Saigon Hospital of Cosmetic Surgery - Director Nguyen X Cuong, M.D.

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.

Are You A Candidate?

It also may be that the face needs Mandibular (jaw) augmentation (jaw) augmentation or Malar (cheek) augmentation to balance out the features either in addition to chin augmentation. It is very common to have chin augmentation in conjunction with rhinoplasty, as well. A qualified plastic surgeon can help determine your needs by examining your facial structure and photographs. Some surgeons even draw a graph on a photo of your face to measure the distances from each facial feature or utilize computer imagery to help portray the possibilities. However, you mustn't rely on the accuracy of the surgical outcome when computer imaging is utilized. The image is only an approximation although it can be used to help convey your desires to your surgeon.

Are You A Candidate For Chin Augmentation?
First and foremost, an individual must be in good health, not have any active diseases or pre-existing medical conditions and must have realistic expectations of the outcome of their surgery. Communication is crucial in reaching one's goals. You must be able to voice your desires to your surgeon if he/she is to understand what your desired results are. Discuss you goals with your surgeon so that you may reach an understanding with what can realistically be achieved.

You must be mentally and emotionally stable to undergo an cosmetic procedure. This is an operation which requires patience and stability in dealing with the healing period. There is sometimes a lull or depression after surgery and if there is already a pre-existing emotional problem, this low period can develop into a more serious issue. Please consider this before committing to a procedure.

You must have no bone disorders, are not or have not been on Accutane for the last 6 months or sometimes more (it causes excessive facial bone growth, called Hyperostosis, and increased, keloid-like scarring after skin trauma (such as incisions). Only a qualified plastic surgeon can determine this after speaking to you as well as going over your medical history, examining your facial structure and skin. You must realize that no doctor can perform miracles but a highly skilled surgeon can transform what you do have into a more balanced look altogether.

Unfortunately, all surgeries have risks and complications. Although chin augmentation is not a comparatively difficult and invasive procedures, complications can and do happen. These include allergic reaction to the anesthetic used. You will have a chance to review the risks associated with anesthesia further along in the tutorial.

Infection
You could develop a post-operative infection and need to have the implant removed, the infection dealt with and still have to wait for several months before an additional surgery can be performed to re-implant. Infections usually occur with the first few weeks. Some possible infections and a more common one being Staphylococcus, or simply Staph. A more severe one is Methyl Resistant Staphylococcus aureus, or MRSA. This strain is a Methycillin-resistant "bug", but is not considered a "super bug" and is usually sensitive to at east 3 types of antibiotics. In itself it is very rare, much less with BA.

Be sure your thoroughly wash the face and neck area with an anti-bacterial soap such as Hibiclens or Anti-bacterial Dial for a few days before surgery.

Some patients are instructed to wash with these anti-bacterial soaps every day for 3 days beforehand. This precaution will assist in ridding the immediate area of Staph which naturally occurs on the skin. Your surgeon will also "scrub" your face and neck with Betadine solution right before your incision is made.

Hematoma & Seroma
There is a risk of developing a hematoma [: a mass of usually clotted blood that forms in a tissue, organ, or body space as a result of a broken blood vessel ] or a seroma [: a collection of the watery portion of the blood of an animal which may need to be aspirated]

Implant Shifting (Displacement) & Asymmetry
There could be asymmetry due to malposition of the implant by the surgeon, swelling, trauma, hematoma, or general . There is also the risk of "shifting". If this happens a second surgery may be needed to reposition the implant.

Extended Loss of Sensation (Numbness)
Although you will be numb from the anesthetic and swelling -- as you heal various areas will regain sensation before others. Remember that you are healing and to be patient. Numbness of the lips should subside in 2-3 weeks post op. If not, the implant sometimes may need to be trimmed or the "wings" (if applicable) moved downwards soon after to prevent permanent loss of sensitivity. Let your surgeon know if you still have lip numbness after the 3 week period. The surgery to correct this is usually performed within 4 weeks after the original surgery.

Autoimmune Disorders Related To Silicone
There is no conclusive evidence with autoimmune disorders regarding silicone toxicity, rheumatoid arthritis, lupus, cystic fibrosis, fribromyalgia, etc.. Solid silicone facial implants have been used for decades in cosmetic, non-functional applications without any ill effects.

