Michael P. Morrissette, DDS, FACS

There will likely be no difference between a complete setback and a 4 mm setback. A 7 mm is by no means excessive. It would help to see pictures and understand your goals.

The 2 options available for treating a slightly recessed chin are a chin implant and a sliding genioplasty. Both are performed in the office with intravenous anesthesia. Both procedures will improve your facial balance and profile. Some patients select the sliding genioplasty because they don't want a silicone implant. The results achieved with either procedure will be similar.

Without the benefit of a physical exam, it is difficult to comment on another surgeon's surgical plan. In general, advancing the chin will give the appearance of a more well-defined jawline and the face will appear slimmer. The soft tissue of the chin does not respond 1:1 with the bony changes. In some cases, any movement less than 5 mm has minimal effect. You may want to consider removing a central wedge of bone to make the chin narrower. Shaving the chin bone can cause a healing response that allows the bone to heal back to its original shape. Your mentolabial fold does not appear deep, so I am not sure you need any vertical lengthening.

The profile photo shows that you have a deep mentolabial fold. This usually indicates that the chin is short in the vertical plane. You would likely benefit from a sliding genioplasty that lengthens the chin and sets it back slightly. The surgery is performed in the office under intravenous sedation. It does not change your bite.

The genioplasty surgery can be easily reversed by removing the plate and performing a second osteotomy. Ptosis is not likely if the Mentalis muscle is properly sutured. The bone is porous, and the soft tissue can reattach to the bone. The soft tissue changes are not 1:1 with bone changes. For example, moving the bone forward or back 5 mm may only show a 3mm change in the soft tissue. The chin can be shaved to create a more tapered appearance. The chin can be shaped to produce less prominence and obviate the need for a second osteotomy.

There are two things that can be considered. Some fatty tissue can be removed from beneath your chin and along your jawline to make it appear well-defined and well-contoured. Based on your profile photo, you have a deep mentolabial fold (the fold beneath your lip). This usually indicates a short chin in the vertical dimension. A CT scan would allow measurement of the height and determine whether you would benefit from a chin lengthening procedure. This would improve your overall facial balance.

Yes, you would benefit from a sliding genioplasty. I would recommend moving your chin 9-10 mm forward. This should greatly improve your facial balance.

This finding is common after such a genioplasty with FSS. In some cases, the chin is made narrower, and the step-off is significant. Reversing the genioplasty won't improve the jawline. I would recommend a custom silicone implant going from the angle to just beyond the step-off. This should give you a nice continuous jawline.

Based on your photos, I would recommend a minimally invasive approach. Improved definition of your lower face can be achieved with lower face and neck liposuction. You likely have good skin tone, which will not require skin removal. Occasionally, there is a pocket below the platysma muscle that requires a small incision under the chin to remove fat.

Most fillers will resorb and require replacement. I recommend pyriform silicone implants for a permanent solution. They are placed in the office with local anesthesia. They can also be easily removed. The area does not pose a risk of bleeding, as there are no vessels encountered when placed through an intraoral incision.