Q: Dr. Eppley, I have several questions about vertical chin lengthening. They are as follows:
1) Given my case of wanting vertical elongation with some minimal horizontal projection, are my needs best served with a chin implant or a sliding genioplasty and which one in your professional opinion would you recommend and why?
2) I am primarily interested in a sliding genioplasty and would prefer to avoid an implant. In my case, would you be willing and able to do a sliding genioplasty on me instead of an implant?
3) Can vertical elongation be achieved with a sliding genioplasty?
4) With a chin implant, can vertical elongation be achieved?
5) I noticed that when I smile, my chin seems to jut out. However, upon closer observation, I noticed that it is because my entire face goes upward when I do smile. Would A chin implant emphasize this jutting out of the chin?
6) What a sliding genioplasty emphasize this jutting out of the chin as described above?
7) Since my chin seems to jutt out when I smile, it is possible for a sliding genioplasty to be done primarily for vertical elongation purposes and minimal forward movement?
8) Do you think I would have mentalis muscle strain with a sliding genioplasty?
9) If a sliding genioplasty is done, is there a chance that my lower lip might not be able to touch upon the top lip and would struggle to close my mouth? Is this is same as mentalis muscle strain?
10) Will the lip curl of my lower lip downward be exaggerated with a chin implant given that a chin implant primarily is done for horizontal projection and not for vertical elongation which is my goal?
11) With a sliding genioplasty, because the bone would be brought down and slightly out, will that create a more v-shape/heart shape look to my lower face?
Thank you so much Dr. Eppley and I look forward to your response.
A: In answer to your specific questions:
1) For pure vertical chin elongation, either a sliding genioplasty or a chin implant can be used. But the chin implant would have to be custom made to achieve a vertical lengthening since they are not manufactured in standard shapes to normally do so. I have done in either way for various patients and their affinity or disdain for an implant will determine the choice. Most, if not all, Asian women that I have treated or discussed this type of chin change are going to opt for a sliding genioplasty approach.
2) Your preference for a sliding genioplasty indicates that is the preferred choice for you.
3) Vertical elongation alone can easily be achieved with a sliding genioplasty.
4) Only a custom chin implant can achieve vertical lengthening.
5) and 6) Neither a chin implant or a sliding genioplasty is going to make this jutting out of the chin change. Whether it would make it worse can not be predicted.
7) A sliding genioplasty can be done in any dimension one wants. While it may be commonly done for horizontal advancement, that does not mean it has to be done for that movement. You seem to be under a misconception that it is somehow unusual or difficult to just move the move for vertical lengthening alone when it is not. That is the easiest movement to make for a sliding genioplasty.
8) Any change in the bone position of the chin runs the risk of creating a mentalis strain. It is not very common but potentially can happen.
9) Lower lip incompetence and mentalis strain are indeed related. Again it is not a very common problem to occur after a sliding genioplasty but is possible.
10) Since you are not interested in a chin implant, this question does not seem applicable.
11) Vertical lengthening of the chin by a bony genioplasty is a well known facial bone technique for making the face more heart shaped. This can be particularly aided by also narrowing the chin bone as it is lengthened.
Dr. Barry Eppley