Silicones are synthetic polymers and are made by combining oxygen and silicon and in high temperatures and pressures can produce polydimethylsiloxane (PDMS). The fluids are made from linear chains of PDMS whereas the gels are lightly crosslinked to give it a thicker cohesive-ness. The elastomer implant implants contain very little free PDMS so that it remains a solid.

General Dissatisfaction
Also, there are the risks of it just not living up to what you expected. Many times women will get very scared during the first few weeks and insist the chin implant makes them look masculine. TO avoid this problem, choose your surgeon wisely and remind yourself that you WILL be swollen for quite some times. Some days, more so than others.

Contraindications
If you are in poor physical and/or emotional health or have unreasonable expectations, non-elastic skin previous existing medical conditions or bone disorders, you are probably not a good candidate for chin augmentation surgery.

You should not be or have not been on Accutane for the last 6 months. Accutane may cause Hyperostosis, an increased growth rate of bone matter. Most often-affected areas are the hands, feet and face and increases your chances of keloid-like scarring from skin trauma (such as incisions).

Also chin augmentation is not recommended to correct micrognathia [: abnormal smallness of one or both jaws] or retrognathism/retrognathia [: a condition characterized by recession of one or both of the jaws].

The costs of chin augmentation surgery varies significantly between surgeons, medical facilities, and regions of the country. Patients who need additional or more extensive surgery will require more intensive and expensive treatment. In non-private surgery centers or in-office Operating Rooms the prices may include the following. However, in hospitals, surgery charges can usually be separated into five parts:

All fees are averages; out-patient charges, including surgeon fees, anesthesia, Operating Room charges, and implants if applicable - unless otherwise noted. Lab fees, such as "blood work", are normally an extra $35. - $75., plus medications are usually an additional $120. Physicals are more, HIV tests are additional and any other fees that you may be responsible for (X-rays, etc.). If you are to be staying in a hospital or are opting for home healthcare - these expenses are additional. This factor really depends upon the region, surgeon, etc.

Injectable Products
This usually requires no surgical team, operating room or anesthesia other than local/regional and possibly an oral sedative. The costs are significantly lower regarding the procedure it self, although the product may be more expense and cc (cubic centimeters of product) do add up. Inquire beforehand regarding your needs and the going price at that time for the desired product. Also inquire regarding touch ups for permanent injectables.

*Costs for medications, blood tests, and emergency surgeries, if applicable, are not included.

Depending upon the amount of augmentation and the technique or material used (if applicable), chin augmentation can last about 45 minutes to 1 hour and 15 minutes hours, depending. Possibly more if bone grafts, reconstruction, revision surgery or additional procedures are performed.

First, you will have monitoring pads attached to you so that the surgical team can properly monitor your vital statistics before, during and after your operation. When you are brought to the operating room, electrodes will be plugged into these pads which are connected to the monitoring equipment. However, your heart and oxygen saturation may be monitored before you are brought into the O.R. at the same time your IV is inserted.

I.V Insertion
You may or may not have already been hooked up to the saline IV drip and are awaiting the O.R. to be prepared for your surgery. Other surgeons wheel you into the O.R. and insert your IV then. If you had been given an oral sedative or valium prior you usually could care less what they are sticking in you. If you haven't been given a sedative, the initial first few minutes until you are anesthetized may be stressful.

Having an IV inserted feels sort of like blood being drawn, but for a shorter period of time. It's the initial placement of the IV catheter that may sting a bit. Some patients get it in the crook of the elbow, some the hand. I dislike the ones in the hand as it's a nasty place for a bruise to be, at least with the arm you can hide it, it all depends upon your veins though. So if your veins are not very prominent this can be a problem. Some patients even have to be catheterized in the neck.

After the needle is injected into the vein, it is pulled out and a little Teflon tube is left in your vein. This intravenous tube is called a catheter. However many people consider the whole access system a catheter. Let's call the access system a 'catheter hub' for simplicity. This hub usually contains the catheter, a needle, a flashback chamber and tubing connected with a luer lock.

