Microgenia
• Micrognathia
• Retrognathia
• Address occlusal problems first

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Augmentation

• Sagittal augmentation
• Vertical augmentation secondary
• Lateral augmentation tertiary

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Lower lip analysis

• Lower lip posterior to upper lip
• Chin soft tissue pad thickness
• Labiomental fold crucial
• Caution in patients with high labiomental fold

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Chin Pad Thickness

• Soft tissue thickness of 8 to 11 mm normal
• Avoid setting back jaws with thick pads
• Attempts at setback leads to bony irregularities,
  soft tissue pad ptosis and an unsupported chin pad

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Biomaterials

• Silicone implants inert
• Supramid - moderate foreign body reaction
• Proplast type I and type II - harder to carve
• ePTFE - less underlying bone resorption
• Porous vs. nonporous implants

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Surgical Techniques

• Intraoral vs. extraoral
• Placement of implant subperiosteally
• Advantages and disadvantages
• Center the implant
• Closure in layers with pressure dressing for days
• Placement on the pogonion

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Pogonion Placement and sublabial filler
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Chin Fixation
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Complications

• Technically easy
• Size mismatch
• Malpositioned implant
• Removal of implant
• Lip numbness

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Malpositioned implant
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Implant removal
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Lip Numbness
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Postoperative Result
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Malar augmentation

• Indications for augmentation
• Aesthetics of the malar mound
• More youthful appearance

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Determination of malar eminence
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Hinderers malar eminence
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Powells eminence
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Prendergast
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Implant types

• McGhan
• Binder submalar
• ePTFE
• Porous polyethylene

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Operative Techniques

• Intraoral incision usually
• Elevation over zygoma
• Precise pocket
• Fixation unnecessary

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Complications

• Malpositioned implant
• Infection
• Sizing most common complaint
• Small audmentation can be performed with ePTFE
• Silastic only used with sinus fracture