Sliding Genioplasty with Pre-Existing Chin Implant

Q: Dr. Eppley, I had an extra large Implantech conform chin implant put in last year and then got a revision to up the size to an extra large Implantech Terino 1 square chin implant. 

However, with the increased size in implant, a few additional issues have arisen. 

1) I am still unsatisfied with my profile view – my chin still looks slightly recessed. I am interested in a sliding genioplasty to further augment my chin. 

2) The larger implant size has made the pre-existing asymmetry in my chin more evident. If I were to undergo any sort of sliding genioplasty procedure, I would want to have the asymmetry corrected in terms of removing the excess bone growth on the right side of my chin. 

3) The dip/groove between my lower lip and chin has deepened. It is a horizontal line (not sure if it’s the labiomental groove or not) and has become more prominent with the implants. Not sure what would be done to fix this. 

In summary, there’s an array of things I’d like to do to my chin area – would this all be possible while still maintaining the chin implant? As in, either leaving it in during the procedure or temporarily removing it and placing it back in in order to maintain the increased projection. 

Thanks for your time! 

A: Thank you for your inquiry and detailing your chin surgery issues as well as objectives. In answer to your questions:

1) If the chin implant is in the proper position, (low on the chin bone), then a sliding genioplasty can be done with the chin implant in place.

2) It is not clear to me just yet whether/how the chin asymmetry can be improved. It may be best done by making a change in the movement of the sliding geniopalsty from side to side as it comes forward. It may be difficult to remove bone from the chin with the chin implant in place. But just based on a description I can not yet say how it might be done.

3) Deepening of the labiomental groove is always to be expected as the chin comes forward albeit with an implant or a sliding genioplasty. Further forward movement can be expected to even worsen its depth. With a sliding genioplasty the management strategy can be to fill in the bony step-off with cadaveric bone chips/graft.

Dr. Barry Eppley

Indianapolis, Indiana