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

Overview

Balance between the middle and lower thirds of the face affects how the nose reads, so a receding chin is often addressed alongside rhinoplasty. The authors present a method of assessing chin deformity and a hybrid treatment. Among their patients, 22 who were offered a chin implant declined, prompting an alternative approach, and 20 with insufficient cartilage received fat grafting alone.

Sections of note

• Design: retrospective analysis, 49 patients with chin retrusion of 2.5 to 6 millimetres. Level of evidence IV.
• The hybrid technique supports tissue beneath the muscle with nasal septum cartilage plus fat injection, and tissue above the muscle with fat injection alone.
• Three groups were compared: implant, hybrid chin advancement and fat grafting alone.
• Preoperative Legan angles were statistically similar across groups.
• Postoperative Legan angles and advancement were significantly greater in the implant group, p less than 0.0001.
• Comparing hybrid against fat grafting alone, the hybrid group achieved significantly greater postoperative angles and advancement, p less than 0.0001.
• Stated guidance: fat grafting suffices for about 2 millimetres, the hybrid method for about 4 millimetres, and implants or bone genioplasty for more than 6 millimetres.

What it means for a patient

• The amount of advancement needed determines the method, and the article gives approximate thresholds for each.
• The hybrid approach uses your own septal cartilage, already exposed during rhinoplasty, plus your own fat, avoiding an implant.
• Patients declining an implant was the driver for developing the alternative, so the technique addresses a preference as much as an anatomical need.
• Limits: 49 patients, retrospective, one surgeon, groups formed by patient choice rather than randomization, and no stated follow up length.

Why this paper matters

Profile balance depends on the chin as much as the nose, but many patients refuse an implant. Offering graded alternatives keyed to the amount of advancement needed makes chin correction more acceptable. How long fat and cartilage grafts hold their volume at the chin is not reported.

Terms

• Chin retrusion: a chin that sits further back than the ideal facial profile line.
• Genioplasty: surgery to reposition or reshape the chin bone.
• Fat grafting: transferring the patient's own fat to add volume.
• Legan angle: a measurement of facial convexity used to assess chin position.
• Sagittal plane: the front to back plane seen in a side profile view.