Chin augmentation is a cosmetic surgery done to enhance a weak chin or balance the facial features by augmenting the chin using

• Artificial implants
• Bio implants such as bone or tissue grafts taken from the patient or a donor
• Fat grafting or fat injections
• Sliding genioplasty
• Injectables fillers such as collagen, HA etc

A chin augmentation is done when the following conditions exist

• weak chins
• sagging skin in the chin
• unbalanced facial features

• Silicone Implants
• Expanded Polytetrafluoroethylene (ePTFE):
• Polyethylene Implants
• Hydroxyapatite Implants

• Bone Grafts
• Cadaveric Bone Grafts- bone grafts from deceased donors
• Autologous Tissue Grafts (excluding fat) - use of own tissue from elsewhere on your body
• Autologous Fat Transfer (Fat Grafting) - removing surplus fat cells with meticulous extraction methods and to re-implant to the chin
• Cadaveric Tissue Grafts & Cultured Tissue - Cadaveric tissue grafts derived from deceased donors. 
• AlloDerm – made by removing a thin layer of skin tissue (an allograft) from the 'donor' at the time of death, placing it into an antibiotic solution , processing by removing the epidermis and all of the cells in the dermis
• AlloGraft - provided by both cadaveric and family donors
• Apligraft - cultured from infant foreskin cells and bovine (cow) collagen.

• Collagen - an injectable bovine-derivative (made from cow collagen)
• Hyaluronic Acid
• Injectable Hydroxyapatite Paste - injectable paste forms of HA
• Poly-methyl (methacrylate) (PMMA)
• Hydrophilic Polyacrylamide Gel
• Injectable Silicone (polydimethylsiloxane oil)

• Candidates without any cardiac condition or serious incidence of hypertension
• Candidates not taking anticoagulants such as warfarin or heparin
• Candidates with a receding chin and a normal dental bite
• Candidates who wish to improve their external appearance
• Candidates who are physically healthy, psychologically healthy and have realistic expectations from the procedure
• Candidates who seek improvement rather than perfection
• Candidates who are not "overly" skinny, with a major metabolism and have a little extra fat somewhere on the body to spare for augmentation procedures using fat grafting

1. Implants
   • Implants shift out of position requiring a second chin operation to correct the problem
   • Infection
   • Numbness
   • Reaction to the anaesthesia
     
     
2. Sliding genioplasty
   • Under- or over-correction of the defect
   • Injury to the major nerve in the chin
   • Failure of the bone segment to reunite properly with the other parts of the jaw
   • Damage to the roots of the teeth
   • Haematoma
     
     
3. Grafts and autologous mediums
   1. Bone Grafts – bone infection, excessive calcification, secondary site infection
   2. Cadaveric Bone Grafts- rejection
   3. Autologous Tissue Grafts (excluding fat) – rejection, contour irregularities, absorption, additional site infection
   4. Autologous Fat Transfer (Fat Grafting)
      • Infection, haematoma and asymmetry
      • Permanent discoloration due to a ruptured superficial blood vessel at the treatment site during an injection.
      • Calcification
      • Fat embolism resulting in stroke, when a substance has been mistakenly injected into a blood vessel
      • Formation of a distorted look, fatty cysts and fat necrosis if extreme over correction is used
      • Intra- (during) and post-operative bleeding, blood clots at the treatment and removal sites 
      • Vulnerability of treatment sites to blood borne infections for up to three months
      • Formation of scar tissue
        
        
4. Injectable fillers
   • Collagen – allergic reactions
   • Hyaluronic Acid – allergic reactions
   • Injectable Hydroxyapatite Paste - resorption
   • Poly-methyl (methacrylate) (PMMA) - allergic reactions

• During the initial consultation, a thorough discussion on the expectations of the patient is understood
• The dental history and X-ray studies of the head and jaw are taken
• Photographs are taken for further comparison after procedure.
• The doctor discusses and advises on options of anaesthesia, surgery options, incisions (if any), type of facilities and cost with the patient.
• The doctor provides guidelines on eating and drinking, smoking, taking or avoiding certain vitamins and medications
• The patient must arrange for transportation and assistance to leave for home after the surgery

