How Do I Vertically Lengthen My Chin?

Q: Dr. Eppley, I was wondering if you could please provide an assessment, based on the photos attached, as to whether you think I would be a suitable candidate for a chin implant. I am considering a vertical chin implant from Implanttech, to add to both horizontal and vertical projections. The only concern that I have is that it may accentuate the labiomental fold which is already moderately deep in my opinion, as I do not want to end up with a witch chin. If not a chin implant, I will start considering sliding genioplasty instead as an alternative. Grateful for your valuable opinion. Many thanks in advance.

A:Thank you for sending your pictures. When you have a primary vertical length deficiency of the chin, primary meaning that the need for vertical lengthening is greater than the need for horizontal advancement, this always poses challenges that most standard chin implants cannot overcome. While there is one style of standard chin implant, the vertical lengthening chin implant, it has imitations. It was developed years ago and extensive experience with it has demonstrated that in almost every case itx shape is going to have to be modified so that is not overly round. It also has a set amount of horizontal and vertical lengthening, which are equal, and as a result most of the time is also have to be modified to fit the patient. The standard vertical chin implant has its role in chin augmentation but the reason to use it is economic, meaning one chooses it not because it is the best approach to the problem but because it costs less than the better solutions.

In vertical chin lengthening the better approaches are either a bony genioplasty or a custom vertical lengthening chin implant. Each of these has their benefits and it is important to understand their differences. In the bony genioplasty the amount of vertical lengthening is essentially unlimited and there is never any concerns about the soft tissue chin pad following the bone downward. Its primary aesthetic limitation is that it cannot widen the chin or make it more square which for some men may be an issue. In a custom chin implant the amount of vertical lengthening achievable is in the 6 to 7 mm range because of the need for the soft tissue chin pad to be able to be redraped over the implant once it is released for implant insertion. In a custom-designed implant it has the advantages a precise control over the amount of vertical and horizontal changes as well as the shape and the placement a Screw fixation holes.

That being said and how it applies to you, based on my initial imaging which may or may not be an acceptable amount of change, you really have the option of either the bony genioplasty or a custom implant if you prefer to go to the best solution approach. Your chin augmentation dimensional needs fall within the scope of what both approaches can do with the understanding of the aesthetic differences between them

In regards to the labiomental fold it is important to understand that any form chin orientation done either by the bone or an implant is going to deepen it to some degree. This is unavoidable as the fold represents the insertion of the mentalis muscle which sits above the effects of any form of chin augmentation. The advantage of vertical chin lengthening is that it does help to mitigate the labiomental fold deepening effects. The deepening comes from the horizontal advancement and the vertical lengthening helps decrease that effect as it pulls the soft tissue chin pad downward. It would also be fair to say that the  bony genioplasty more favorably decreases the labiomental fold deepening effect as it has a more downward repositioning of the soft tissue chin pad.

As an ancillary comment to the effect of chin augmentation in your case, you ideally would benefit from submental liposuction to optimally improve the cervicomental angle and avoid a double bubble profile result.

Dr. Barry Eppley

World-Renowned Plastic Surgeon