Can A Custom Chin Implant Fix Step Deformities After A Prior Sliding Genioplasty?

Q: Dr. Eppley, Can a custom chin implant fix a step deformity from a previous 10 mm genioplasty and add some extra projection as well (~5-6 mm)? I’m a patient that was born with extreme microgenia but with proper jaw alignment and teeth position, it’s just that the size of the chin is extremely small. So I went to a maxillofacial surgeon and got a 10 mm genioplasty that was properly done, the only thing I did not like was that they did not use cadaveric bone chips to cover the step off and now the chin looks more like a stair instead of being convex. The problem is that the horizontal projection is still not enough even after the 10 mm genioplasty and that the chin lost its convexity. That’s why I asked the same maxillofacial surgeon if it was possible to fix everything with a custom implant and he told me that it was too risky because it could get infected, since it would be too close to the tooth roots and the mouth. Do you agree with this? I can’t leave it like this, I need to find a solution.

A: In larger sliding genioplasty movements the greater the likelihood of inferior border irregularities and  a disconnected look of the chin can result if the angle of the bone cut is too oblique. For some additional horizontal advancement and coverage of the inferior border defects a custom chin implant would do so effectively.

The statement ‘ it was too risky because it could get infected, since it would be too close to the tooth roots and the mouth’  has no biologic basis. A custom chin implant is placed through a submental incision. It is a common secondary genioplasty procedure and I have done it many times.

Dr Barry Eppley

Plastic Surgeon