The hub acts as an injection port and is taped to your skin to keep it from getting knocked out. Medications can be injected into the body via this port or be connected the tubing to allow automatic infusion of drugs and intravenous fluids with a computerized drip system. In short, the IV is for a saline drip to keep you hydrated and also acts as a vascular doorway for medications, many times including anesthesia. You may or may not receive some medications to help you relax or feel sleepy at this time. This can help with pre-operative anxiety if you were not given an oral medication to do so.

Revision Surgery is the procedure to correct or change the results of a prior chin enhancement procedure. Reasons may include any one or a combinations of the following:

Many times your original surgeon can correct any of the above, although for severe problems which you think may be the fault of the surgeon -- it may be best to seek another opinion.

Monitoring Equipment
Regardless of the order and manner in which they insert your IV, after you are placed on the operating table they will talk to you for a minute or two and hook you up to the heart monitoring and oximeter machines, possibly wrapping your legs with compression cuffs and other final preparations. Your vital signs will be monitored, including your blood pressure, body temperature, pulse rate/heart beat, and your breathing rate -- all very important factors to determine if you are okay while under anesthesia. The O.R. staff will also check your blood pressure.

You have more than likely had your blood pressure taken before with the use of a cuff which inflates firmly around your arm. You will also have an oximeter clip (or strip) placed on either your finger, your earlobe, or possibly on your big toe. The oximeter machine monitors the oxygen/carbon dioxide saturation in your blood -- this is very important. Your anesthesia and saline will also be closely monitored and meticulously controlled. You may also have intermittent pneumatic compression sleeves placed on your legs to decrease the risk of Deep Venous Thrombosis (DVT) and subsequent pulmonary thromboembolism. Heavier patients may especially benefit from this. These devices are inflatable sleeves for your legs which are either thigh high or knee high that inflate and deflate to keep circulation optimal. You may also have heat lamps or heated blankets, depending upon the surgeon, your temperature, etc. Your vital statistics must be determined as stable before going any further.

Anesthesia Types Used In Breast Reduction Surgery
If you and your surgeon have chosen an IV Liquid Sedative, they will either manually insert medications with a hypodermic into a Y site or injection port along the length of the silicone tubing connected to your catheter hub/IV or more than likely your anesthesiologist will attach a bag of anesthetic or use a computer-controlled drip system. The computer system automatically infuses a few drops of anesthetic every few seconds into a drip chamber where it mixes with the saline. The drip crate can also be controlled via the roller clamp. Flow regulators can also regulate the flow rate.

When the anesthesiologist releases the roller clamp the mixture starts heading towards your body. The effects of the anesthesia are felt soon after injection or opening the roller clamp--afew seconds in fact. It feels like heat going into you veins then creeping up your arm; then it jumps from your shoulder to a metallic-like taste under your tongue and then you are blissfully anesthetized.

If you have chosen Gaseous-state anesthesia (Twilight, Gaseous General) Your mouth and nose will be covered with a mask and you will usually be told to count back from 100. You will usually remember getting only to about 96 before falling fast asleep. Then, the anesthesiologist will more than likely intubate you. Intubation usually involves an endotracheal tube down your throat to deliver gaseous anesthesia to your lungs. However, some surgeons give you a little IV sedation and then intubate you and switch over to gaseous sedation. Both of these maneuvers eliminate the horrible experience of having a tube shoved down your throat while you are awake, which is unheard of in this day and age.

Another option is with the use of a laryngeal mask airway (or LMA). This is a lot like the older intubation for General but there is a shorter tube and a little balloon the size of your two thumbs at he end. The tube holds your tongue down and of the way so it does not obstruct your breathing and the balloon inflates and bocks fluid from entering your windpipe either from saliva or stomach acid and makes a seal so the gas can be delivered to your lungs. It is basically like a diaphragm for your windpipe. With the older intubation you have the pleasure of having a tube down your throat but you don't usually remember it going in. You may wake up with a raw throat with either but it is usually less so with the LMA. You may wake up with an irrigated and dry throat regardless because canned or cylinder air (scubadiving tanks as well) is d-r-y. There is no moisture in these tanks. It is your turbinate structure (three little fleshy flaps in your sinuses) inside your nasal structure that mostly warms and humidifies the air which you breathe. When you have to humidify your air, your body needs more moisture. The saline drip will assist in this as well.

