Genioplasty

Genioplasty is a procedure used to improve the appearance of a persons chin. This can take the form of chin height reduction, rounding or augmentation using osteotomy (cutting the bone) or implants.

A sliding genioplasty, involves mobilizing a horseshoe-shaped piece of the bottom part of the chin bone by osteotomy and sliding it either backwards or forwards, finally fixing it in place with two or three little titanium screws. The teeth are not moved in this operation (that is called a sagittal osteotomy of the mandible), which we can do as well, but this is a procedure intended to realign the upper and lower teeth.

This procedure is performed through an intra-oral incision. The bony piece is cut and then moved forward and secured with screws. Placement of a bone graft is also an option, although we usually only do that for reconstructive cases. Do know that you will be able to feel some slight dents both underneath the jaw and in the front part of the new “chin” — where it was slid forward. However, tissue will cover your new chin and look very natural. There are no visisble scars.

Genioplasty has more of an incidence of nerve damage (especially the inferior alveolar and mental/menton nerves) than chin augmentation via alloplastic implants. It is the most difficult or time-consuming for the surgeon to perform and has more down time, but less risks in the long run. The advancement can be very slight or more dramatic, depending upon your needs.

The results can appear very natural when performed correctly. The results may be comparable to a chin implant. The choice of an implant or bone advancement is up to the patient and neither one is risk free.

 

sagittal osteotomy sliding genioplasty

 

This is a picture of an osteotomy of the mandibula (lower jaw ) + a sliding genioplasty.
The mandibula bone cut will realign the teeth, whereas the chin work only has a cosmetic effect.
Both procedures may be combined or done separately.

 

Advantages genioplasty

    • it is your own tissue . Never has problems of late infections.

     

    • once in the correct position, it will stay there forever, as your own bone is fixed by your own glue (new bone and collagen).

     

    • it improves the jowls .

     

    • it does not provide you with a pointed and narrow chin

     

    • it does not give you a longer chin in the front view

     

Disadvantages

    • more expensive , as more time consuming. Can only be done by very skilled surgeons.

     

    • initially more swelling (1-2 weeks)

     

Chin Implants

An intraoral incision is placed within the lower portion of the inside of the mouth between the lower gums and the bottom lip/chin area. This is beginning to be the incision placement of choice for most surgeons. Although the intraoral incision has the advantages of no visible scar, it runs the risk of a slightly higher rate of infection due to the bacteria present in the mouth. Be sure to tell your doctor if you smoke or have any gum disease or cavities. These two factors could cause an infection as well as impede healing.

The second option is referred to as an extraoral incision or quite simply “under the chin”. We don’t do this very often.

 

Advantages

    • simple , quick , cheap

     

Disavantages

    • higher rate of infection

     

    • implant may slip  , leading to strange ‘plastic’ flippy edges which you can feel when someone touches your chin

     

    • scar capsule around the implant, leading to bone erosion and the implant sinking in the bone after many years

     

    • more prominent but smaller pointy  and longer chin  in the front view

     

Conclusion: an implant is only good if it is for a small augmentation.

Aftercare in case of problems: if the implants slips, the only thing one can do is remove it . This means the pocket was made too big. There is no way one can fix a slipped silicone implant.

If it gets infected , the treatment is removal and a new implant after 4 months. Removal would be free (under a local anaesthetic) , but a new insertion would cost you 500 £ (under a twilight) .

 

Incision Care and Scar Lessening

Eat soft foods during the first 2 weeks, rinse your mouth after each meal and drink with water (no sugar) , and brush your teeth twice a day (gently) . Chorhexidine mouth-wash is useful after surgery.

No tonguing the incision or touching it with your fingers or any other object unless specifically told by your surgeon.

Sutures are dissolvable . If still not dissolved after 10 days, it is best to have them removed in the office or by your nurse/ GP.

 

Injectable Fillers

Injectable products for chin augmentation can deliver immediate results but is only good for a minor chin augmentation (eg Radiesse).