Sliding Genioplasty

Q: Dr. Eppley, I was previously going to have a chin implant with screw fixation. At the time, I was planning to get one and was planning to consult with you.  I’ve done a lot of research since that time and have come to the realization that I’d like to address my issues with bimaxillary advancement as my entire jaw region isn’t adequately projected and I have a “fleshy neck” appearance in photos and on video. My airway is also smaller than it should be and obstructive sleep apnea is an issue.To the point – I’m debating getting a sliding genioplasty in conjunction with my bimaxillary advancement to advance the chin horizontally.  I want my chin to be closer in line with my lips and I did not know if bimaxillary surgery alone would address this or not.  Would a sliding genioplasty be a bad idea (too deep labiomental fold afterward)? Thank you

A: Having done lots of orthognathic surgery, including bimaxillary advancements, the only reason to pursue that course is for the purposes of improving sleep apnea. From an aesthetic standpojnt, bimaxillary osteotomies along would not cure the weaker chin and fleshy neck appearance that is of concern to you. That anterior movement of the mandible, in the range of 6 to 8mms, would help your chin projection but since the upper jaw is coming forward it would not provide the ideal correction. Cephalometric tracings would verify the accuracy of that statement. A sliding genioplasty would still be needed to provide the aesthetic goal of making the chin be closer in line with the lips. The bimaxillary advancement would make the amount of amount of the sliding genioplasty less however. All forms of chin augmentation, including a sliding genioplasty, will make the labiodental sulcus deeper. That is unavoidable but a 4 to 5mm sliding genioplasty advancement would not make it that much deeper or would make for a minimal adverse change in its depth.

Dr. Barry Eppley
Indianapolis, Indiana