Small chin - Anterior vertical insufficiency

When the lower jaw (mandible) is underdeveloped, it results in a small chin , especially in height. Thus, in the medical field, we speak of people with a so-called ” short face ” profile. Consequently, the chin-lip fold is often very pronounced. Also, the lower lip pushes on the upper lip and can give a face an aged and sad appearance.

It is distinguished from the receding chin or the receding chin. In fact, this type of chin, also called skeletal Class II malocclusion, is not necessarily small in height but it is positioned backwards which makes it less visible.

It is also distinguished from a simple chin that is too small, which only requires a lengthening genioplasty or Chin-wing genioplasty. In fact, here it is the entire lower jaw that is hypertrophied and this causes functional problems (position of the teeth, snoring, sleep apnea, difficulty chewing, etc.).

A “small chin” can therefore pose aesthetic and/or functional problems.

When the surgeon deems it necessary and feasible, it is possible to operate on the patient. This is called osteotomy (cutting of the jawbone) and correct replacement using small plates and screws (osteosynthesis). This type of operation is part of orthognathic surgery.

Operation to lower the small chin and the entire lower part of the face

The operation will aim to:

Enlarge the lower part of the face.
Lower the chin too small.
Improve the profile and aesthetic harmony of the face.
Allow better occlusion of the lower teeth vs. the upper teeth.
Details of the small chin operation:

Operation under general anesthesia.

1 to 3 days in hospital or clinic.
Operation through the mouth (no visible scars).
15 days rest, 3 months to resume sport, 6 months to see the final result.
The operation is often preceded and followed by orthodontic treatment (dental appliances).

What is the cost of orthognathic surgery in the case of anterior vertical insufficiency known as "Short Face"?

Orthognathic surgery is expensive because it is technical and performed in an operating room under general anesthesia. Costs include preoperative consultations, surgical fees, anesthesia fees, hospitalization fees, postoperative care, and orthodontic fees if orthodontic treatment is required before or after surgery.

In France, lower jaw lowering costs between 8,000 and 30,000 $.

Is orthognathic surgery reimbursed?

Orthognathic surgery is reimbursed in certain situations and specific conditions. Social security and mutual insurance companies do not reimburse operations performed for purely cosmetic purposes. In fact, these are “non-medically necessary plastic surgery procedures” according to social security.

However, reimbursement is possible in cases where the surgery is performed for medical reasons. Indeed, it allows for the correction of functional disorders:

respiratory problems,
malocclusion (lower and upper teeth that do not match).

Therefore, both the surgeon and the patient must provide supporting documents to prove the necessity of the intervention.

When to have an operation?

Planning

Choose a time when you can take the time you need to recover. Therefore, avoid scheduling short face surgery before major events or periods of stress.

Availability

Make sure you have enough time available for pre-operative consultations, orthodontics, surgery, and recovery. Follow your surgeon’s recommendations.

Season

It’s advisable to schedule the surgery in winter for practical reasons. However, the scars are inside the mouth and are therefore not exposed to the sun. Therefore, there are no risks in this regard.

Is chin surgery painful?

Pain during surgery
The surgery is performed under general anesthesia. Therefore, there is no pain during the operation since the patient is unconscious.

Postoperative pain
It is normal to experience some pain, pressure and discomfort, despite painkillers.

Swelling and bruising
Swelling and bruising in the lower face are common. Therefore, localized cold can help reduce swelling. We recommend using a hot water bottle filled with ice water for this.

Sensitivity to touch
The operated area is sensitive to touch for a while, but this sensitivity decreases as healing progresses.

Before/After Simulations of a Short Face

What are the risks of chin reduction surgery?

Bleeding

Excessive bleeding may occur during or after surgery. In most cases, it is controlled during surgery, but postoperative bleeding may require further surgery.

Infections

Although infections are rare, there is a risk of infection after surgery. Antibiotics are prescribed to prevent infections. Overall, it is essential to follow all postoperative instructions to reduce this risk.

Anesthetic Reactions

Adverse reactions to anesthesia can occur. However, these reactions are rare and are usually well managed by the medical team. You will have an appointment with the anesthesiologist before the operation.

Bruising and swelling

Bruising (accumulation of blood) and swelling are common side effects after surgery. They can contribute to postoperative discomfort and take time to resolve.

Altered Sensation

Numbness or tingling sensations often appear in the lower part of the face after surgery. Either the surgery did not go as planned, or there was a misunderstanding with the surgeon because no before/after photo simulation was performed before the operation.

Asymmetry

Despite the surgeon’s efforts to achieve symmetry, there may be slight asymmetry after complete healing.

Aesthetic dissatisfaction

Sometimes the patient is not satisfied with the result.

What are the steps of short face surgery?

1) Initial consultation

This is the first appointment with the surgeon. Often, it’s the orthodontist who refers you to them. The patient discusses their aesthetic or functional concerns and expresses their expectations for the surgery. The surgeon examines the patient’s face and teeth and informs them of the implications and risks of surgery. If the patient is still motivated, the surgeon will prescribe numerous tests (X-rays, 3D scans, etc.).

2) Simulation

A before/after graphic simulation from a photo is created to simulate the result. This helps the patient visualize and demonstrate the desired outcome. Create a simulation.

3) Preparation for the intervention

The patient undergoes medical examinations to assess their general health and their ability to undergo surgery (blood tests, appointment with the anesthesiologist, etc.).

The patient discusses potential risks and expectations with their surgeon. They then sign an informed consent form.

4) Day of the intervention

General anesthesia
Before the procedure, the patient is anesthetized.

Incisions
At the beginning of the procedure, the surgeon makes the necessary incisions in the gums and then peels back the gums to access the jaw bones.

Cutting and fixing bones
Then the surgeon cuts the bones to be moved, places them at the desired angle and offset (sometimes using a splint) and fixes them using small titanium plates and screws.

Sutures and dressings
Finally, once the changes are made, the surgeon closes the incisions with sutures and applies a mouth dressing.

5) Post-operative period

The patient is monitored during the postoperative period to ensure that they wake up and recover normally. Painkillers and antibiotics are prescribed to manage pain and prevent infection.

6) Follow-up

The patient has regular follow-up appointments with the surgeon to assess healing, remove sutures (except for absorbable sutures), and monitor progress. This is because full recovery takes several months, and final results may not be immediately apparent due to residual swelling.

What are the benefits of ultrasonic surgery?

Ultrasonic surgery, also known as piezo orthognathic surgery, is a newer approach to surgery. Cutting is performed by vibrating inserts placed in contact with the bone. The micro-vibrations are caused by a piezoelectric machine. Therefore, this technique offers many advantages:

Preservation of structures

The use of ultrasound allows for a gentler and more precise approach, which can help preserve soft structures (skin, veins, nerves, etc.). This minimizes trauma to surrounding tissues.

Less bleeding

Ultrasonic instruments help reduce bleeding during surgery. This contributes to faster recovery and less postoperative bruising.

More precise cuts

Cutting bone with a piezoelectric device allows for more precise cutting.

Less invasive technique

This method is less invasive than traditional techniques. Indeed, the use of a burr can burn the bone and damage soft tissue if the surgeon slips. As a result, recovery is faster and postoperative swelling is reduced.