Weak chin and deep mentolabial fold, is a second sliding genioplasty possible? (Photo)

Question

5 years ago I had orthognathic surgery performed to correct my overjet,and in conjunction my oral surgeon did a sliding genioplasty. I loved the results from the surgery, but I feel as though I can have more projection of the chin as well as correct some of the prejowl area. I consulted with a plastic surgeon and he said a chin implant could do the job but I'm concerned that I have a deep mentolabial fold and it make it worse. Is it possible to have a 2nd sliding genioplasty?What are my options?

Alejandro Nogueira, MD · Answer

Of the difference between a simple sliding genioplasty and a multidimensional augmentation genioplasty.Sliding genioplasties are ONLY for those cases with a good size of the chin, even slightly vertically oversized, in which the chin is weak or receded, this is lacking the balanced projection according to the rest of the face, specially compared with the lower lip.However, doing a simple sliding genioplasty in a microgenia case, which is a chin with abnormally underdeveloped dimensions, a mini-chin, if you slide it forward... you stay the same mini, the same problem and just a very subtle anterior projection increase, it is totally disappointing and frustrating.For microgenia or small chins a multidimensional augmentation genioplasty is necessary, which is more complex and technically demanding if compared with the sliding genioplasty, takes longer time, needs better planning and of course is more expensive; it is the same safe then sliding genioplasties but is performed by few surgeons.You are a good example of my words: you were a case for three dimensional augmentation genioplasty with (elbow or hip) bone supply in order to heighten, widen and anteriorly augment your chin, and never a sliding one.Both, sliding and multidimensional augmentation genioplasties are awesome and highly recommended procedures, but they have to be thouroughly and adequately indicated for the suitable cases.If you wish better grounded opinion well lit, focused and standard images have to be assessed: frontal, both lateral and both oblique views.
Feel free to request any additional information from me.

William Portuese, MD · Answer

A chin implant would be a better alternative to augment the chin forward due to the fact that the augmentation is three-dimensional and there is a weak pre-jowl sulcus present. Chin implants are manufactured in a large variety of sizes and shapes, and can be custom carved when necessary to meet patient's unique anatomy. Chin implant placement would also give width to the chin itself which would hate help with facial balance and proportions in addition to the forward projection. Chin implants can be placed under local anesthesia as an outpatient procedure through very small incision underneath the chin. For more information  and many before-and-after examples, please see the link and the video below

Barry L. Eppley, MD, DMD · Answer

It would be helpful to know how far forward your chin was initially moved and to see after surgery x-rays of the bone position. Whether you have another sliding geniplasty or have a chin implant, your labiodental fold is going to get deeper, that is unavoidable at this point. Also,If you get a second sliding genioplasty the 'divots' right behind the sides of the chin will get deeper. You already have some of that effect now.

Weak chin and deep mentolabial fold, is a second sliding genioplasty possible? (Photo)

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