Can I Get Away With A Chin Implant Overlay?

Q: Dr. Eppley, I am seeking a conservative chin implant overlay to add approximately 6–7 mm of horizontal projection plus 3–4 mm of vertical lengthening on top of a previous sliding genioplasty (8–9 mm bony advancement at the time, now settled to ≈5.5–6 mm). I recently consulted with a local doctor in my area that appears to have some relevant experience with chin augmentations on top of a prior sliding genioplasty. After reviewing my photos, it was recommended that a combined chin implant + deep-neck contouring/platysma tightening procedure because he believes a standalone implant on a post-genioplasty patient would not deliver an optimal or predictable long-term jawline definition. While I respect this opinion and conservative philosophy, I am specifically looking for the least invasive option that still achieves strong forward projection and a crisp submental angle. Given that I am very lean, have no visible platysmal bands, and no significant submental fat, and excellent skin elasticity, I believe a properly selected extended anatomical / pre-jowl implant as a standalone procedure should be sufficient. 

Would you be willing to perform a standalone chin implant overlay in my case, and do you believe the result can be excellent without deep-neck work?Thank you in advance for your time and expertise.

A: Thank you for your inquiry to which I can say the following:

1) Your original chin deficiency was in the range of 20 to 25mm so a 9mm bone advancement, while helpful, is way short of the mark. So it is no surprise now that a secondary chin augmentation is being considered.

2) The debate is not between a secondary chin augmentation vs a deep plane facelift (quite frankly a bit of a silly recommendation given the actual goal) but between the method of chin augmentation (implant overlay vs secondary bony genioplasty).

3) Once a bony genioplasty is performed the soft tissue chin pad is going to be tight. You will be lucky to be able to place an implant of 3 to 4mms of added horizontal projection and any vertical lengthening (Iwhich you don’t need) is not going to happen as the chin pad will not follow it down.

4) When more then 3 to 4mms of added horizontal augmentation is needed you have to move the bone.

5) Therefore what you really need to decide is whether you want an implant for just a very minor improvememnt or a more visible change by moving the bone.

Dr. Barry Eppley

World-Renowned Plastic Surgeon