Secondary Genioplasty

Q: Dr. Eppley, I’m a young male hoping to get some advice from you on a secondary genioplasty. I really respect your work and blog and appreciate you taking the time to inform the public on so many medical topics.

I’ve had a short chin growing up and by the time I was 21, I had saved enough to undergo a sliding genioplasty. The operation improved my profile by a mile. I wasn’t 100% happy with it but I could live with it, you know.

It’s been almost a year now, and I’ve lost a couple of pounds. I’ve lost some fat around the face and jaw and now I’m realizing that my chin is a lot narrower than I thought it was. I think the extra chub around my face was hiding the bony narrowness of the chin.

Now, I’m looking at this as a chance to undergo a secondary sliding genioplasty to maybe increase projection by just a couple more mm and widen the chin by maybe 6mm or so, so it isn’t as narrow.

I would like to stay away from implants and a submental approach wouldn’t work for me anyway. If I had to place an implant intraorally, I would much rather prefer just going through with a bony augmentation. Anyhow, I hope you can provide a response to my next questions as it would really easy the mind.

(1) Would it be safe to recut the mentalis muscle with a secondary sliding genioplasty and what are the risks? I know I shouldn’t be scarring the mentalis muscle if I can prevent it, but I would like further aesthetic improvement. I think I was one of the lucky ones to have no apparent aesthetic issues with my tissue and muscle after my surgery.

(2) My main worries are lip sagging, chin dimpling at rest, or mentalis muscle contracture. Am I at risk of this if I undergo a secondary procedure with the movements I am hoping for?

(3) If I were to widen my chin, logically there is excess bones at the side. Would this be palpable or can they be camouflaged with bone cement so it blends in with the jawline, instead of being burred down?

A: In answer to your secondary genioplasty questions:

1) The ideal and assisted method of changing the width of your chin would be a custom made implant to do it placed through an intraoral approach. This avoids a lot of potential contour problems from trying to make the chin bone do something that it can not do well. (widen the chin) It is the one dimensional change in a sliding genioplasty that the procedure does not do well because of the step-off created behind the wing and its widening effect will not flow evenly back along into the jawline.

2) That being said, a secondary genioplasty can be done to both bring it forward and widen the chin. While there is always a risk of some mentalis muscle or lower lip issues every time you do an intraoral approach, that seems to be more often caused by a technical issue not an inherent or inevitable part of the procedure.

3) In widening the chin with a sliding genioplasty it is important to angle the opening of the midline cut so that the side winds are placed more inward, this avoiding a major palpable step off. Bone cements are very difficult to make work inside a limited soft tissue tunnel. Such access does not favor their working properties.

Dr. Barry Eppley
Indianapolis Indiana