What are your thoughts about Genioplasty Step-off? (photo)

While step-offs are common in sliding genioplasties, one must be careful to not create a solution that is more of an issue that the problem it is designed to treat. Many inferior border step-offs are relatively minor and are not an aesthetic concern. The angle of the bone cut and the dimensions of the bony movement also play a major role in whether a step-off is major or minor. It is true that the further back the bone cut is (low angle cut) the less likely a step-off will be an issue regardless of what bony movement is done. 

I have been doing osseous sliding genioplasties 15 years, not one single step off happened in my cases; this complication is due to poor healing and consolidation of the slided piece of bone sawed off, much likely because the fixation technique was poorly executed.Find a good surgeon and he'll not mess around.I don't recommend such far extension of the cut, much less reaching to the mandibular angle.If you wish, additionally to the horizontal anterior advancement, some vertical increase, then we can add a bone graft layer between the mandible and the advanced piece of chin.

The image you show demonstrates a 'low angle' slope to the lower jaw. In that instance, the 'long low bone cut' can be quite simple. In other instances, the higher and steeper 'slope' of the jawline means that the 'back end' of the bone cut might have to be tapered with strips of Gortex-like material in order to ensure a smooth continuous jawline. In all cases, the back end of the cut should be as far back as possible in any event