Autologous Fat Grafting to the Chin: A Useful Adjunct in Complete Aesthetic Facial Rejuvenation.

The chin makes up the central unit of the face and neck, and is a significant factor in facial harmony and aesthetics. Historically, correction of microgenia required surgical intervention with a sliding genioplasty, or placement of a permanent implant. However, these techniques require more extensive surgical intervention, prolonged downtime, with higher costs and complications. Furthermore, chin rhytides and descent of chin fat lead to an aged appearance of the chin and lower face that is difficult to correct with a chin implant alone. Autologous fat grafting in facial rejuvenation has expanded in its application and can serve as an effective technique to correct and enhance chin aesthetics, including lateral chin hollowing, asymmetry, mild microgenia, and correction of deep labiomental sulcus or a bifid chin. This article and accompanying video demonstrate the authors' technique for chin augmentation and refinement with autologous fat.

Assessing Patient-Reported Outcomes Following Orthognathic Surgery and Osseous Genioplasty.

Primary outcomes for orthognathic surgery and genioplasty patients include satisfaction with appearance, improved motor function, and enhanced quality of life. The goal of this study was to assess outcomes among patients undergoing these procedures, and to highlight the potential use of FACE-Q instrument for use in patients with dentofacial deformities. A total of 56 patients presenting for orthognathic surgery and/or osseous genioplasty completed the FACE-Q during preoperative and/or at postoperative visits. FACE-Q scores increased following surgery in satisfaction with facial appearance overall (+24.5, P < 0.01), satisfaction with lower face and jawline (+40.7, P < 0.01), and in all satisfaction with chin items (profile, prominence, shape, and overall). Patients also demonstrated increased social confidence (+8.9, P = 0.29). There was no improvement in psychologic well-being (-0.8, P = 0.92). All 3 surgical groups of patients experienced gains in satisfaction with appearance following surgery. Patients who underwent orthognathic surgery either alone or in combination with genioplasty demonstrated statistically significant improvements in satisfaction with facial appearance overall (P < 0.01 for both groups), whereas patients who underwent genioplasty alone did not (P = 0.13). In addition, patients who underwent orthognathic surgery combined with genioplasty demonstrated greater improvement in satisfaction with chin than patients who underwent genioplasty alone. In conclusion, patients who underwent orthognathic surgery and/or genioplasty demonstrated improvement in appearance and social confidence. The use of this model supports the successful outcomes possible for patients undergoing these procedures.

An Assessment of the Quality of Life of Patients With Class III Deformities Treated With Orthognathic Surgery.

PURPOSE: To evaluate quality of life (QoL) from a broad perspective by a comparison of Turkish patients undergoing orthognathic surgery to correct Angle Class III skeletal deformity with a control group composed of participants without dentofacial deformity using general health, generic oral health, and condition-specific QoL approaches. MATERIALS AND METHODS: Thirty patients who underwent orthognathic surgery to correct Class III relations (monomaxillary and bimaxillary groups) and 30 participants with Class I skeletal structure and good dentofacial harmony (control group) were evaluated. Condition-specific QoL through a 22-item Orthognathic Quality of Life Questionnaire (OQLQ), generic oral health-related QoL through a 14-item Short-Form Oral Health Impact Profile (OHIP-14), and generic health-related QoL through a 36-item Short-Form Health Survey (SF-36) were assessed. RESULTS: When the groups were compared, OQLQ scores showed a significant difference in the oral function domain only in the bimaxillary group (P < .05), and OHIP-14 scores showed significant differences in half the OHIP-14 subscale scores in the monomaxillary and bimaxillary groups (P < .05). The SF-36 scores showed significant differences only for the vitality domain in the monomaxillary group and the vitality and mental health domains in the bimaxillary group (P < .05). CONCLUSIONS: For condition-specific and health-related QoL, the QoL of orthognathic surgical patients appeared to be similar to that of participants without dentofacial deformities. Oral health-related QoL of orthognathic surgical patients seemed moderately similar to that of participants without dentofacial deformities. The combined use of these methods is helpful for evaluating QoL from a larger perspective.

Subjective assessment of facial aesthetics after maxillofacial orthognathic surgery for obstructive sleep apnoea.

We aimed to evaluate the subjective perception of facial appearance by patients after maxillofacial surgery for obstructive sleep apnoea (OSA), and explored the possible correlation between satisfaction and surgical outcome. A total of 26 patients, 24 men and 2 women (mean (SD) age 45 (7) years), subjectively assessed their facial appearance before and after operation using a visual analogue scale (VAS). To investigate a possible association between postoperative facial appearance and surgical outcome, we analysed postoperative scores for the apnoea/hypopnoea index (AHI) and Epworth sleepiness scale (ESS). Postoperatively, 14 (54%) indicated that their facial appearance had improved, 4 (15%) recorded a neutral score, and 8 (31%) a lower score. The rating of facial appearance did not correlate with changes in the AHI or ESS following surgery. This study supports the view that most patients are satisfied with their appearance after maxillofacial orthognathic surgery for OSA. The subjective perception of facial aesthetics was independent of the surgical outcome.

Patients offered orthognathic surgery: why do many refrain from treatment?

AIM: To examine factors associated with patients' decision to decline surgery. MATERIAL/METHODS: Of 470 consecutive patients referred to the University of Oslo from 2007 to 2009, a sample of 160 subjects who had not undergone surgery was identified and contacted. 236 operated patients from the same period served as a comparison group. Morphology was assessed from cephalograms and photographs, and the individuals' opinions were recorded using questionnaires. RESULTS: Dentofacial morphology represented normative treatment need and was generally similar except for a higher rate of severe negative overjet in the operated group (p < 0.001). The most prevalent reasons for declining surgery were risks of side effects, the burden of care, and a general reluctance to undergo surgery. Many un-operated subjects were dissatisfied with their masticatory function and dentofacial appearance. CONCLUSION: Informed consent to orthognathic surgery represents a challenge both to the patient and the professional. The findings imply that patients' motives and fears should be explored during consultation and that the information provided should be adapted to the potential risks and benefits related to the actual treatment.

Reduction genioplasty enhances quality of life in female patients with prognathism and maxillary hypoplasia undergoing bimaxillary osteotomy.

The structure of the chin determines facial attractiveness and is directly linked to quality of life (QoL). In patients with prognathism and maxillary hypoplasia, bimaxillary osteotomy (BIMAX) with mandibular setback does not always lead to a more slender chin or improved aesthetics. The aim of the present study was to evaluate whether QoL differed between females undergoing BIMAX alone (group I; n=30) and those undergoing BIMAX combined with reduction genioplasty (group II; n=30). Presurgical and postsurgical evaluations included cephalography, photogrammetry, and the Oral Health Impact Profile with one additional domain (aesthetics). Setback of the hard tissue pogonion was significantly greater (P=0.006) in group II (7.1mm) than in group I (2.7mm). Only in group II were soft tissue pogonion changes highly significant (P<0.001), amounting to a mean of 5mm. In both groups, the QoL domains 'social disability', 'psychological discomfort', and 'dissatisfied with aesthetics' changed significantly towards lower impact scores. Changes in the latter two domains were significantly greater in group II patients than in group I patients (P=0.021; P<0.001) and were correlated with changes in the soft tissue pogonion in the horizontal (P=0.024; P=0.022) and vertical directions (P=0.037; P=0.042). Genioplasty addresses both psychological and aesthetic concerns, and therefore significantly enhances postsurgical QoL.