First is the type of anesthesia to have. It is generally a minor enough of a procedure that it can be done under just local anesthesia like going to a dentist. In addition, some kind of sedation can be given such as oral medications or intravenous sedation, which provide even more relaxation. General anesthesia is also an option and is commonly used when it is combined with other procedures or in a more extensive procedure where the bone is cut and the chin slid forward.
Where to place the incision is also a question. The incision under the chin is short, well hidden and typically leaves a barely noticeable scar. The one inside the mouth under the lower lip leaves no external scar but may have a higher risk of infection.
There are a variety of implant types, styles and sizes that must be considered. Pre-formed silastic implants are popular because of their ease of insertion and the fact that they don’t require any manipulation or carving by the surgeon. These have a very low infection rate and generally provide a very natural result but they do not become incorporated into the bone like more porous implants. These implants require a lot of carving and shaping by the surgeon at the time of surgery and they are less resistant to infection.
The amount of projection the implant provides is determined by its size. Your surgeon should help you determine which implant size would be best for you. All of the pre-fabricated silastic implants come in three or four different sizes. They also come in various styles depending on whether the desired end result is to be a broader chin, a narrower chin or one with a cleft; the latter is usually only inserted into male patients.
Implants can also be positioned more on the front of the chin so that only projection is provided without lengthening the chin or it can be placed more inferiorly on the bone to allow for a slightly longer chin if that is desirable.
For the patient who is not interested in placement of an implant but desires more projection to their chin, a sliding genioplasty is a possibility. In this procedure, the incision is placed in the mouth behind the lower lip. The muscle is elevated off of the jawbone, more extensively that is required for insertion of an implant. A saw is then used to transect the bone in a horizontal fashion, allowing the surgeon to push the bone forward to provide more projection to the chin. It is then secured in place with titanium plates and screws to hold the bone together until they heal together. A porous spacer can also be added between the bone fragments to lengthen the chin at the same time.
This is typically a more extensive procedure with a longer recovery and somewhat higher risks than inserting an implant.
Patients who are considering chin augmentation are often mostly concerned about the appearance of their chin and neck on profile. It is possible to perform liposuction of the neck at the same time as a chin augmentation surgery through the same incision to improve the neck contour.