Do I need a large chin implant, sliding genioplasty or both? (photo)

Question

Hello, I have a small face and an extremely weak and recessed chin. I've been told by my dentist that I have an underdeveloped lower jaw and possibly an overdeveloped upper jaw. My whole profile is hideous and I refuse to have anyone take photos of me at this angle. I know I would need to seek out a plastic surgeon for specifics, but in your professional medical opinion, do you think I need a large chin implant (with wings?), a sliding genioplasty or BOTH to improve the harmony of my face?

Joshua Lampert, MD, FACS · Answer

For a lower jaw lacking in "bone stock" and an extremely recessive chin, I will typically favor an implant.  Sometimes patients do have a very underdeveloped jaw, and despite an aggressive jumping genioplasty, they will still require greater augmentation for an adequate aesthetic result.  In these patients, there are two options.  Some surgeons will recommend taking a bone graft to achieve greater augmentation in these cases.  I feel that patients are generally more happy with an implant at this point, and reserve bone grafting for any patient who refuses an implant.  Chin implants and most osseous genioplasty (sliding or jumping) procedures are planned and performed as ambulatory surgery.  I allow all of these patients to go home after surgery.  If a bone graft is harvested, however, then overnight stay may be preferred.  To determine which procedure is best, the patient should really be examined by a board certified plastic surgeon.  They should see someone who performs both procedures to really understand and appreciate the pros and cons of each.  This way, the patient and doctor may, together, make an informed decision.

John Frodel, MD · Answer

In my opinion, either a conservatively sized implant or genioplasty would be helpful.  Ideally, you would likely benefit from moving the entire mandible, but this is more complex, costly, and time consuming.  The key is that the advancement of the chin is not too much with either an implant or genioplasty, as it can appear unnatural if made too big.  The specialty of your surgeon is not important, as opposed the level of experience that they have with problems similar to yours.

Joseph Niamtu, III · Answer

You do have a very recessive chin (I have a very recessive hairline :).You are probably more of a candidate for a sliding genioplasty as it can do more.  I have done a number of cases like yours using the genioplasty plus chin implant.  No one can make a completely accurate diagnosis without examining you and viewing some jaw Xrays.Joe Niamtu, III DMDCosmetic Facial SurgeryRichmond, Virginia

William Portuese, MD · Answer

A chin implant can be inserted through sub mental approach under local anesthesia as an outpatient procedure. The size of the implant is determined at the time of examination/consultation. A sliding genioplasty is performed by oral surgeon as an inpatient surgical procedure at a hospital. If your dentition is significantly off, the sliding genioplasty may be the better option.

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