08-08-10 | Posted by Dorene Kaplan

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Meet the Man Who Knows Chins

Dr. Yaremchuk is Clinical Professor of Surgery at Harvard Medical School and Chief of Craniofacial Surgery at Massachusetts General Hospital. His expertise in male cosmetic surgery includes developing several models of chin implants that are used worldwide in aesthetic and reconstructive procedures. Dr. Yaremchuk custom carves all of the facial implants he uses in surgery, and has personally designed many of them. He is the author of three textbooks, 40 book chapters, and more than 100 scientific articles.

www.dryaremchuk.com

What are the current trends in plastic surgery among men?

In general, there are an increasing proportion of men seeking plastic surgery. In the older age group (over 50) work place competition and a greater overall acceptance of male cosmetic surgery leads many men to facial rejuvenation and hence facelift and eyelid surgery.

In younger men, rhinoplasty continues to be a frequent procedure. In addition, there are a large number of men who have become aware that basic changes to their facial morphology are possible. More still, this group is looking to implant surgery to increase the size and projection of their chins and mandible as well as midface area.

How do chin implants work?

Chin implants are used to increase projection of the chin. They may be placed through either incisions made on the inner surface of the lower lip or by making an incision beneath the chin.

Chin implants come in different sizes and shapes to meet the needs of the patient. Implants are made of two types of materials: 1) silicone rubber and 2) porous polyethylene. Depending on the surgery procedure, implants may be stabilized with sutures or tiny screws.

Why is a prominent chin such an important facial feature?

The size and projection of the chin should be in balance with the other features of the face. A chin that is very small often makes other features (particularly the nose) look too large. Chins that lack projection also provide poor support for the soft tissue envelope with resultant lack of definition. Poor skeletal support leads to the appearance of premature aging.

Would it be correct to say that a balanced chin matters more to a man’s face than to a woman’s face?

A balanced chin is equally important to both men and women. However, since on average, men have longer chins and jaws than women, a small chin and mandible is more detracting from a man’s appearance than it is from a woman’s.

Men recognize the importance of an appropriately sized chin and jaw to their appearance. Most men who wear beards do so to camouflage a small chin and lower jaw.

Some patients and surgeons now realize that many, if not most people, who desire chin implants have not only a small chin, but also a small posterior jaw. In these patients, usually men, it is appropriate to augment both the chin and the posterior jaw; in other words, the entire lower jaw.

In what situations would you recommend a facelift? Facial implants?

The goals of facelifts and facial implants are different. Patients with drooping cheeks, jowls, and loose neck skin benefit from a facelift. Patients who are deficient in the projection of their facial bones such as: the chin, posterior mandible (or  jaw), cheek bones and infraorbital rim (bones around the eyes) benefit from facial implants.

Recent studies performed at Stanford and the University of Rochester have shown that the facial skeleton tends to atrophy with aging. In other words, skeletal features like the angle of the mandible become less pronounced with aging. As a result, the soft tissues are less well supported and contribute to the aging appearance. To counteract that phenomenon, it can be appropriate to augment certain areas of the facial skeleton with implants – either as an isolated procedure or as part of a rejuvenative soft tissue procedure such as the facelift, mid-face lift or blepharoplasty (eyelid surgery).

In this day and age, why is bad plastic surgery still so prevalent?

An effective plastic surgery procedure requires:

1) Accurate identification of the problem.

2) An operation which effectively corrects the problem without introducing new problems.

3) The ability to technically execute the procedure.

The failure to fulfill any one of these criteria will lead to bad plastic surgery. With poor reimbursement for non-cosmetic medicine, many practitioners are attempting to perform cosmetic procedures to make a living. These practitioners are unlikely to fulfill all three of the before mentioned criteria necessary for a good result.

Many [patients] particularly have come to me requesting correction of problems after “franchise” surgery procedures. Franchises recruit physicians and train them to perform certain procedures and recruit patients to have those procedures. This operation may not be appropriate for the patient and the recruited surgeon may not be sufficiently trained to perform the procedure.

What major innovations do you expect to see next in aesthetics?

Fat grafting is conceptually a very attractive modality to replace soft tissue volume lost with age. Presently, the amount of fat that survives after injection is unpredictable, and hence so is the result. Reserachers are curently sorting the variables that are responsible for fat and hence the predictability of the result. When this is realized, the value of this modality will increase significantly.

Aside from invasive procedures, what can be done to maintain or achieve a youthful appearance?

Skin care and fillers are proven modalities to maintain a youthful facial appearance. Rest, exercise, and a healthy diet cannot be overstressed.

What inspired you to choose craniofacial plastic surgery?

Craniofacial surgery addresses the face and particularly the underlying facial skeleton. It was not until I was in practice that I realized how powerful changes to the facial skeleton are in the overall facial appearance. I saw that the facial skeleton was highly responsible for the facial appearance and realized that being able to manipulate the facial skeleton brought power both to restore or to change the facial appearance. This is true both for the reconstructive and the cosmetic patient.

What is/are your signature procedure(s)?

These procedures are those I have extended from my experience in craniofacial reconstruction. Techniques that I have used to reconstruct distorted eyelids or orbit bones after trauma, I have gradually applied to cosmetic problems. In the orbital (eye) area this might include building up the infraorbital rims with implants for people who have very flat mid-faces and tend to have problems with the lower lid after conventional lower lid surgery. As a primary procedure, I often treat these patients with infraorbital rim implants and a midface lift.

In patients who have lower lid descent after eyelid surgery, I might add a lateral canthopexy procedure (tightening of the ligament and/or muscle that supports the outer corner of the eyelid) – also borrowed from craniofacial surgery.

I also do a lot of implant surgery. With implants I can create contours similar to those resulting after orthognathic surgery, a surgery to correct conditions of the jaw and face related to structure, growth, sleep apnea, TMJ disorders or to correct orthodontic problems that cannot be easily treated with braces. This is useful for patients whose tooth fit is normal or has been normalized by orthodontic treatment.

There is also a group of patients who have had orthognathic surgery to make their teeth fit but are left with some less than ideal skeletal contours after the skeletal movements.

In general my experience with craniofacial surgery has grown from operating on the face on much deeper tissue levels than most plastic surgeons. It gives me a better understanding of the anatomy and the results of changing the deeper anatomy. This has not only allowed me to develop many niche procedures, but also to refine conventional facelift, eyelid, and nasal surgery.

How should a patient go about securing the best plastic surgeon for his/her needs?

Patients should make sure that the surgeon they choose is board-certified (something that can be found out online), operates only in accredited medical facilities and fulfills continuing medical education requirements.

It is also, of course, important for a patient to feel comfortable with their surgeon.  They should answer all of your questions thoroughly and clearly; offer alternatives, where appropriate, without pressuring you to consider unneeded or additional procedures; welcome questions; make clear the risks and outcomes; and leave the final decision up to you.