Cases in Genioplasty

The genion is the anterior point of the chin. Chin problems can include: under-projection, over-projection, vertical excess, vertical shortness, and angular deformity (crooked chin). Patients who are dissatisfied with a previous chin implant are frequent candidates for combined removal of the implant and genioplasty. Many patients with chin problems have normal dental occlusion, meaning they don’t need movement of their teeth to correct the chin. Under-projection is the most common chin complaint. The best correction of this problem is by surgical advancement of the bony chin, not by insertion of an artificial implant. Correction of all other bony chin problems cannot be solved by an artificial implant.

I perform chin surgery (and other orthognathic surgery) in the hospital or accredited outpatient surgery center, usually as an outpatient procedure under general anesthesia. Genioplasty normally should not be done before skeletal maturity. Chin alteration is not usually an insurance covered procedure, unless the patient suffers a syndrome or other birth defect. The procedure is done through an intra-oral incision, so that there is no visible scar. The mentalis muscle is divided to expose the chin periosteum which is then dissected off of the bone. The sensory nerves to the lip are identified and protected. If the chin is retrusive, the bone is advanced after separating it from the tooth bearing part of the mandible (jaw). The bone is still attached to its adjacent muscles and their blood supply. The advanced bone is then reattached to the jaw, usually with tiny steel- wire sutures which do not show and are permanent. The position of the bone is checked and the repair of the mentalis muscle is performed. The oral mucosa is then sutured with resorbable suture. An external supportive dressing to reduce swelling is worn for 2-3 days, then removed in the office. The surgery requires between one to two hours. Patients are recovered in the post-operative recovery room and then discharged home with an adult escort. Patients may drink clear liquids immediately after surgery and regular food by 3-5 days. An oral narcotic is prescribed but usually discontinued by the patient after 2-3 days. Pain and bruising are minor to moderate in both time and severity. Visible swelling persists for about 10 days. Bone and final healing requires at least 2 months. There are no physical restrictions, however, after 6 weeks.

Genioplasty is a permanent, stable solution to almost all chin abnormalities. The office consultation involves taking a standard history and physical examination and a discussion of the patient’s goals. A lengthy discussion follows of the patient’s precise diagnosis, its possible solution by a surgical strategy and the techniques involved, and the risks and benefits of surgery covered. Standard photographs are taken. Many of my genioplasty patients have been previously treated elsewhere unsuccessfully with chin implants. It is common to perform genioplasty and rhinoplasty in one surgery on a patient with combined nose and chin disharmony. As a craniofacial and maxillofacial surgeon, genioplasty represents one of the simplest bony operations that I perform. Butif genioplasty were truly “simple”, most plastic surgeons would offer it (most do not due to inadequate training), especially because its results are vastly superior to a chin implant.