How it differs from operating only on the nose
People who come in because they dislike their profile almost always point to the nose, which is the most visible feature. But the profile comes from the relationship between three points, forehead, nose and chin, and if one is out of proportion the others look it too.
Rhinoplasty corrects the nose. Profileplasty analyses the whole profile and decides what should be changed and what should be left as it is. Often the conclusion is that the nose is enough; in other cases the change the patient is looking for only comes if the projection of the chin is also modified. That decision is made at the assessment, before the operating theatre.
Why the nose and chin are assessed together
The eye does not measure millimetres, it compares. Two almost identical noses look very different depending on how the chin is projected.
A short chin makes the nose look bigger
This is the most common case. With a receding chin, the profile slopes backwards from the lower lip and the nose sits forward. The person feels they have too much nose when what is missing is projection lower down. Reducing the nose in that case can make the whole worse. An augmentation chin surgery changes the profile more and sometimes means the nose needs much less work.
When one structure is enough
If the chin is fine and the problem is a hump, a drooping tip or a deviation, rhinoplasty alone solves the reason for the consultation, and adding chin surgery only adds recovery and risk. The reverse also happens: some profiles have a balanced nose and a short chin, and operating on the chin is enough.
What it can include
Nose
This is the most usual part. A primary rhinoplasty, an ultrasonic rhinoplasty when the bone work is significant, or a revision rhinoplasty if there has been previous surgery. If breathing is also difficult, the functional correction is planned in the same operation.
Chin
With an implant that increases projection, or by moving the bone itself with an osteotomy. It depends on how far it needs to move forward, whether the height also needs changing and the relationship between the teeth.
Neck and jawline
With fat under the chin or platysmal bands, the angle between neck and jaw is lost and the chin looks shorter. Treating the neck with a neck lift changes the profile without touching the bone.
Lips
If the distance between the base of the nose and the upper lip is long, a lip lift shortens it. It is a small procedure with a large effect on how the lower third of the face reads.
How it is planned
With standardised photographs in profile, from the front and at three quarters, always with the same light and distance. On those images the angles between forehead, bridge, tip, lip and chin are analysed and compared with what the patient describes.
That comparison is the important part of the consultation, because the analysis and the patient's perception do not always match. A simulation is useful to discuss the direction of the change and never as a commitment to a result: each tissue responds in its own way.
The bite is also assessed. If the relationship between the two dental arches is altered, the problem may be skeletal and call for orthognathic surgery or orthodontics. Spotting it beforehand avoids operating on the consequence instead of the cause.
What it does not solve
- Sagging facial skin, which is a matter for a facelift.
- The structure of the jaws when the problem is the bite, and it does not replace orthodontics.
- Skin quality, wrinkles or blemishes.
- Making one face look like another. The aim is to balance a specific profile.
Recovery when nose and chin are combined
Combining both lengthens the time in theatre and does not double the recovery, because the two recoveries run in parallel. In the first week the appearance is more noticeable than after a rhinoplasty alone.
The nasal splint comes off around the first week. In the chin, sensation in the lower lip may be altered for several weeks and usually recovers. The profile settles over months, because the tip of the nose is the last part to lose its swelling.
Risks and limitations
Bleeding, infection, changes in sensation, asymmetries, unpredictable healing and the possibility of a touch-up. With a chin implant, also displacement or the need to remove it.
When dissatisfaction with the profile is out of proportion to what can be seen, or shifts focus every few months, surgery rarely resolves the distress. In that case the right course is not to operate.
Frequently asked questions
Are profileplasty and rhinoplasty the same?
No. Rhinoplasty operates on the nose. Profileplasty analyses the whole profile and decides what to modify: the nose, the chin or both. Many profileplasties include a rhinoplasty.
Can the nose and chin be operated on at the same time?
Yes, when the analysis shows that both structures are involved. It is a single operation, with one anaesthetic and a single recovery.
How do I know whether my problem is the nose or the chin?
By the relationship between them. If, in profile, the line slopes backwards from the lower lip, the chin probably lacks projection. The photographic analysis at the consultation confirms it.
How long does it take to see the result?
The chin can be seen as soon as the initial swelling goes down. The nose takes much longer: the tip becomes defined over months.
Is there a visible scar?
It depends on the approach. In open rhinoplasty the scar is on the columella and is usually barely noticeable. For the chin, access can be from inside the mouth. Healing varies from person to person.
What if I only want to change my profile a little?
That is a reasonable request. A moderate change to a single structure can balance the whole without remaking the face, and limiting the scope is a valid decision.