Do I need a large chin implant, sliding genioplasty or both? (photo)

For a lower jaw lacking in "bone stock" and an extremely recessive chin, I will typically favor an implant.  Sometimes patients do have a very underdeveloped jaw, and despite an aggressive jumping genioplasty, they will still require greater augmentation for an adequate aesthetic result.  In these patients, there are two options.  Some surgeons will recommend taking a bone graft to achieve greater augmentation in these cases.  I feel that patients are generally more happy with an implant at this point, and reserve bone grafting for any patient who refuses an implant.  Chin implants and most osseous genioplasty (sliding or jumping) procedures are planned and performed as ambulatory surgery.  I allow all of these patients to go home after surgery.  If a bone graft is harvested, however, then overnight stay may be preferred.  To determine which procedure is best, the patient should really be examined by a board certified plastic surgeon.  They should see someone who performs both procedures to really understand and appreciate the pros and cons of each.  This way, the patient and doctor may, together, make an informed decision. 

A chin implant can be inserted through sub mental approach under local anesthesia as an outpatient procedure. The size of the implant is determined at the time of examination/consultation. A sliding genioplasty is performed by oral surgeon as an inpatient surgical procedure at a hospital. If your dentition is significantly off, the sliding genioplasty may be the better option.

In my opinion, either a conservatively sized implant or genioplasty would be helpful.  Ideally, you would likely benefit from moving the entire mandible, but this is more complex, costly, and time consuming.  The key is that the advancement of the chin is not too much with either an implant or genioplasty, as it can appear unnatural if made too big.  The specialty of your surgeon is not important, as opposed the level of experience that they have with problems similar to yours.