Which mentoplasty technique is most recommended for mandibular asymmetries?

Mentoplasty is the surgery that aims to achieve natural changes in the shape and position of the chin in order to harmonize it with the rest of the facial structures.

In what type of patients is mentoplasty indicated?

It is mainly indicated in those patients who present alterations in the projection (by excess or defect) or symmetry in the chin area. In general, isolated mentoplasty should not be performed to correct global problems of the mandibular bone (micro-retrognathia or prognathism) with bite alterations. In these cases, the option of joint maxillary and mandibular surgery (orthognathic surgery) should be considered. However, there are patients in whom the relationship between the teeth is normal and isolated mentoplasty could easily camouflage jaw problems without the need for major surgery.

From what age can it be performed?

Mentoplasty, as well as any other surgery that aims to change the shape and position of the facial bones, should be considered once the skeletal development of the patient is completed, which is usually from the age of 18-19 years.

What does the intervention consist of?

There are three main types of interventions possible. Firstly, there is the option of mentoplasty by osteotomy or cutting of the mandibular bone. This surgery is usually performed by the maxillofacial surgeon, who has more experience in facial osteotomies. It consists of making, with an intraoral approach, a cut in the chin area (anterior region of the jaw), under the dental roots and chin nerve. The purpose is to mobilize the chin, which will later be fixed with osteosynthesis materials in the position previously planned by the surgeon with the patient.

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With this technique, better long-term results are achieved, since, as there is no prosthesis, there is no risk of rejection, fibrosis or mobilization. In addition, there are no external scars, and it allows the correction of mandibular asymmetries with greater predictability than with prostheses.

The second option is mentoplasty with filling materials. It consists of filling the chin area to give it more projection, either by lipofilling, i.e. transfer of the patient’s own fat, or with resorbable fillers, generally hyaluronic acid.

The disadvantage of this second option is that it is difficult to achieve a predictable and homogeneous result because a liquid material is inserted and modeled. In addition, there is a loss of the filling material over time that often makes reoperation necessary to maintain the result.

Finally, the third possible mentoplasty procedure is the one that uses prostheses. In this procedure a prosthesis of silicone or other material (medpor, titanium) is implanted, of small dimensions, whose texture and hardness resembles the bone, thus preventing a notable difference between a natural chin and the one that has been improved with a prosthesis. The procedure can be performed intraorally or in the neck, under the chin. The problem with this option is that practically 100% of the prostheses usually generate long-term inconveniences, with foreign body reaction, movement of the prosthesis or even erosion of the bone, and then they must be removed. This is why it is not the most recommended technique, especially if the patient is young.

For all these reasons, chin cutting is the most effective and safe technique. With the planning software and the 3D image tests, the patient decides in which part of the bone he wants to make the cuts and the program allows him to move it in the three axes of space, creating different result options. The patient only has to choose the one he/she likes the most, how it would look with more or less advancement. The patient is thus able to foresee how the result would look like.

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Then, thanks to this planning, the guides are used in the operating room to make the cuts in the bone: the specialist moves them and fixes them with the mini titanium plates and screws made to measure. Stability is achieved and the bone is prevented from returning to its initial position; in this way, the changes obtained are definitive and stable in the long term.

When are the results visible after mentoplasty?

The results are appreciable from the immediate postoperative period. The technique is performed on an outpatient basis under sedation and local anesthesia. The initial swelling resolves in a matter of 7-10 days, making normal life (except for certain sports) in about 2 weeks.