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Deep Mental Crease

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Fig. 56.1. a Wide chin turning the "triangle of youth" upside down. b Reversion of this triangle makes the appearance more feminine, and more youthful

Fig. 56.2. a Submental skin excision with simulating cannula for liposuction above the skin. b Liposuction performed below the skin. Witch's chin c before and d after its correction performed together with face-neck-lift

If the submental crease is too deep, we make skin excision. We cut the underlying slice of connecting and fat tissue so that a proximal distal flap can be formed, turned backwards, and sutured below the proximal edge of the skin excision. In this way, the submental depression has been filled up. An intradermal pull-out skin suture finishes the procedure.

The asymmetry could also arise as a problem either through atrophy on one side or as unilateral hypertrophy.

If asymmetry is due to hypertrophy, we can correct it by gentle liposuction.

1. 56.3. a Witch's chin correction. b Subcutaneous flap reversed and sutured. c Witch's chin with submental excess skin. d After face-neck-lift and witch's chin correction, submental skin is tightened and the mento-cervical angle is well defined. The same patient from the other side e before and f after correction
2. 56.3. a Witch's chin correction. b Subcutaneous flap reversed and sutured. c Witch's chin with submental excess skin. d After face-neck-lift and witch's chin correction, submental skin is tightened and the mento-cervical angle is well defined. The same patient from the other side e before and f after correction

Fig. 56.4. a Hypotrophy of left side of the chin. b Four months after microlipofilling of the left chin, lips, and nasolabial folds

Fig. 56.5. a Slight lipohypertrophy of the right side of the chin. Ten years ago, this woman was Miss World. b We removed excess fat and used it for minimal lip correction. Nobody can get enough of beauty

Fig. 56.6. a Putting the implant over chin skin, we check if the implant size is appropriate. b Translabial approach of implantation. Patient c before and d after face-neck-lift, submental liposuction, and chin implant

For chin augmentation a horseshoe-shaped sili-cone implant of proper size is the most suitable and least complicated method. This shape of implant does not produce pressure on underlying bone and consequent atrophy of it.

It is possible to make the implantation through a submental skin incision, but we prefer the infralabial approach without visible scars. The 3-cm-long incision on the lower lip should be done at least 5 mm above the lower preoral vestibular crease. If the inci

1. 56.7. a Incision of 3 cm with radiosurgery does not bleed. It is placed 5 mm above the lower preoral vestibule. b Implant insertion into prepared subperiosteal pocket. c Suture line does not involve the gingiva. d Check of the ends of the "horseshoe" silicone implant
2. 56.7. a Incision of 3 cm with radiosurgery does not bleed. It is placed 5 mm above the lower preoral vestibule. b Implant insertion into prepared subperiosteal pocket. c Suture line does not involve the gingiva. d Check of the ends of the "horseshoe" silicone implant

Fig. 56.8. Chin a to be corrected and b after implantation it looks rejuvenated

Fig. 56.8. Chin a to be corrected and b after implantation it looks rejuvenated sion were in the deepest crease of the lower preoral vestibule, we could not suture it onto the gingiva. Once we have come with our rasparatorium to the tip of the mentum, we should create a subperiosteal pocket symmetrically left and right, but not too wide and not too narrow.

After the silicone implant has been placed, we clean the pocket with dilute Betadine solution.

If somebody has a chin dimple which is undesirable and has excessive alar cartilage of the nose, like "cherry tip deformity", we can diminish it by use of a crushed cartilage graft. Through translabial approach of the lower lip, we reach the subcutaneous layer below the dimple, divide the skin adhesions which connect skin and periosteum like a retaining ligament, and insert crushed alar cartilage into the preformed pocket.

Fig. 56.9. a Undesirable chin dimple b flattened with crushed cartilage. c Alar cartilage removed from the nose. d Crushing cartilage with a hammer

Sometimes there is a supramental crease which is -

too deep and disturbs somebody's facial harmony. We Bibliography can flatten it in a similar way as for a witch's chin. We excise 2-3 mm of skin, prepare a pedicled slice flap Please see the general bibliography at the end of this from mental subcutaneous tissue, which is pretty book. firm, overlap it, and suture it below the upper skin edge.

Fig. 56.10. a Supramental deep longitudinal notch en face. b After tient. d Postoperative look excisional flattening.

c Preoperative side view of the same pa-

Fig. 56.10. a Supramental deep longitudinal notch en face. b After tient. d Postoperative look excisional flattening.

c Preoperative side view of the same pa-

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