Another option is with silicone tubing which is placed in the nose, however this is rarely used as surgeons and anesthesiologists prefer that the windpipe be protected and the tongue held down and throat firmly held open for longer procedures. Be sure to ask your surgeon which method he will be using if you are interested. Regardless of which method, the gaseous anesthetic is mixed with oxygen and this is how you will breathe during your surgery.

You may then be marked with a magic marker type pen for the implant placement areas and incisions if your placement is to be performed extra-orally.

Sterilizing The Surgical Field
The O.R. staff will then scrub your face and neck (and other areas if you are having other procedures) with a 7.5% Betadine Surgical Scrub. The O.R. staff will then rinse off the area with sterile gauze soaked in saline and then paint your surgical area with the 10% Betadine Solution which resembles a brownish, iron-colored liquid. This will sterilize the area by killing surface bacteria, fungi, protozoa, viruses and yeasts. A common bacteria found on the skin is the naturally occurring Staphylococcus aureus, or simply Staph) and decrease your risks of an infection.

The Surgery
You will be injected with a solution of Lidocaine, epinephrine and saline. The epinephrine is a vasoconstrictor. This will impede your skin's ability to bleed excessively by narrowing the bore of the blood vessel.

The incision will be made in the predetermined placement, the periosteum and other tissue dissected from tehbone, the implant is then situated directly on top of the bone and checked for the proper look suitable for the patient's features. It is possible that it may be removed and further customized several times during the operation. The implant either sutured or screwed into place. Sometimes percutaneous sutures are used. This is where they 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, the implant may not be sutured in at all, only the pocket, relying on your body's collagen to secure into place. If no implant/sutures are used you may have tape or a head wrapping that is worn at night to help it heal properly in the face.

The surgical team then performs a sponge and instrument count and your surgeon then closes your incisions with, more than likely, a non-dissolvable type suture. You may have an antibiotic-soaked piece of gauze placed between your lower lip and gums and perhaps 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 and in front of 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 two hours. You have had injections of local anesthesia and this will numb the inside of your mouth. Take care not to bite the inside of your mouth as you will not feel it if you lacerate the mucosa. 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, more than likely epinephrine that is used as a vasoconstrictor. The recovery nurse usually has wrapped you in a warm blanket but if not, request one. It certainly makes things more tolerable. You may even be fortunate to have heating lamps.

Some patients feel nothing different although if you have had General you may feel a little sick, hopefully your surgeon gave you something to lessen this. 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 your surgeon 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.

For Injectable Products
There is sometimes an injection into the nerve cluster on the chin which will numb the lower half of the face. Injections of whatever product was discussed beforehand will be implanted via a hypodermic. You may be asked for input and given a hand mirror. Do remember that there may be swelling if these products are suspended in saline. A majority of the swelling will subside within a few hours if this is the case. Products such as injectable hydroxyapatite or hydoxyl-apatite like Radiance FN (or Radiesse), Reviderm Intra, Artecoll and fat grafting. You will more than likely be able to drive yourself home if only local or regional anesthesia is given. If you were given an oral sedative it is unlawful, and dangerous, for you to drive yourself home.

Initial Recovery: Anesthesia
After you are awakened and brought into the recovery room, 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 two hours or more. You will feel quite tender and possibly confused as the anesthesia wears off. If you feel any discomfort you may want to ask for a pain reliever which you will more than likely have been asked to bring with you. 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, more than likely epinephrine that is used as a vasoconstrictor, and the cold saline which will have been introduced into your system for the last few hours, and still may be. The fact that the operating room is usually very chilly, surely does not help matters in this regard. The recovery nurse usually has wrapped you in a warm blanket but if not, request one. It certainly makes things more tolerable. You may even be lucky enough to have heating lamps! Some surgical theaters are more like the dollar theater rather than IMAX, so ask first.

