Would a genioplasty help me achieve more projection in the chin? Should I consider other procedures? (photos)

Question

Male, 22 6'0", 175 lbs. Current body fat probably 15-20%. I am aware that my chin isn't quite recessed, but there is no real projection to it either, especially when compared to my lips. I look to my parent's and sisters chin, and they at least have some projection. I have had orthodontic treatment in the past and I recently spoke to an orthodontist to see if they could help but I was told to look into genioplasty. Is that procedure too extreme for what I am seeking?

Timothy Osborn, MD · Answer

You appear to be a good candidate for a genioplasty.  This would bring your chin forward and slightly down, creating more facial balance and the projection you are looking for. It will also add length and definition to your jawline. The benefit of a genioplasty is that it lasts forever, and the whole procedure is done through the mouth, which means no external scarring. I would say a genioplasty would be the best option for you to achieve your aesthetic goal. Our office provides morph photo simulations of your expected outcome, so you have a better idea of what the result would look like. We would be happy to schedule a consultation to discuss your options further.

Michael P. Morrissette, DDS, FACS · Answer

It appears that you are a candidate for either a sliding genioplasty or chin implant. Both procedures would add horizontal projection to your chin. In addition, I would simultaneous jawline and neck liposuction to improve and define your jawline and neck.

William Portuese, MD · Answer

A genioplasty is performed by an oral surgeon under general anesthesia in a hospital setting with an overnight stay and is much more invasive than a chin implant. A genioplasty is usually performed when the teeth are significantly out of alignment. Placement of a chin implant is done under local anesthesia for purely cosmetic purposes. In our practice, we make a small incision underneath the chin and place the implant directly over the mandible to augment your chin to look very natural. The procedure takes about 30 minutes

