… in other words, balancing the pivot point.
This principle applies to facial aesthetics, and in particular, nose and chin surgery.
An easy way of considering vertical facial proportions is to break it up into thirds: the upper third, made up of the forehead and eyes; the middle third, dominated by the nose; and the lower third, composed of the mouth and chin. When there is a good even balance in size and dominance between the thirds, the face presents itself in a very pleasing manner. Given that there is generally minimal variation in forehead size, vertical facial balance is essentially determined by the size of the nose and the chin.
I see many patients who come in and wish to have their nose reduced in size. Patient will often comment that they look at a photo of themselves or in the mirror, and the first (and only!) thing that they see is their nose. Indeed, a prominent nose will instinctively draw the observing eye to itself. If a prominent nose is coupled with a deficient chin, then this will make the situation worse, can portray an obvious “top heavy” facial appearance. The impact that the chin plays in facial balance is often underplayed. It is often the sole cause of facial imbalance, and will frequently make the nose appear larger and more prominent than it actually is.
In my clinical assessment, it is important to first examine the nose and the chin on their own, and then the two structures together in unison. The fulcrum or pivot point in terms of balancing the nose and the chin is usually around the upper lip region. A quick look at a lateral or profile photograph will give us a general impression of whether a patient is “top heavy” or not. The next step in deciding whether we perform a reduction rhinoplasty, a chin augmentation, or both will be governed by the outcome of this assessment.