Q: Dr. Eppley, I have been self conscious about my deficient chin my whole life. If I so much as look down, I develop a double chin despite being 5’7″ and weighing only 114 pounds. I used to diet often thinking that this would decrease the roundness/fullness of my face but it wasn’t until recently that I realized it is really the lower 1/3 of my face and its overall deficiency that is causing my face to look round and short.
As you can see, I have a very horizontally as well as vertically short chin. The reason I would like the sliding genioplasty vs. a chin implant is to add vertical length to my face as I feel its shortness makes me look younger than I am and also meek/shy which decreases my confidence in my daily interactions with others.
I’ve done the research on sliding genioplasty vs. chin implant, and one of the questions I have is: If I would like a little extra width added to my actual chin (You can tell in the pictures, especially the one head-on picture, that it is not only short vertically and horizontally, but it is narrow), I have read that only an implant can widen at this area, and that a genioplasty by nature of cutting the bone and advancing it will actually serve to further decrease the width of the chin. Is this true? I would like to decrease the odds of this happening if at all, although perhaps adding width to the chin would not even be as beneficial as I think given my facial size in general and would throw everything out of line aesthetically?
In addition, I have read that only a sliding genioplasty can add vertical height to the chin in addition to horizontal projection, but in other more recent publications I have read that there are new implants manufactured now that can be tailored to the patient and add vertical height as well. Would this be an option for me as it is more cost effective or is sliding genioplasty exclusively the way to go given my individual anatomy?
I am anxious to hear back from you, and thank you so much for taking the time to review my pictures!
A: Many of your perceptions about chin augmentation surgery are correct as it relates to the differences between a sliding genioplasty and a chin implant. Historically, it was true that only a sliding genioplasty could add vertical length to the chin but that is no longer true. There are new performed vertically lengthening chin implants (actually they move the chin position out at a 45 degree angle thus adding both length, projection and width) and custom implants can be made from the patient’s 3D CT for any amount of differing chin dimensional changes.
While a one-piece sliding genioplasty particularly if it adds vertical length can make the chin more narrow, that can be solved by modifying the bone That can be managed by doing a midline split/expansion genioplasty technique and widening the bone as it comes forward and down.
As you can see there are a number of ways to accomplish what you are after for our chin. But the first place to start is to precisely determine what exact chin dimensional changes you need. I will have to do some computer imaging but my initial guess is that about 5mms forward and 5mms vertically longer would be about right. I doubt if your chin should be made any wider as you want to get away from a round and short look and even a slightly more narrow chin in and of itself makes the face look longer.
Dr. Barry Eppley