Sliding Genioplasty: Safe, Effective, Easy Procedure
As a craniofacial surgeon (one who is board certified in plastic surgery and fellowship-trained in craniofacial surgery), I have performed numerous sliding genioplasties as well as implant procedures to strengthen the chin. Both procedures are very straight forward, take about the same amount of time to perform, and can be effective in most cases. However, there are multiple benefits to performing a genioplasty in which the chin is cut and the bone is advanced and then secured in position with a small titanium plate. There is no risk of implant infection when performing a genioplasty in which your own bone is used to achieve the augmentation. Chin implants are also prone to shifting position resulting in post-op asymmetry; this doesn't occur with a sliding genioplasty as the bone is secured in place. Both procedures can be performed through a similar intra-oral incision. Placing the implant through this approach increases the chance of infection. Placing it through an external incision on the chin to reduce the chance of infection produces a visible scar. As every patient is different, be sure to review the details of each procedure carefully with your surgeon to make the best choice for yourself.
The Choice of Chin Implants vs Chin Osteotomies Depends On The Problem
While chin implants are by far the most common method of chin augmentation, they are not ideal for absolutely everyone. Large chin deficiencies as well as vertical chin problems may be better treated by moving the chin bone to a better position. When horizontal chin deficiences are greater than 10mms (as determined by a side view picture), then one needs to carefully consider the osteotomy option. Off-the-shelf chin implants do not usually give more than 10mm of projection. When the chin is vertically short and needs to be lengthened or when it is too long and needs to be shortened, an osteotomy is the only treatment option.
Chin implant versus sliding genioplasty
Both a chin implant and a sliding genioplasty can be very effective for augmentation. However, only a sliding genioplasty can recess a chin, lengthen the chin, as well as correct an assymetry.
Chin implant options
The simplest explanation is that sliding genioplasty is used most often for assymetries of bone while an implant is best used when their is symmetry of sides. Many genioplasties are performed in the setting of a normal chin enhancement.
Chin Implant Vs Sliding Genioplasty
Sometimes either is fine, but many times there are significant differences in results. You are 'right on the money' about vertical height being one of the important differentiators. I use a simple facial analysis to determine whether vertical height is optimal (and this has been published in different forms by myself and my colleague and mentor, Dr. Steve Byrd. I take a ruler and measure mid face height, lower face height, nasal length, chin vertical, nasal projection and chin projection. Lower facial height should be equal to or up to 3mm greater than mid face height. Chin vertical, as measured from where the lips meet to the bottom of the soft tissue chin should be equal to nasal length. The whole measurement process takes less than 30 seconds. Some under projecting chins are too long and this results in "mentalis strain" - dimpling of the chin and difficulty in closing the lips. The vertical height can be corrected along with the projection deficiency using a sliding genioplasty. Decreased vertical length, which tends to make the nose look longer than it is, and can lead to an appearance of lower facial weakness, can also be corrected nicely with a sliding genioplasty. Many surgeons are not comfortable doing genioplasties and don't offer them. It really is a very straight forward operation, should take about as long as placing a chin implant, and is done through a hidden incision inside the mouth.
Chin implant versus sliding genioplasty
Chin implant versus sliding genioplasty is a big decision. A chin implant is inserted for cosmetic purposes up to about 8 or 9 mm of anterior projection. Chin implants to give a few millimeters of added height and width, since the implant is three-dimensional. Chin implants are placed through a sub mental incision under local anesthesia as an outpatient procedure.
A sliding genioplasty is performed under general anesthesia and usually requires an in-hospital stay for 24-48 hours after the procedure. It's best to perform this procedure when the teeth are significantly out of alignment and there is a significant bony deficiency present, and more than 10 mm of augmentation is required.
Chin implant or sliding genioplasty
The choice between a chin implant or a sliding genioplasty depends on the individual patient's's anatomy. Most patients would be better served with a well planned and executed Chin implant augmentation. Sliding genioplasty has a higher complication profile, and should be reserved for the patients that can not be helped with chin implant surgery alone. A well trained and experienced surgeon should be able to guild you in your choice.
Chin Implant Almost Certainly A Better Option
Chin augmentation can be done by either adding an artificial material (chin implant) or by moving your own bone forward (sliding genioplasty). A sliding genioplasty is a much more complex operation, requires a larger incision, has a higher rate of complication, is far more dificult to undo, has a longer healing time, and puts your teeth and nerves at greater risk. In addition, there are dozens of chin implant shapes and sizes to pick from compared to very limited options with a sliding genioplasty.
I use silastic chin implants which I insert via a 1/2 inch incision either inside your mouth or under your chin (you choose). Silastic is a material which has been used for this purpose for decades and is known to be safe. Their is usually no bruising, minimal pain, mild swelling, and very rare complication. The operation can easily be done under local anesthesia, if you like, allowing you to drive home. It takes about 30 minutes total and if you choose to be awake you can even inspect your appearance with several sizes before finalizing things.
We do know that chin implants tend to put a dent in the bone after a while. This is not a problem unless you decide to remove or change out the implant at a later time. If you change your mind about an implant (either just don't like it at all or want a different size), it very easy to switch for the first several months. Later than that and the operation gets more difficult becuase of the ridge in the bone, but it still can be done.
Sliding genioplasty vs chin implant augmentation
These can achieve different results and there is no one correct operation for all patients. You should discuss these options with your surgeon and review the risks alternatives and beneifts.
Implants can be removed and are therefore have the potential to reverse the surgical results if desired. Sliding or osseous genioplasty is a technically more challenging surgical procedure and does involve greater risk.
Choosing a chin implant or sliding genioplasty depends on your aesthetics
I discovered a new theory on facial beauty called the Circles of Prominence. Based on this theory, the bottom of your chin should be about three iris widths from the center of your lower lip. This is ideal in a female.
But for males, this distance can be larger. Males are distinguished significantly by the appearance of their jaws or lower third of the face.
Also the prominence at the bottom of the chin should be about 3 iris widths but in men can be larger. The larger the chin the more masculine. If you were to draw a circle 3 iris widths centered at the center of the lower lip, you will delineate the area that should stand out in your mouth area from the rest of the face.
Depending on these parameters, I would decide if you would need a chin implant or a genioplasty. Generally if the vertical height that you are wishing to increase in your chin is greater than 3-4 mm you will be better off with a genioplasty instead of a chin implant.
Your jaw can also be augmented with a lateral jaw implant depending on what you look like and this can be done inside your mouth without external incisions. This lateral jaw implant can be used to widen the lower jaw area.