Vertical Chin Lengthening

Q: Dr. Eppley, I do have a few questions concerning the lower third of my face which I hope you can answer.I am  interested in perhaps vertically lengthening my chin since I think my chin and lower facial height is vertically deficient. If I understand correctly a sliding genioplasty is the best option for achieving vertical chin length. I am also hoping that the genioplasty can contour my chin to create a smoother transition from the chin to the jaw. My main concern regarding the sliding genioplasty is that I don’t want to add too much length since my jaw is quite narrow. I already have a narrow face and I think if I were to add a substantial amount of vertical length to my chin this would only serve to accentuate my narrow face. I would end up with a long, narrow face, which often does not look appealing. 

My questions are:

1. Do you agree that my lower third + chin are indeed vertically deficient?

2. Do you think I could benefit from vertical chin lengthening?

3. Looking at my face, what facial type do I have (narrow, long and narrow, oval etc…)?

4. Looking at my pictures + x rays, do you think that my lower jaw width is indeed too narrow for my face?

4a. Follow up question… what is the ideal width of the mandible relative to the face (wider than the eyes, cheekbones, face)?

5. Will the sliding genioplasty create a longer, more narrow face?

6. Could you provide a bit of information about jaw implants and ramal augmentation (what material is used, infection risk, bone resorption, effects on soft tissue, long term risks/complications)?

Finally, a few things regarding my dental health. I have been told that I have a very thin biotype, in fact my periodontist told me I have some of the thinnest bone and gums he has ever seen. I have very little bone surrounding my lower incisors and from what I understand about the sliding genioplasty procedure, the incision is made very close to the lower incisors. I have also read about a case where the patient had significant gum recession following the sliding genioplasty procedure due to wound contraction. Is my thin biotype an issue when deciding whether I am a good candidate for the sliding genioplasty procedure?

Thank you,

A: In answer to your questions:

1) A sliding genioplasty is one method of vertical chin lengthening but not the only one. A custom made vertical lengthening chin implant can also be done and is the most assured method of a smooth transition from the chin to the jawline going back.

2) I do not have an opinion about your facial width or length. This is a matter of personal aesthetic judgment for which only you can truly answer that question. Ultimately that question is best answer by computer imaging so you can determine whether such lower facial changes are aesthetically advantageous.

3) Since I have not seen your intraoral anatomy or an x-ray of your jaw I can not comment on the state of your dental health and whether it would be adversely affected by an intraoral bony genioplasty. But the development of gingival recession from a sliding genioplasty is likely a reflection of surgical technique and is not a standard result from the procedure. It is not a postoperative finding I have ever seen.

Dr. Barry Eppley

Indianapolis, Indiana