About Face

Procedures Menu

About Face

Chapter Seven The Lips The Shape What Can Be Done Chin Surgery Lip Surgery The Paris Lip

What Can Be Done

Most cosmetic surgeons will try to view the lips in the context of the entire lower third of the face, and this involves an assessment of the neck and chin. The chin is second only to the nose in its importance to the human face. A “strong” or prominent chin is seen as a sign of strong character. Likewise, a “weak” or receding chin leaves the impression that a person is a ditherer, of low resolve. (Look no further than two contemporary Canadian politicians for an illustration of public perception on the matter: both prime minister Brian Mulroney and former prime minister Joe Clark have “taken it one the chin” for their prominent and not-so-prominent chins.)

The chin profile is largely determined by the angle at which it meets the neck. The neck-chin junction, as it is called, is the angle created by the underside of the chin (where you hold a buttercup to see if someone likes butter, according to an old adage) and the front of the neck, down to the Adam’s apple. There is a system of categorizing the relationship of the neck to the chin, called the Dedo classification. These six classes are based on the degree of looseness in the skin, fat accumulation, bone position and “retrognathia” - the orthodontic situation when the upper jaw is normal in size and the lower jaw is so much smaller and farther back that it prevents the teeth from fitting together properly.

Dedo also takes into account the tone of the platysma muscle, which I described in the chapters on aging skin and the face-lift. With age, the platysma muscle sags forward on either side of the neck and it creates what looks like “cords”; this can be corrected with a face-lift.

Class 1, according to Dedo, defines a patient with good platysma muscle tone, little neck fat and a normal neck-chin angle; this patient would be an unlikely candidate for cosmetic surgery. Class 2 is a patient with some sagging skin in the neck-chin area, but no extra fat or platysma “coring”; a face-life would probably correct he problem. Class 3 is a patient with excessive fat under the chin, which obliterates the normal neck-chin angle. This requires a submental liposuction (liposuction under the chine) and a face-lift because the patient’s skin would not contract. Class 4 is a patient who shows the classic platysmal “cording”; as I mentioned, this problem can be corrected during the face-lift operation. Classes 5 and 6 are patients with structural problems deeper than the soft tissue of the neck and chin.

Better dental care is the norm these days, so it is rare when we find that neck-chin distortions are the result of dental or skeletal defects, as we do with Class 5 patients. These are people plagued by either congenital or acquired “retrognathia.” Their problems of proportion can be caused by an irregular “bite,” or imperfect “occlusion” - when the upper and lower teeth don’t fit together behind closed lips the way they should. If trouble of this type is identified, a patient will be advised to visit an orthodontist/oral surgeon for assessment and treatment of the bony problem before we start to work on the soft tissue. It is not unusual for a cosmetic surgeon to work closely with an orthodontist or oral surgeon when dealing with problems in this area.

A Class 6 patient is the rare exception to all of Dedo’s other classifications: these people have a low-lying “hyoid” bone. The hyoid is the U-shaped bone at the root of your tongue - at the top of your voice box. Quite often, a Class 6 patient appears to have the simpler problems of excessive fat and platysmal cording that we find in other classifications. However, a low-lying hyoid bone is not correctable. Neither oral nor facial plastic surgery will make a difference. However, soft tissue, surgery would restore the neck to its more youthful appearance.

[previous page] [next page]