If I Get A 10mm Vertical Chin Lengthening Will It Pull My Lower Lip Down?

Q: Dr. Eppley, I am considering holistic genioplasty. Due to my relatively strong facial features and overall body structure, my primary aesthetic goal is to achieve a chin that provides a pronounced vertical projection. I am personally drawn to a longer facial appearance and believe that increased vertical chin height would enhance overall facial harmony. Although I have not yet discussed specific measurements in detail with a surgeon, based on personal evaluation, photo editing, and proportional measurements, I find a vertical chin advancement of approximately 10 mm aesthetically appealing. At this level, I observe improved balance between the maxilla and the chin, as well as better harmony in relation to my lips. I understand that horizontal projection is more complex to evaluate subjectively, and at this stage I am less certain about my preference in that dimension. My main questions are the following: From your professional perspective, is a vertical advancement of around 10 mm generally considered excessive or outside the typical aesthetic range? Beyond the aesthetic aspect, is there a risk that such vertical elongation could pull the lower lip downward and potentially lead to lip incompetence or difficulties with passive lip closure? I fully understand that definitive decisions require clinical examination, cephalometric analysis, and surgical planning. My intention is not to predetermine measurements, but rather to better understand what is realistically and safely achievable. For reference, I am also sending three images: One image is taken from a CT scan. During the scan, my head was positioned somewhat awkwardly on the scanning table, which makes it appear slightly projected forward. The second image shows my natural side profile. The third image shows my face with a more neutral head position and an estimated vertical chin projection of approximately 10 mm.

A:I am not certain what makes a vertical lengthening bony genioplasty holistic but I will assume what you really mean is autologous. I believe the three questions you are asking are the following:

1) Is a 10 mm vertical lengthening bony genioplasty a normal procedure that most surgeons perform? I of course can only answer based on what I do and such amounts of vertical bony chin lengthening are very normal in my practice. But then I have a different patient population than most surgeons.

2) Despite the amount of vertical bony lengthening performed, often well in excess of 10 mm, I have never seen the lower lip pull down.

3) By the imaging of your ideal aesthetic goal you should realize that is a much greater amount of vertical bony lengthening than 10 mm and probably is at least 15 to 18 mm.

Dr. Barry Eppley

Plastic Surgeon