Genioplasty and Rhinoplasty together or in separated procedures? (photos)

Question

I want to get a genioplasty and a rhinoplasty to correct my profile as well as my front view where my nose is very dominant. Would you recommend to get the rhinoplasty and genioplasty at once, or at separated procedures. Please consider thats WITHOUT the costs, as this is a factor of only a low importance. Is a longer operation always are more dangerous one when it comes to complications?

Sophie Ricketts, MBBS (Hons), FRACS (Plast) · Answer

It is not uncommon for the nose to look over projected or too large for our facial proportions if your chin is recessive (particularly in profile view).In your case a reduction in projection as well as correction of chin recession would provide a well balanced facial proportion both in front view an profile.I find the best way to help the patient understand the anticipated changes is with the use of a 3D camera and simulation software. His allows the patient and I to look at 3D images of the face of the patient from all angles. I can then morph the images to resemble anticipated changes achievable with surgery. The change in your chin position can be achieved with both a genioplasty or an implant. Each have their pros and cons which you would have to discuss in detail with your surgeon. Implants are advantageous in that they are relatively simple to insert, a shorter procedure and easily reversible if required. They do have an infection risk however, as they are a foreign material. Geniopasty is a permanent procedure and involves cutting the bone and moving it forwards and plating it with small titanium plates. The infection risk is lower. It is definitely possible to combine the procedures and it would then mean just a single recovery. The chin surgery would add from 45min (implant) to and hour or so (genioplasty) to your rhinoplasty so the risk or increased complications is fairly low. I would be inclined to combine both.All the best!

Alejandro Nogueira, MD · Answer

You are an optimal candidate for the so called profileplasty, which consists in doing rhinoplasty and chin surgery at a time, a safe and routinary procedure in experienced hands.Your nose needs basic complete rhinoplasty via open approach to shave down the hump, reduce the tip and narrow frontally, make plasties at your bulbous cleft tip, eventually tip grafting and perform osteotomies.Your chin needs anterior advancement and for this I recommend sliding genioplasty, eventually with vertical height increase by means of bone grafting.Being an option, chin implants have serious disadvantages, specially in
the mid and long term, patients are rarely happy with them after 5-6
years, all are out by then or later.Consider the chin advancement by means of sliding genioplasty, the advantages are:-lifetime procedure, no more revision or renewal procedures-more natural than implants-no visibility of implant edges during gestures-improves
the double chin effect at the sub-mental muscles (floor of mouth)
hammock caused by lack of tension there; also improves the shape and
tension of perioral muscles; implants do no offer this feature-horse-shoe enhancement, covering the chin and also the jaw sides of it-no future displacements or neuritis of mental nerves-practically zero infections and 100% healing of bones-no
need for complex plates and screws that may need future removal; just
steel wires synthesis may suffice, they stay buried into bone callusThe cons are:-expensive, but cheap if you consider the lifetime pros-technically
demanding, few surgeons are experienced or comfortable (though I
personally perform 100% of the chin augmentations by this osseous
method, always after offering the patients both options)-scary for the patient (though not so much if you explain well the stuff around it)You'll
 find in this website dozens of negative experiences with chin implants 
in the short and mid term, do read my profile's Q&A and you'll find 
them too. I am doing sliding genioplaties for 15 years with the highest 
success and no one patient regreted, totall the opposite, I did many 
chin implant removals and one staged sliding genioplasties to replace 
them.

P. Craig Hobar, MD(retired) · Answer

Thank you for your question and for posting photos to better help us answer your question. The vertical height along with the deficiency of projection can be corrected through a sliding genioplasty. A chin implant is more effective in correcting projection than vertical deficiencies. When your chin has decreased vertical length, it tends to make your nose appear longer than it actually is. During my consultations I perform a simple facial analysis to determine your chin projection and vertical lengths. I typically use a ruler to measure the midface height, lower face height, nasal length, chin vertical, nasal projection and chin projection. Often times a rhinoplasty is combined with a genioplasty in the same procedure to ultimately balance out your facial features. Yes, this does entail a slightly longer initial surgery but, only by about 30 minutes. Doing them together means one down time, one anesthesia and a little bit of cost savings. It is very safe to do both procedures together. Typically measurements are taken in the office to determine the placement of the chin in comparison to the nose, this will give your surgeon a good idea if you would benefit from these together. Your chin vertical should be equal to your nasal length. I would also suggest asking your surgeon if they offer computer imaging to show you before and after pictures with both a rhinoplasty and chin enhancement.

Dennis Barek, MD (retired) · Answer

If you can get a chin augmentation, instead of genioplasty, then the two procedures can be done together and are usually done together. I don't do genioplasties and rarely see the need for them.

Gerald Wittenberg, MSc, DMD (retired) · Answer

The focus should be on increasing the height and projection of your chin. Once that is done, the nose will 'appear' less prominent and more balanced. You can then decide if the nasal changes are still a goal. If you are already certain (cosmetic computer imaging helps); then you can easily do both a the same time.

Genioplasty and Rhinoplasty together or in separated procedures? (photos)

Answers (5)

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