Hybrid Chin Advancement: Combining Fat and Sliced Cartilage Grafts for Chin Augmentation During Rhinoplasty

Abstract

Background: Facial balance significantly impacts aesthetics, particularly in the middle and lower thirds. Patients with chin retrusion often benefit from sagittal plane chin advancement in rhinoplasty, enhancing surgical outcomes and satisfaction.

Objectives: This article presents a method for analyzing chin deformities and discusses a hybrid treatment approach to harmonize facial features, complementing rhinoplasty.

Methods: The chin positions of patients treated by the senior author were assessed. A retrospective analysis included 49 patients with chin retrusion of 2.5-6 mm. Among them, 22 patients initially offered chin implants declined, leading to planned chin augmentation. Fat grafting was exclusively performed for 20 patients lacking sufficient cartilage. The "Hybrid Chin Advancement" technique involved supporting tissues beneath muscles with nasal septum cartilage and fat injections and tissues above muscles with fat injection alone.

Results: Pre- and postoperative Legan angle measurements and chin advancements were compared across three groups. While preoperative Legan angles were statistically similar, postoperative Legan angles and advancement changes were significantly higher in the implant group (p < 0.0001). Comparing hybrid chin advancement and fat grafting groups, postoperative Legan angles and advancement changes were significantly higher in the hybrid chin group (p < 0.0001).

Conclusions: Fat grafting suffices for mild advancements (~ 2 mm), while the hybrid chin method is effective for moderate advancements (~ 4 mm). For advancements exceeding 6 mm, implants or osseous genioplasty are optimal. Our study's hybrid approach offers an easy, safe, and reliable method for achieving facial harmony in the lower two-thirds without compromising patient expectations.

Level of evidence iv: This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .

Keywords: Cartilage graft; Chin augmentation; Fat grafting; Rhinoplasty.

Fig. 1

Schematization of pogonion, menton, and gnathion

Fig. 2

Measurement of Legan angle. G: glabella, Sn: subnasal, P: pogonion

Fig. 3

Conception of hybrid chin advancement

Fig. 4

a Legan angle before hybrid chin advancement, b decreased Legan angle after hybrid chin advancement

Fig. 5

Anterior view of patient by VECTRA® a preoperative, b postoperative

Fig. 6

Basal view of patient by VECTRA® a preoperative, b postoperative

Fig. 7

Left lateral view of patient by VECTRA® a preoperative, b postoperative

Fig. 8

Left oblique view of patient by VECTRA® a preoperative, b postoperative

Fig. 9

The red ring indicates increased chin projection after hybrid chin advancement

Fig. 10

Views of patient with hybrid chin advancement, postoperative 1. Year follow-up a preoperative/anterior view, b postoperative/anterior view, c preoperative/lateral view/right side, d postoperative/lateral view/right side, e preoperative/lateral view/left side, f postoperative/lateral view/left side

Fig. 11

Views of patient with hybrid chin advancement, postoperative 1. Year follow-up a preoperative/anterior view, b postoperative/anterior view, c preoperative/lateral view/left side, d postoperative/lateral view/left side, e preoperative/lateral view/right side, f postoperative/lateral view/right side