Chin implant surgery (using grafts, artificial implants), Sliding genioplasty

• The patient may seek a copy of the manufacturer’s brochure for the implant (chin implant surgery)
• If the surgeon is planning to make a submental incision, the patient should use an antibacterial facial cleanser for two days before surgery.
• The doctor will perform a physical examination to evaluate the general health, skin and facial structure
• Patients should stop smoking and discontinue all medications containing aspirin or NSAIDs for two weeks prior to surgery
• Patients scheduled for an intraoral approach should rinse the mouth with mouthwash three times a day for two days before surgery.
• The patient should not eat or drink anything for eight hours prior to the procedure.

Fat injections and Injectable fillers

• The doctor will inject a small amount of collagen, usually into the forearm just below the skin's surface, to determine if the patient is eligible for collagen or for certain PMMA treatments.  The injection site should be watched closely for at least 4 weeks for signs of inflammation

1. Chin implants
   • The procedure is performed after administering local anaesthesia with light sedation, local anaesthesia and deep sedation, or general anaesthesia.
   • An incision is made inside the lower lip, or under the chin.
   • A pocket is created at the tip of the chin which is washed out with an antiseptic solution
   • An implant of the desired size and shape is then placed in the pocket.
   • If the incision is inside the mouth, it is closed with sutures (stitches) that later dissolve.
   • If the incision is under the chin, removable sutures are used.
   • The chin is then taped to minimize swelling
     The surgery is completed in 30-60 minutes.
     
     
2. Sliding genioplasty
   • The procedure is performed after administering local anaesthesia with light sedation, local anaesthesia and deep sedation, or general anaesthesia.
   • An incision is made inside the mouth in the area of the lower lip.
   • The tip of the chin bone is then cut with an oblique saw, moved forward and stabilized with wires or plates.
   • The incision is closed and the patient's head is wrapped with a pressure dressing.
     The surgery is completed in 45 minutes to two hours.
     
     
3. Fat injections or fat grafting
   1. The patient is administered local anaesthesia on the
      1. donor areas, the areas from where the fat is to be taken and
      2. the chin area
   2. Fat is removed from the donor site, usually the buttocks, abdomen etc, with a small hypodermic needle
   3. The fat is spun in a centrifuge to remove excess fluids and the damaged fat cells are picked out
   4. The undamaged fat cells are then
      1. injected with the use of a separate smaller hypodermic either just under the chin or deep within the muscle or
      2. Implanted, taking individual strands of fat cells one by one through minute incisions on the chin. The incisions are then closed
         
   The procedure is completed in 1-2 hours.
   Note -The treatment area is overfilled to allow for absorption.
   
   
4. Injectable fillers
   1. Collagen
      • Local anaesthesia may be administered.
      • The collagen is injected using a fine needle inserted at several points along the edge of the treatment site. The patient may feel some minor stinging or burning as the injections are administered, if a local anaesthesia has not been used
      • After a bit of collagen is injected, the doctor/nurse immediately massages the area to smooth out the collagen within before it firms up
      • The area is slightly overfilled to account for the partial absorption of the substance within a few days.
        
        
   2. Hyaluronic Acid
      • The treatment area is wiped with an antiseptic.
      • Local anaesthetic may be used to numb the treatment area.
      • HA is injected either by
        • serial intradermal puncture technique, where a series of small injections are given with a very fine needle or
        • tunnel or threading technique, where the needle is withdrawn as the hyaluronic acid is injected
      • The doctor/nurse then lightly massages the area
        
        
   3. Injectable Hydroxyapatite Paste - injectable paste forms of HA
      • The treatment area is wiped with an antiseptic.
      • Local anaesthetic may be used to numb the treatment area.
      • The paste is injected using a fine needle inserted at several points along the edge of the treatment site.
      • The doctor/nurse then lightly massages the area
        