Some patients feel nothing different than waking up from a good night's rest. Although if you have had General you may feel a little sick, hopefully your surgeon gave you something to lessen this. Although I was prescribed Zofran, I forgot to take it and got sick as soon as I got into recovery. Your prescribed medication should alleviate any pain or discomfort. However, if you believe your pain to be out of the ordinary once you get home, call your surgeon 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.

Incision Care
Please keep your incisions/suture line dry if they are extra-oral. Your surgeon may have placed Steri-Strips on top of your incision line and sutures or you may have has internal sutures but externally may have had tissue glue to bind your incision edges. Either way your surgeon will give you specific care instructions at your pre-operative appointment or sent home with you the day of your surgery. It is best to learn before so that your spouse, friend or caretaker will understand and assist you instead of having to learn the last minute. Also take care in not getting creams or lotions, nor topical arnica into the incision. These can cause inflammation.

For intra-oral incisions, keep your mouth clean! You may be asked to use Listerine several times a day and stay on a liquid diet until the incisions are healed. This is common, so expect it just in case. Do not tongue your incisions, or feel them with your fingers. If you must touch your incision line for applying medications (although rare), only touch them with a clean, gloved finger. Disposable latex or vinyl gloves can be bought at your local drugstore.

Suture Removal
You may have your incision sites checked and your stitches removed in approximately 10 days if they are non-resorbable. Suture removal may be painful, especially if the wound edges are snipped with the surgical scissors accidentally. It is generally a quick process and nothing to worry about although know that there may be some discomfort associated with the removal process. It may feel like a tugging sensation or slight stinging.

However, if you have intra-oral sutures, it is unlikely you will have them removed. They will eventually dissolve and fall out.

Monitor Your Temperature
Take your temperature regularly. An elevated temperature could mean an infection. Take those antibiotics ON TIME and don't forget if you are a female taking birth control that some antibiotics can interfere so in the event that you do have relations, use another form of protection as well. Although you should not be doing any type of activity such as this because it can raise your blood pressure. Your surgeon will let you know when you are released for normal activity.

Soreness & Pain Factor
Pain tolerances depend upon the individual but you will feel tender, stiff and sore for a few says and will more than likely not want to move too much. This will subside. Be sure to take your required medications and follow the precise instructions provided to you by your surgeon. Common pain medications may be Vicodin, Vicodin ES, Percocet, etc. There is no reason to suffer, so please take your medications regularly instead of waiting to feel pain before taking a pain reliever. The less pain you have, the better your experience and the faster you will make a full recovery.

Swelling (Edema)
As with all surgeries, swelling will be an issue. Swelling is a normal reaction to an injury and is categorized as a natural inflammatory action. Fluids high in white blood cells and hemoglobin will accumulate at the treatment site to treat the injury. You may be swollen for up to 3 to 5 months, although this could be very slight and only noticed by you. Swelling is not necessarily a bad thing, however severe swelling can be a problem. Let your surgeon know if you feel your swelling is not normal.

Treatment for prolonged edema include increasing your fluid intake, preferably water, normal to low sodium intake, movement such as light walking, in some cases the prescribing of prednisone. Diuretics are not advised and should be avoided unless specifically instructed. This includes natural diuretics as well.

Bruising
Bruises may or may not be present after your surgery, This depends entirely on the patient, the technique and the effectiveness of the epinephrine. One thing is for sure, bruises will usually get better. Perhaps you can ask your surgeon about Vitamin A and C to reduce swelling and discolorations and improve healing. Cold compresses will reduce the chances of bruising and reduce swelling during the first 48 hours. They can also assist in pain relief and swelling reduction thereafter however, please be careful that you do not injure your skin. The ice may hurt at first but will feel better as your skin gets used to it. Ice should not be placed directly on the skin as this can cause injury.

Warm, gentle compresses starting at the 48 hours post-op mark can assist in bruise removal by dilating the blood vessels to help the body remove blood and damaged tissue away from the treatment area. However, warm compresses should only be used after the 48 hour mark, and not before.

