Considering and heavily masculine facial features of this case and the personal wishes of the patient a procedure of medium complexity was planned for the nose; should the patient had wanted a more ambitious change in his look, had the case be female or other issue would have been present a more sophisticated structure rhinoplasty might have been applied; essentially the patient wanted to boost his masculine look with the genioplasty and prevent any kind of masculinity loss due to rhinoplasty, by means of downsizing the nose and advancing the weak chin; great was taken not to deproject, lift or rotate the tip in excess for a man's look and neither lower too much the dorsum.
The patient underwent a basic rhinoplasty via closed endonasal approach with moderate reduction of the full nose with dorsal hump shaving, tip's alar cartilages reduction, tip deprojection and the mandatory osteotomies to close the roof; no other maneuver was deemed indicated or necessary, neither wished by the patient.
The weak chin lead not only to a receded profile but also to substantial secondary issues like a remarkable double chin and jowls due to soft tissues flaccidity around the chin, jaw and upper neck; these secondary issues are the rule and systematically associated to weak chins, obtaining a beneficial side effect correction for free when patients get an osseous genioplasty, although never when chin implants are used since prosthetic augmentation of the chin, among other serious downsides and risks, does not modify the attachment insertion points of the muscles of the face, floor of the mouth and neck, neither obtain the same grade of soft tissues tightening; however osseous genioplasties do literally face lift the lower third of the face, but instead a posterior pull near the ear by means of an anterior one forwarded from the chin due to its increase in projection.
It is to be noted and remarked this patient did not undergo any kind of face or neck direct lifts, mid face techniques or other maneuvers to rejuvenate his cheeks, jowls and neck but simply an osseous genioplasty; this means that a single procedure on the chin entails an en bloc rejuvenation, reshaping and tightening of lower cheeks, jowls, corners of the mouth, marionette lines and upper neck double chin, in one sitting, conservatively and affordably, without cutaneous visible scars, with quick aesthetic recovery, minimal risks and intraoral incisions only.
The chin suffered not only recession but also a subtle although noticeable deformity due hypoplasia of the left half of the osseous chin, confirmed by the pertinent preoperative imaging test; thus a very thin, long and triangular wedge of bone graft, harvested from the patient's elbow, was inserted to level both halves of the chin, with the excellent results which can be seen in the images; an horizontal osteotomy allowed an sliding genioplasty to advance the chin in association of the aforementioned custom bone graft.
The final result is a balanced profile keeping up and boosting patient's masculinity, including a comprehensive rejuvenation of the lower two thirds of the face and neck; a brand new facial look is achieved with total naturalness and improved masculine features.
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