Can The Vertical Height of The Chin Be Reduced After A Previous Sliding Genioplasty?

Q: Dr. Eppley, five years ago I had a sliding genioplasty to increase the projection of my chin. The titanium plates and screws are still in place. Although I am very happy with the new projection of my chin, I would like to have a decrease in the vertical length of my chin. Is it possible to simply cut out the bone below the titanium screws (below the red line on my x-ray pic) My surgeon told me that there are special muscles attached to this area and for this reason this wouldn´t be possible. This would lead to a droopy chin. He told me that vertical reduction of the chin could only be achieved by cutting out a horizontal slice of bone between the chin. What is your opinion on this?

A: To decrease the vertical height of the chin, if you are using an intraoral approach, it would be better to redo the horizontal osteotomy for the sake of keeping the soft tissues attached to the underside of the chin bone. The challenge in repeat sliding genioplasties is not the bone cut or removing the needed amount of bone but getting the old plate and screws out. Sometimes this can be next to impossible particularly if more than one screwheads sheers off. It is for this reason that removing a wedge of bone on the underside of the chin is appealing. Knowing how to reattach the muscles (mentalis muscle resuspension) is the  key to successfully using that approach for vertical chin reduction.

Dr. Barry Eppley

Indianapolis, Indiana