Permanent bruising is a risk but very rare. if this is the case and you have discolorations after several months post op, you may wish to seek Intense Pulsed Light treatments. These treatments target the hemoglobin in the blood. [Hemoglobin <he*mo*glo*bin> (noun) : an iron-containing respiratory pigment of red blood cells that functions primarily in the transport of oxygen from the lungs to the tissues of the body.] A highly advanced computer regulates the light pulse to a specific wavelength range, which in turn heats the visible, targeted blood vessel(s). Thereby damaging or otherwise destroying the targeted lesion while sparing the surrounding healthy or normal tissue. The penetration depth and degree of heat is highly controlled so that most complications contributed to these specific factors are not an issue with Pulsed Light Therapy.

Sleeping
Sleeping is going to be difficult at first. It is important to sleep with at least 2 to 3 fluffy pillows under your upper back and head to keep yourself elevated. This helps relieve pressure from your treatment area hence reducing swelling and pain. Many patients opt to place a pillow under their knees to help keep them from rolling over during the night. Some place pillows alongside them and create a sort of recovery nest.

Many surgeons offer their patients a prescription of Ativan or Valium to ease pre- and post-operative jitters, sore muscles and help put you to sleep. I personally found valium very helpful in falling, and staying, asleep. My back was a little sore due to sleeping upright for 10 days so the valium eased this as well.

Just be sure that you do get some sleep because your body can heal itself better while it is at rest. Besides sleeping is a good way to past the time during recovery. Just be sure to have someone wake you up to take your meds, eat some healthy meals and drink your fluids.

Bathing
You may want to sponge bathe until you feel better. You may need assistance if you are disoriented. A shower chair helps, but be sure not to get an extra-oral incisions wet. You also may have a support garment so don't remove this to shower, nor get it wet, unless your surgeon instructs. Bottom line, ask your surgeon when he is okay about your taking a bath or shower. Baths are easier but you may need assistance actually getting out of the tub.

You should wash your hair beforehand and either braid it or keep it back in a ponytail if it is long enough. This will keep your hair clean and out of the way when you are eating and taking medications, or if you get sick. You may not be able to wash your hair for a while due to dizziness, pain or disorientation. If you must wash your hair, please get a friend to assist you in the sink or with a hand held shower head. Or if you wish, have your hairstylist wash your hair for you a week post op or more.

Activity
Even though you may not feel like it, your surgeon will more than likely advise you to walk and move around as soon as you are able. If you do not and lie around you may develop clots and or hold fluid (swelling, edema) a lot longer.

You will be instructed not to exercise or engage in strenuous activities for at least 3 weeks. Raising your blood pressure can cause bleeding and you don't want that. Don't lift anything over 5 lb. and try not to raise anything over your head until your surgeon releases you for activity. Take your time in healing so that you give yourself the best healing environment possible.

Scars & Keloid Prevention
If you have extra-oral incisions and would like help with keloid prevention and scar flattening some surgeons suggest silicone gel sheeting. Some products are manufactured, such as those from BioDermis, or scar tapes such as made by Curad or Band-Aid.

Numbness & Loss of Sensitivity
There may be some loss of sensation at first. This is usually caused by the swelling from the trauma cutting of your nerves ability to transmit pain or touch sensations. This usually will subside within a few weeks but be aware that in rare cases, loss of sensation may be permanent. You may also experience sharp pains, burning sensations, heat, tingling, prickling, etc. This is from nerve damage and the sensations of the returning function of the nerves will result in the physical descriptions above. Motor nerve damage is rare, but numbness after is common and usually almost always returns.

What Will I Look & Feel Like? PLEASE READ!
If you have had a chin implant, you will notice your chin will be swollen, firm and possibly bruised. Your tissue will soften up and your swelling will subside. The firmness is from the swelling which is essentially fluid retention in your tissues. This is a natural reaction to a wound of any sort, it is your body's way of repairing it self. The cold compresses in the first 48 hours, or for comfort thereafter, will significantly lessen the swelling, as will keeping your torso elevated.

If you have had injectables, the swelling may be less, however I have seen injections cause great swelling. Bruising is commonly less, but of you develop bruising don't be alarmed. Your cheeks may also be firm as well.

As far as what you will first look like... You may feel you look like a "pumpkin head", many patients on our message boards feel this way. This will pass, remember your results aren't near being seen. Give it time. Don't jump to conclusions just yet, you will probably not like them at first and think your cheeks are too big. Please be patient.