        
   4. Poly-methyl (methacrylate) (PMMA)
      • The treatment area is wiped with an antiseptic.
      • Local anaesthetic may be used to numb the treatment area.
      • PMMA is injected into the skin by the tunnel or threading technique, where the needle is withdrawn as the PMMA is injected
      • The doctor/nurse then lightly massages the area
        
        
   5. Hydrophilic Polyacrylamide Gel
      • The treatment area is wiped with an antiseptic.
      • Local anaesthetic may be used to numb the treatment area.
      • The gel is injected into the skin by a retrograde technique, where the needle is withdrawn as the gel is injected
      • The doctor/nurse then lightly massages the area

All the procedures are done on an outpatient basis.
Following implant surgery and genioplasty

• The patient experiences some swelling and bruising which will begin to disappear within the first 5-7 days.
• The tape is removed about a week after the surgery
• Black and blue marks may be visible around the chin and neck
• Pain and discomfort last for several days following the procedure which can be eased by pain medication prescribed by the doctor
• Facial movements, such as talking and smiling, may be difficult for several days following the surgery
• The patient may feel a degree of numbness that should disappear within 1 to 3 months
• The patient may wear a support brace while sleeping to allow the tissues and implant to heal in the desired position and prevent shifting in the first few weeks
• The dressings usually remain intact for 48-72 hours.
• The sutures, if any, will be removed in approximately 3 to 5 days
• The plastic surgeon will give instructions regarding dental hygiene, eating and any restrictions to activities after surgery.

Following fat grafting and filler injections
Fat

• Some swelling, bruising or redness in the donor and recipient sites is seen
• Swelling and puffiness may last several weeks while redness and bruising usually lasts about 48 hours

Filler injections- cellulose

• Temporary swelling and redness in the treated area should dissipate within a few days.
• Tiny scabs over the needle-stick areas is seen which generally heal quickly.

Following implant surgery and genioplasty

• The patient should rest in bed for the first day or two after surgery.
• The patient may apply cold compresses, or small ice packs to reduce swelling and relieve discomfort.
• Patients can return to work with the help of camouflaging cosmetics at about 5 days post-op.
• The patient can expect to resume regular activities in about 1 to 2 weeks.
• After a few weeks the chin will feel tender and the patient may also have a feeling of tightness or stretching in and around the jaw, which will gradually disappear within a week or so.
• The patient will be on a liquid or soft-food diet for several days.
• The patient must keep the head raised by using two to three pillows.
• The patient should rinse the mouth with a solution of hydrogen peroxide and warm water two to three times daily
• The patient should avoid sleeping on the face and unnecessary touching of the chin area
• The patient should avoid vigorous physical exercise for about two weeks
• The patient must inform the doctor immediately if any of the following occur
• Temperature elevation greater than 101 degrees
• Sudden swelling or sudden discoloration
• Haemorrhage
• Increasing redness and tenderness of the wound edges indicating infection
• Allergic reaction to drugs
• Shifting of the implant(following chin implant surgery)

Following fat grafting and filler injections

• The patient must arrange for assistance  at home for 1-2 days
• The patient must get plenty of rest and follow a balanced diet.
• The patient must add more raw fruit to the diet and increase fluid intake to avoid constipation.
• The patient must take pain medication as prescribed.
• The patient must avoid alcohol for 3 weeks as it causes fluid retention
• The patient must start walking as soon as possible, as this helps to reduce swelling and lowers the chance of blood clots
• The patient may shower 48 hours after treatment
• The patient must avoid exposing scars to sun for at least 12 months
• The patient must always use a strong sun block
• The patient must inspect daily for signs of infection
• The patient must stay out of the sun until redness and bruising subsides (usually 48 hours)
• Repeated treatments may be necessary
• The patient must contact the doctor if any of the following occur
• increased swelling or bruising
• increased redness along the treatment site
• severe or increased pain not relieved by medication
• side effects to medications; such as, rash, nausea, headache, vomiting.
• oral temperature over 100.4 degrees.
• yellowish or greenish drainage from the treatment site or notice a foul odor.
• bleeding from the treatment site that is difficult to control with light pressure.
• loss of feeling or motion.
• sign of abscesses, open sores, skin peeling or lumpiness.