Plastic surgery restores form and function through reconstructive procedures, cosmetic enhancements, and body contouring.
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Sliding genioplasty, also known as osseous genioplasty, is the gold standard for complex chin corrections. This procedure involves a horizontal osteotomy, which is a precision cut through the chin bone. The lower segment of the bone is then mobilized.
Because the bone itself is moved, this technique offers three-dimensional control. The chin can be moved forward for projection, backward for reduction, downward for lengthening, or upward for shortening. It can also be shifted laterally to correct asymmetry.
The versatility of sliding genioplasty makes it superior for patients with vertical height issues. An implant cannot effectively lengthen a short face or shorten a long one. Physically moving the bone alters the skeletal proportions of the lower face.
This procedure also carries the attached muscles with the bone. As the bone is advanced, it pulls the muscles of the floor of the mouth forward. This tightens the submental area and improves the neckline more effectively than an implant.
Chin augmentation using implants is a standard procedure for patients requiring mild to moderate horizontal projection. The implants are typically made of solid silicone, porous polyethylene, or ePTFE. These materials are biocompatible and designed to last a lifetime.
The procedure involves creating a small pocket over the front of the chin bone. The implant is inserted into this pocket and sits snugly against the mandible. It adds volume to the chin, pushing the skin and soft tissue forward to improve the profile.
Implants come in various shapes, including central buttons and extended anatomical designs. Extended implants taper along the jawline, helping to fill in the pre-jowl sulcus and creating a smoother transition from the chin to the jaw.
This approach is less invasive than cutting bone and typically has a shorter recovery time. However, it is generally limited to increasing projection and cannot significantly alter the vertical height or correct severe asymmetry.
Chin reduction is performed for patients with macrogenia, or an overly large and prominent chin. This can be vertical excess, where the face looks too long, or horizontal excess, where the chin protrudes too far forward (the “witch’s chin” appearance).
The procedure involves an osteotomy similar to sliding genioplasty. The bone is cut, and a wedge of bone may be removed to shorten the height. Alternatively, the bone segment can be set back and secured to reduce projection.
Managing the soft tissue is critical in reduction surgery. If the bone is reduced but the skin is not addressed, the excess soft tissue can bunch up or sag, creating a fleshy deformity. Surgeons often perform soft tissue tightening or suspension concurrently.
Sometimes, a simple burring or shaving of the bone is performed for minor reductions. However, aggressive shaving can detach muscles and lead to soft tissue ptosis, so osteotomies are generally preferred for significant changes.
Patients with a short lower facial third often exhibit a compressed appearance. Vertical lengthening genioplasty is designed to increase the distance between the lower lip and the chin. This balances the facial thirds and creates a more elegant proportion.
This is achieved by cutting the chin bone and moving it downward. To fill the gap created between the bone segments, a bone graft (often from the patient’s own hip or a cadaveric source) or a specialized plate is used to hold the new position.
This procedure can significantly improve the labiomental fold. By lengthening the bone, the deep crease under the lip is softened, creating a more youthful and relaxed appearance.
It is a technically demanding procedure that requires precise fixation. The aesthetic benefit is a less “squashed” look and a stronger, more defined lower face.
Vertical shortening is indicated for patients with “long face syndrome” or vertical maxillary excess. The chin appears vertically elongated, often straining the lips to close. The goal is to reduce the height of the mental symphysis.
The surgeon performs two parallel horizontal cuts in the chin bone and removes the slice of bone in between. The bottom part of the chin is then moved up and fixed to the upper part. This physically shortens the bone.
This procedure facilitates lip competence. By shortening the distance the lower lip has to travel to meet the upper lip, the mentalis muscle can relax. This eliminates the dimpled, strained look of the chin at rest.
Careful attention to the nerve roots is essential, as the tooth roots and the mental nerves limit the space for osteotomies.
In the context of sleep apnea treatment, the genioplasty is aggressive. The focus is on maximizing the forward movement of the bone to open the airway. This is often called a Genioglossus Advancement.
The surgeon creates a rectangular window in the chin bone that captures the attachment of the tongue muscle (genioglossus). This piece of bone is pulled forward and locked in place, physically dragging the tongue base away from the back of the throat.
This procedure is strictly functional but inevitably changes the appearance of the chin. Surgeons try to balance the need for airway expansion with an aesthetically acceptable cosmetic result.
Often, this is combined with other jaw surgeries (maxillomandibular advancement) to maximize the airway volume for patients with severe obstructive sleep apnea.
Revision surgery corrects unsatisfactory results from previous chin procedures. This may involve removing a malpositioned or infected implant, or recutting the bone to correct asymmetry or improper projection from a prior sliding genioplasty.
Revision cases are complex due to scar tissue and altered anatomy. The surgeon may need to use bone grafts to fill defects left by previous surgeries or custom-carved implants to camouflage irregularities.
The goal is often to restore normal anatomy or correct specific deformities, such as the “witch’s chin,” that can occur if the soft tissues were not resuspended correctly during the first surgery.
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Titanium plates and screws are used to secure the bone in its new position. These are biocompatible and typically stay in place permanently. They are strong enough to withstand the forces of chewing and muscle movement while the bone heals.
While rare, the body can react to a foreign object. The body typically forms a capsule of scar tissue around the implant. If this capsule contracts or if infection occurs, the implant may need to be removed. Solid silicone is generally well tolerated.
This deformity occurs when the soft tissue of the chin sags off the bone, creating a drooping, ptotic appearance. It can happen after aggressive bone reduction if the muscles are not appropriately reattached or simply due to aging.
Intraoral incisions are closed with absorbable sutures that dissolve on their own over a couple of weeks. This means there are no stitches to remove and no visible scars on the face.
Not always. Small vertical gaps can sometimes fill in with new bone naturally over time. However, for significant lengthening (more than a few millimeters), a bone graft or a synthetic bone substitute is usually required to ensure stability and proper healing.
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