Chin augmentation with cervical flaps associated with rhytidoplasty

1 Ferreira Segantini Cirurgia Plástica, Uberlândia, MG, Brazil. Conflicts of interest: none. Introduction: The lack of chin projection in the lower third of the face is sometimes responsible for the breaking of the facial contour harmony. Alloplastic implants, fillers, and osseous advancements have been used to correct these deformities. In this study, we propose a new maneuver to increase chin projection by using a cervical flap associated with rhytidoplasty. Methods: We assessed 11 patients who underwent operations using the cervical flap for chin projection between January 2017 and January 2018. The inclusion criteria were only patients who desired chin augmentation without the use of prosthetics, fillers, or osseous approaches, and those who would undergo rhytidoplasty. Results: A cephalometric analysis revealed improvements in chin projection and cervical contour, and no complications in the immediate or late postoperative period. Conclusion: In addition to presenting satisfactory results and acceptance, the cervical flap used for chin augmentation eliminated the use of synthetic materials, reduced surgical costs, and improved safety and durability, achieving a more refined mandibular contour and natural chin projection. ■ ABSTRACT


INTRODUCTION
The chin plays a major role in the contour of the lower third of the face; its absence or excess causes an aesthetic rupture and break in facial harmony. The chin morphology is determined by osseous components and soft tissues, which vary with sex and age. Most of the aesthetic changes of the chin are evident mainly in the local osseous component 1 .
Generally, most complaints encountered in medical practice emphasize discontent with the cervical region. However, without identifying the disproportions of the chin components in the local context, it is up to the physician to ascertain the correct interpretation and suggest the best management for each patient.

OBJECTIVE
To describe a new technique for chin augmentation using a cervical flap associated with rhytidoplasty.

METHODS
This study was a prospective evaluation of 11 female patients between the ages of 40 and 65 years who underwent a chin augmentation with cervical flaps between January 2017 and January 2018, performed by the author through private services (Ferreira Segantini Plastic Surgery-Day Hospital).
We conducted our analysis with the aid of photographic documentation of the patients who underwent the procedure.

RESULTS
All the patients underwent a cephalometric analysis, which, in turn, plays a major role in the assessment of the relationship of the chin with other bone structures and soft tissues of the face.
For this study, we considered the imaginary lines created by Frankfurt (horizontal) and Gonzales-Ulloa (vertical and tangent to nasion) (Figure 7).
All the patients presented good recovery and did not present with any complications in the immediate or late postoperative period.

DISCUSSION
Many procedures have been used to aesthetically improve the lower third of the face, producing efficient results with an effective increase in chin projection.
Silicone implants have been applied the most, as it demonstrates efficient results and are easy to handle. However, approximately 50% of the patients present with bone erosion³ due to local compression of the prosthesis. The most frequent complications include choosing the wrong implant size, prosthetic displacement, infection, extrusion of the implant, sensitive alterations in the lower lip, and impaired chin muscle function, where intraoral access 4 is responsible for most complications.
In well-selected cases without occlusion problems, basilar osteotomy 5 exhibits excellent results. Despite the low incidence of complications 6 , patients do not generally accept the procedure owing to fear of bone manipulation.
Despite the easy application, the use of fillers such as hyaluronic acid has temporary results and, in some cases, can cause intense and sometimes prolonged erythema, papulopustular polymorphic acne, intense edema, skin nodules 7 , and necrosis 8 . Regardless of their associated low incidence rates of complications and easy treatment, fillers performed with fat grafting 7 may show partial or total reabsorption and asymmetries, and some cases might require several sessions to obtain a good result.
Among the strategies to improve chin contour with autologous tissues is the proposal by Viterbo and Brock in 2013 9 to perform "gliding mentoplasty," which includes intraoral access and easy execution, and can be performed in isolation without a greater approach to the face. Nevertheless, it may be insufficient in cases that require a volumetric increase.
All the patients evidenced an improvement in chin projection, ranging from 32.5% to 60% in relation to the Gonzales-Ulloa line and cervical contour (Figures 8-10).