Can A Second Chin Osteotomy Be Done After A Previous One For More Chin Advancement?
Q: Dr. Eppley, I had a chin osteotomy several years ago but still feel my chin is short. Do you think another chin osteotomy can be done. I do not want an implant for more chin if I can avoid it. I have attached an x-ray so you can see what my chin looks like now.
A: Your x-ray shows that you had a sliding genioplasty fixed together with cerclage wires. What this means and shows is that the back cortex of the chin segment has been brought forward enough to be attached to the front cortex of the mandible. This means that the chin segment has been brought forward as far as it can go. This is an older genioplasty technique that dates back to a time when only wires were available for facial bone fixation. Since the wires can only attach to the cortices of the bone, the chin is brought forward whatever distance the back end of the chin and the front edge of the upper bone will allow as they match together. In today’s genioplasty bone fixation techniques, plates are used that move and hold the chin together at any desired distance horizontally as well as vertically.
In theory, you should not be able to get any more advancement out of the chin segment once a ‘maximal’ bony genioplasty has been performed. But there is one thing that is a bit unusual in the way your chin osteotomy was performed. The x-ray shows that it was cut at a very low horizontal level. This has left a lot of bone height between the lower end of your incisor teeth and the top edge of the bony cut. This suggests that a new osteotomy could be done above the old one, bringing more of the chin forward. This would create a ‘stairstep’ chin osteotomy approach which I have done at the same time but never as a staged procedure which is actually safer. So I do think a repeat chin osteotomy is possible to gain more chin projection. In stairstep chin osteotomies, I do recommend the use of hydroxyapatite granules or demineralized bone to fill in the steps at the end of the procedure for maximal bony healing.
Dr. Barry Eppley