The importance of chin balancing in rhinoplasty procedures

Many of us are familiar with the idea of rhinoplasty and how surgeons can help craft the perfect nose to balance your appearance, but fewer are as aware of the crucial, sometimes missing, other half of the equation – the chin. Another key focal point of the face, the chin needs to be taken into consideration when any surgeon performs a rhinoplasty.

Take a moment to consider it – if a patient with a large nose and matching chin undergoes a rhinoplasty with the goal of achieving a smaller nose, their overall appearance will look unbalanced following just the rhinoplasty procedure. In other words, their chin will then become the focal point of their face, leaving the nose looking too small. Essentially, the balance of the chin and the nose must remain in harmony to achieve the most optimal facial aesthetics.

How does chin balancing work with rhinoplasty? What are the most common methods of reaching the right facial harmony between the nose and the chin? To learn more about how crucial chin balancing is in combination with rhinoplasty, we reached out to ASPS Member Surgeon Richard Reish, MD, FACS, and Darrick Antell, MD.

The importance of the chin in rhinoplasty

The appearance of the chin can play a make-or-break role in the outcome of any rhinoplasty procedure. Chin balancing add-on procedures are actually very common with most rhinoplasties, which allows surgeons to achieve overall facial balance rather than simply improving the appearance of one feature – the nose.

"When evaluating someone's profile, it is important to factor in the fact that the chin and the nose are like a teeter totter with one another," said Dr. Antell. "If you make the chin stronger, you may make the nose appear smaller and vice versa."

Naturally, when thinking of rhinoplasty, you might only think of the nose, but the chin is an important element for balance.

"This is the most popular procedure to do in combination with rhinoplasty," said Dr. Reish. "The chin plays such an important role. We always want to analyze preoperatively how the chin actually looks before determining what to do with the nose. This is especially true in the patient who has an overprojected or long nose, shortening that or deprojecting that can make the chin look stronger."

Interestingly, while the chin is such a crucial component in the overall results of rhinoplasty, many patients are unaware of its key role.

"Many patients, however, don't realize that chin surgery is available," said Dr. Antell. "Not only to make it more prominent, but you can also make it less prominent, or you may straighten the chin out if it's crooked or lengthen it if it's too short vertically."

Planning for chin balancing with rhinoplasty

Many patients may be great candidates for a chin balancing procedure along with their rhinoplasty, but it's often a difficult topic to broach if the patient is unaware of the option.

"I try to be as diplomatic as I can when I bring up the topic of the chin," said Dr. Antell. "Many times, people will say, 'Yes, I always thought my chin was a little bit soft,' but sometimes they might say, 'No, I'm perfectly fine with it.' And then the conversation doesn't go further beyond that point."

Surgeons will lay out all the various aesthetic options, but it's essential that the patient's desires take priority.

"We as surgeons have to be really delicate about the approach to this," said Dr. Reish. "Yes, it is really important to consider the balance of the chin and nose, but we should guide patients into the right options for them. However, the motivation behind doing both procedures at the same time needs to come from the patient side and not be too overly directed from the surgeon."

Another important consideration when planning for chin balancing with rhinoplasty is the overall appearance and function of the jaw. Many surgeons can help address this concern, but some cases may require the expertise of a surgeon who is also experienced in dentistry.

"I have both a medical and a dental degree, so I perform a lot of chin surgery," said Dr. Antell. "In my practice, my patients value the fact that I have an understanding of the jaw entirely and not just the chin."

Popular methods of achieving chin balancing with rhinoplasty

If you're a good candidate for chin balancing, the most common and successful procedure is typically chin augmentation with an implant.

"The main option we always want to talk about first and foremost is a chin implant," said Dr. Reish. "There are several types, and some better than others. I like MEDPOR implants – this is a porous implant that bone will grow into, meaning that it will fuse. They are often fixated into the bone with titanium screws to keep it in place. These implants are customizable, so every single implant that comes into the operating room will be custom-carved to the patient's face."

In addition to traditional surgical options, patients have other less invasive treatment options available.

"I still think the gold standard in most cases is a chin augmentation with an implant, but there are other methods," said Dr. Antell. "This includes adding filler to the chin, which can give a modest improvement. Filler can also be reversed by dissolving it, if the patient is unsure."

A final important note regarding chin augmentation in conjunction with rhinoplasty is that this procedure consistently offers a high level of patient satisfaction, yielding subtle yet life-changing results.

"Chin surgery is one of my most favorite operations," said Dr. Antell. "It makes a big change in a person's appearance. However, it's not something that's noticeable, typically to their family or friends. One of my favorite stories is about a gentleman whom I did a chin augmentation on, and some months later, his mother told him that, 'He doesn't need a chin implant,' but she didn't realize that he'd already had it! He finally told her what he had done, and two years later, his father came in and had a chin implant as well, as he realized his son looked so much better."

For any patient considering a rhinoplasty procedure, another adjunctive option that may help them achieve the facial balance of their dreams is chin augmentation. Whether this involves treatment via an implant or a noninvasive option like dermal fillers, having the right balance between the chin and the nose can help promote overall facial harmony in all patients.

To find a qualified plastic surgeon for any cosmetic or reconstructive procedure, consult a member of the American Society of Plastic Surgeons. All ASPS members are board certified by the American Board of Plastic Surgery, have completed an accredited plastic surgery training program, practice in accredited facilities and follow strict standards of safety and ethics. Find an ASPS member in your area.