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Dr. Victor Eduardo Alvarez Murillo

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Dr. Oscar Oeding

Dr. Marios Saenz

Dr. Jacobo Zafrani

Dr. Roberto Velázquez

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Chin Augmentation

A weak chin can make a normal nose appear large and an already prominent nose seem even larger. It may also give the appearance of a 'fleshy' neck. On the other hand, a too prominent chin may give the appearance of having too small of a nose. The end result should be a balanced relationship between the structure of the face.

Chin augmentation is the use of synthetics or biologicals to augment, or make the mentum/menton (the lower portion of the face lying below the lower lip and including the prominence of the lower jaw -- called also chin) bone structure of the face more prominent. It can give balance to an otherwise less defined face or further augment an already existent chin structure. The fleshy pad of the chin is normally from 8 to 11mm thick.

BEFORE THE SURGERY EVERY PATIENT MUST:

  • Surgery Costa Rica will schedule an appointment with your doctor for you. During this visit you can ask him any questions you might have about the surgery.
  • Have a complete medical check up, an electrocardiogram and laboratory blood and urine tests; including a complete whole blood count, partial tromboplastin time, prothrombin time, platelets, and HIV.
  • Take antibiotics such as Augmentin 500mg, (one capsule three times a day with each meal) Cipro or Ceclor 500mg (one capsule twice a day with a full breakfast and dinner); two days before surgery, the day of the surgery, and seven more days after the surgery.
  • Inform your doctor of your daily vitamin and medication intake.
  • Notify your doctor of you have developed a cold or the flu a week prior your surgery date.
  • Please avoid: aspirin, more than 500mg of Vitamin E, ginkobiloba, ginseng, or any blood thinners two weeks prior to your surgery. Also avoid alcohol intake, and passive or active smoking for one month before and one month after the surgery. Remember that nicotine and alcohol delays and might even complicate your healing processes.

    THE DAY OF SURGERY:

  • Please brush your teeth, but do not eat or drink coffee or tea.
  • Please do not wear make-up, remove your contact lenses or dentures before the surgery. Do not put any moisturizer in your face.
  • Please remove your nail polish.
  • The evening and the morning prior your surgery, clean the operative area with anti-bacterial soap and water.
  • Please do not bring any jewelry or valuables to the Hospital.
  • Please wear a robe, housecoat or warm up suit that buttons or zips in the front and flat shoes after the surgery. No tight-fitting clothes.
  • Someone must drive you home, to your Hotel, or to the Recovery Home you choose to stay at.
  • Postoperative instructions regarding activity, medications and office visits will be given following your surgery.

    THE SURGERY:

    Depending upon the amount of augmentation and the technique or material used (if applicable), chin augmentation can last about 30 minutes hour to 1 1/2 hours -- depending. Possibly more if sliding genioplasty, reconstruction, revision surgery or additional procedures are performed.

    First, you will be monitored so that the surgical team can properly monitor your vital statistics before, during and after your operation. Prior the procedure you will be given a pill for sedation.

    Once you are on the operating room table, you will then be given local anesthesia. The anesthesiologist will more than likely insert an IV for a saline drip to keep you hydrated and have a vascular "doorway" for anesthesia, antibiotics, and other medications.

    This is usually done before you get into the actual O.R. - by a nurse - and you have a saline bag hooked up to you. The medications will usually be given with a drip system with this saline. As said before, the saline will keep you hydrated both during and post-operatively. The anesthesiologist or surgeon will then determine if you are sedated properly, your stats are stable and if you are ready for the surgery to begin.

    Then, an injection of local anesthetic into the menton nerve cluster usually by way an intraoral injection. This will "numb" the lower half of the face so that you do not feel any pain.

    You will be injected with a solution of Lidocaine, epinephrine and saline, or an epinephrine/bicarbonate/lidocaine mixture. The epinephrine is a vasoconstrictor. This will impede your skin's ability to bleed excessively.

    The incision will be made in the predetermined placement, the implant (if applicable) situated directly on top of the bone and either sutured into it's pocket or screwed into place. I may remove and replace the implant several times intra-operatively to ascertain a custom fit before permanent fixation.

    For sliding genioplasty:

    A sliver or section of bone is sawn off and "slid" forward. The bone graft is then secured into its new place with bone plates and screws.

    The surgical team then performs a sponge and instrument count and your surgeon then closes your incision with, more than likely, a non-dissolvable type suture.

    Sometimes percutaneous sutures are used but only very rarely with chin augmentation. This is normally reserved for malar implants. This is where the sutures stick partially out of the skin and can be removed later on by tugging gently on them after they have partially dissolved within. They can also be sutured with dissolvable stitches inside the surrounding tissues. Even still, they may not be sutured at all, relying on your body's collagen to secure into place. If no internal sutures are used you will more than likely wear your tape or a head wrapping longer unless the pocket specifically fits your implant snugly.

    This wrapping will be worn post-operatively during the day for the recovery period and is worn at night to help it heal properly in the face per your surgeon's instructions. Some patients will have a pressure dressing placed around your head such as you would see in a face lift patient or a neck liposuction patient. If you are not familiar with this "look" it involves wrapping a dressing around the top of your head to underneath your chin, sometimes slightly over your ears.

    Of course there may be differences in surgical technique depending upon the preference of your surgeon.You are then gently awakened and brought into the recovery room where the recovery nurse will monitor your vital stats until you are ready to be released.

    This is dependent upon the individual but may take up to one hour. Your face may feel tight and quite tender as the anesthesia wears off. You may even feel emotional or upset - this will depend upon your body's reaction to anesthesia. You may also experience "rigors" or shivering. This may feel uncontrollable and is usually from the medications. The recovery nurse usually has wrapped you in a warm blanket but if not, request one. It certainly makes things more tolerable.

    Your prescribed medication should alleviate this pain and discomfort. However, if you believe your pain to be out of the ordinary once you get home, call me or the on call staff immediately. You will be driven home by your spouse, significant other or friend as you will not be able to see, much less drive yourself home.

    Thank you!



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    San Jose, Costa Rica
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