Chin Widening Osteotomy
Q: Dr. Eppley, Recently, I’ve been reading your patient questions on chin widening – a procedure I am very much interested in.
One year ago I had a sliding genioplasty to push my chin forward. Without discussion, my surgeon also burred it down on the sides. I had asked for harmonious facial features but burring my chin down to make it narrower was out of line. While the sliding genioplasty itself did improve the side profile of my face, it and the burring has narrowed my chin from the front view and has feminized my face. My surgeon appreciates the look – I do not.
Like some people, I am hesitant on implants and I understand it may be the easiest option to achieve my desired outcome. But i am just not comfortable with the idea of an implant.
1. Is a chin widening osteotomy possible in my case or does the pushed forward chin bone from the sliding genioplasty make it more difficult?
2. I’ve read in one of your responses that this type of osteotomy can create a step off in the chin to jawline area. Is there a limit to which the chin can be widened with a t-shaped osteotomy before it is visibly noticeable in the smile? I’m only interested in adding 4mm or 5mm of width. I’m alright with being able to feel the bone but visibility may be a problem.
3. If a step off deformity is a problem, is there a reason why the step offs can’t be shaved down to meet the edge of the jawline?
4. Is a bone graft necessary for a gap of 4mm or 5mm. If a bone graft is not placed, will the gap stay hollow and eventually fill out or create a bum chin look?
Thank you for your time.
A: In answer to your chin widening osteotomy questions:
1) A widening chin technique can be done in a chin that has already had a horizontal sliding genioplasty.
2) At 4 to 5mms expansion this should not create a lateral step off. Such a step off can be avoided by placed a ‘keystone-shaped interpositional graft and make the separation in the middle osteotomy (without a graft) like a keystone shape.
3) Shaving the pushed out lateral wing if it is present is also a technique to eliminate any lateral protrusion.
4) With a small 4 or 5mm defect an autologous bone graft is not necessary. It is nice to use a small cadaveric bone graft or hydroxyapatite wedge for both stabiity and to ensure complete bony healing.
Dr. Barry Eppley