- Facial Surgery
A facial profile is considered aesthetically balanced when the chin meets a vertical line drawn downwards from the lower lip while the head is in the Frankfurt position. About 10% of patients who request rhinoplasty may benefit from chin augmentation. (Figs. 18 – 7,8) Materials: We prefer to use the Silicon Allograft. Other allografts are commercially available: Marsilene Mesh, acrylics, Sialastic and Teflon. Silicon allografts are easily trimmed, readily available, no reabsorption, relative postoperative tissue tolerance, easy and quick to insert. Disadvantages:
- Implant mobility (free floating)
- Infection: The fibrous capsule formed around the implant acts as a barrier to infection. Therefore, a treatment of antibiotics is justified when the implant site becomes infected, as it is possible to heal without removing the implant.
- The silicon implant size is chosen, autoclaved as described in its information sheet, transferred to Cidex solution for one hour before insertion, then washed with normal saline.
- The skin of the chin and submental region is well cleansed with aseptic solution and drapped.
- A horizontal two cm submental incision is made through the skin. The musculocutaneous flap is elevated to one cm superiorly, then the dissection is carried up to the periosteal layer of the lower symphysis.
- The middle dissection is carried subperiosteally, creating a pocket just medial to the mental nerves. The objective is simple-fill the deficiency. In severe microgenia, two to three implants may be sutured together.
- No-touch technique: the implants should be held by sterile forceps when transferring from the autoclave to Cidex to tray to subperiosteal pocket. Curved hemostats are used to push the graft into position. This reduces the risk of contamination and infection.
- The implant should be positioned between the pogonion and menton level to achieve the most natural chin profile.
- Four burried interrupted 4/0 Dexon are placed deep in the soft tissue below the implant, at the upper limits of dissection of the elevated musculocutaneous flap. This will hold the implant in the pocket and reduce the possibility of implant mobilization and displacement. The flap technique will also prevent later dimpling of the scar.
- The skin is then closed with subcuticular 5/0 Prolene or nylon.
- Steri-strips are applied to the skin around the implant, above, below and along the side of the implant, in order to reduce the possibility of displacement. The steri-strips are removed after ten days. (Fig. 18 – 6)
- An elastic bandage (Elastoplast) is applied. This remains for one week.
- The patient is instructed not to brush the lower teeth in order to avoid excessive movements of lower lip and chin and asked to eat a liquified diet for seven days.
(A)Fig. 18 – 6. (A) Chin augmentation: The Silicon implant size is chosen, autoclave as described in its information sheet, transferred to Cidex solution for one hour before insertion then washed with normal saline. No touch technique: the implant should be held by sterile forceps from the autoclave to Cidex to tray to subperiosteal pocket. A horizontal two cm submental incision is made through the skin and dissection is carried up to the periosteal layer. The implant should be positioned between the pogonion and menton level to achieve the most natural chin profile.
Fig. 18 – 7. The ideal chin projection as described by Leonardo de Vinci. The vertical facial plane line should meet the soft tissue nasion, lower lip and the chin. The Franfurt horizontal is a plane connecting the superior border of the external auditory meatus to the infraorbital rim. Fig. 18 – 8. In the aesthetically ideal patient, both the upper and lower lips should lie slightly behind the E line of Ricketts, with the lower lip closer.
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