Can A Sliding Genioplasty Be Done With A Chin Implant In Place?

Q: Dr. Eppley, Hi. I have a very undeveloped mandible and recessed jawline. I had a chin implant surgery more than a year ago and I had no problem with it, but I still don’t get enough projection with it as I desire, especially from the profile. I want my chin to be more forward, but I also want more projection below my chin as well, to look thicker. So this time I would like to do the sliding genioplasty together with customized angular jaw implants. My questions are these:

1) Can a sliding genioplasty be done with the chin implant already in place without taking it out?

2) How much would all these cost?

3) There is currently a gap between my lower lip and chin. The skin there is pulled backward because I never really had a chin. So will that space be pulled forward after the surgery to fill that gap?

I will share the pictures of me before the implant, the current one and the expected one

A: You have correctly surmised that only a sliding genioplasty can provide any further significant horizontal or vertical lengthening.  The movement you have shown is more of a 30 to 45 degree movement (down and forward) which is good to lessen the impact of further chin augmentation on the deepening of the labiomental fold. What you have demonstrated in your chin augmentation goal imaging is exactly what will happen to the fold. (it will get deeper and this is unavoidable) Usually this is grafted with an allogeneic bone block to soften that adverse labiomental fold effect.

It would be ideal to keep the current chin implant in place and do the osteotomy cut above it so it carried forward with the bone movement, keeping the benefits of the prior surgery as well as not making the bone do all the chin augmentation effect. Whether that is possible depends on where the implant is sitting on the bone. Presuming you have a silicone implant in place this will be determined by a 3D CT scan of your face which is needed anyway for the custom jawline implant.

While the sliding genioplasty can make the movement you have desired you said something which is can not do…make the chin thicker. (wider) Thus what you are really looking at doing (need) is to have the jawline implant wrap around the chin to add width. This is needed anyway to cover the bony steps from the sliding genioplasty and well as create a smooth linear jawline effect.

Dr. Barry Eppley

World-Renowned Plastic Surgeon