Mats Hagstrom, MD (license on probation) · Answer

When it comes to issues related to the mandible it’s important to recognize where the problem lies.
Individuals with a deficient mandible can have the problem be at different locations along with that bone.
If the lack of projection is behind the teeth then dental occlusion is off and individuals generally have a significant overbite. He probably had this to some degree and it has been at least partially corrected with orthodontic treatments. for individuals who have a significant variation in the projection of their teeth will show this by how the upper and lower lips relate to each other on profile pictures.
Individuals who have an under developed man the bull and also have a significant overbite dental occlusion or typically have an upper lip that has far more projection than the lower lip. these individuals may or may not have a chin the projects but the body of the man the ball definitely needs advancement.
And your pictures your lips line up very nicely so I think the issue is not so much in the body of your lip so we can then focus just on the chin itself.
It’s possible to have one part of the band above be too big and one part be too small.
Each aspect of the mandible needs to be assessed separately to get a good understanding of what’s going on.
In regards to your chin only do you have an oblique labiomental angle. And your chin basically slopes backwards. in many ways this is the easiest type of man the ball issue to correct. when all of the problem is further back in the body of the mandible it generally requires jaw advancement or double jaw surgery.
Those are complex procedures that people are often apprehensive to undergo.
In your case you really just need chin augmentation.
There are three primary treatments that do this and all of them work well.
From simple Tamark complex the treatments are using fillers, using a solid silicone (can be other material ) implant or having a sliding genioplasty. Each of these treatments has advantages and disadvantages.
The disadvantage to fillers it’s pretty obvious and that it’s a temporary treatment and a lot of people are not interested in things that need to be done again and again.
The main advantage to using fillers is that fillers are extremely forgiving if you don’t like the outcome.
They can also be adjusted and fine-tune with each treatment slowly perfecting the outcome.
Fillers in the end are the most precise, predictable and most forgiving.
They are also not permanent.
Implants and sliding genioplasty are permanent or potentially semi permanent.
Both procedures can give projection in a horizontal and vertical direction. potentially a sliding genioplasty is may be a bit better for individuals who need primarily vertical augmentation rather than lateral augmentation.(needing the chin to be taller rather than longer).
The procedures can both be done by oral surgeons and plastic surgeons.
The approach will vary to some degree but from what I’ve seen it seems like most sliding genioplasty procedures tend to be done more frequently by oral surgeons while plastic surgeons tend to rely on implants more frequently.
That is not to say there are not plastic surgeons who do the sliding genioplasty or oral surgeons who place implants.
Neither procedure is better than the other. Implants are probably a little more straightforward and a little easier to manage if someone regrets the decision and wants to revert back.
Implants typically will erode the bone slightly over time.  Bone continuously remodels and putting continuous pressure along the bone will cause the bone to slowly change over time.
The degree of a bone erosion is generally not enough for patients to need to redo the procedure though there are times were many years later sometimes people do.
In the end I would say the most important decision is finding the most talented and experience provider. it’s probably more important than choosing the correct procedure as long as you are choosing a procedure that does the intended job.
To find the right provider I suggest you schedule multiple in person consultations with both oral surgeons and plastic surgeons in your community.
See what each provider has to say and see if the recommendations stay fairly consistent.
There are certain skills in consulting with medical providers that most patients don’t have a lot of practice at.
Your goal is to first get an accurate assessment and then get a recommendation for viable treatment options.
Your goal is also to assess the skill and experience of that provider.
To do that I recommend you ask each provider to open up their portfolio and show you their entire collection of before and after pictures of previous patients who had the procedure they are recommending.
Ask them to show you previous patients who are very similar facial characteristics. Being shown a handful of results representing the best outcomes of a provider‘s career is insufficient to get a clear understanding of what average results look like or how many of these procedures anyone surgeon has performed.
For that reason you should ask providers to open up your portfolio and show you all of their before and after pictures. Some providers may be reluctant to do this but I recommend that you ask.
You should also ask the providers to show you examples of excellent outcomes, average outcomes and outcomes that didn’t turn out as well as they had hoped for. again, providers may be apprehensive to do so and may want to stick with just showing you their best results.
For reference an experienced surgeon doing this type of work should have no difficulty showing you at least 50 sets of before and after pictures.
Let them know that your decision with what surgeon you choose will be in part based on who has the most impressive collection of honest before and after pictures.
You should also ask specifically what each surgeons revision rate and revision policy is.
A substantial number of patients are not always happy with the outcome of either a sliding genioplasty or the placement of an implant.
There are variety of reasons patients may want the procedure reversed or adjusted.
The time to talk about these issues is during the consultation.
You should get familiar with what quality before and after pictures look like by looking at lots of pictures online first.
Have pictures of your own face at hand and compare them looking for other people who had similar facial characteristics to your own when viewing results.
Results are highly dependent on each individual persons candidacy for the procedure and what people look like before the surgery has a big part of who is going to get a quality outcome.
In your case I think you are an excellent candidate and this is a pretty straightforward situation.
When reviewing before and after pictures create a rating score like a 1 to 5 or what do you think are good outcomes.
During each consultation rate both the quality and quantity of before and after pictures each provider shows you as well as the overall completeness of the entire consultation consultations should include an examination, discussion of assessment and recommendations, review of before and after pictures, review of medical history, preparation for surgery, discussion of recovery, risks and benefits including alternative procedures etc. etc.
If you don’t take notes during the consultation it’ll be hard to remember who was the better provider.
You’ll get better at the process with practice.
Most people simply call one provider have a consultation and either schedule surgery.
I recommend all patients commit to having at least five consultations before ever committing to having this type of surgery.
I cannot emphasize enough the importance of choosing the right provider and how much difference there can be among different providers despite having equal qualifications regarding board certification, overall good reputations etc. etc.
Do not rush through the process. When in doubt slow down and schedule more consultations.
In your case be grateful that your situation is fairly straightforward and the treatment should be fairly simple and successful with low incidence of poor outcomes.
Dealing with facial aesthetics of the lower one third of the face is not always straightforward and easy and a substantial number of providers miss what the actual problem is and start recommending procedures that don’t work.
I don’t think that’s the case for you since you are basically looking for some thing that treats the actual problem. Things become different for individuals who complain of soft tissue issues related to bone structure like the formation of a premature double chin etc.
Best,
Mats Hagstrom MD

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