Sliding Genioplasty Revision

Q: Dr. Eppley, I am interested in a sliding genioplasty revision. Please see attached my before and after photos and X-rays. I have also attached a photo of my ‘before’ photo which I edited to show the sort of result I was initially wanting. It is difficult for me to judge objectively what looks most attractive on my face so I would appreciate your opinion on my edit.

I am unhappy with how my face now looks 4 months after surgery. I feel my chin looks bulkier and my soft tissue falls under my chin slightly which doesn’t look attractive. My lower lip is also pulled in. Overall I feel that my face looks less attractive, less feminine and out of balance. It has really affected my confidence.

I am due for a second surgery to have my plate removed with my surgeon next week but I haven’t booked it in yet because my surgeon said he isn’t interested in cosmetics and will not try to correct any issues I have with how my chin looks. I wanted another opinion because perhaps my previous surgeon isn’t the right person to do my surgery since our goals aren’t aligned.

Do you think it is possible to solve my concerns with surgery? Is it possible that there is still swelling to go down and things may improve on their own? I understand it is difficult to give advice based on photos but any advice would be very appreciated.

A: Thank you for sending your pictures and x-rays. What is clear is your desired chin augmentation goal and the result you have are dimensionally discrepant. Your sliding genioplasty result shows a horizontal advancement of perhaps 6 to 7mms giving you a result where the chin projection is out to the level of a vertical line dropped down from the lips. While this may be an acceptable goal for a male this is to what most women want and is clearly different than our desired goal.  Your ideal imaging is showing about a 3mm horizontal advancement with a 2 to 3mm vertical shortening or upward inclination as the chin is moved forward. This is much more consistent with a more feminine appearing chin.

Rather than just having the plate and screws removed you can have your osteotomy repositioned/redone to better achieve your chin augmentation goals.

Dr. Barry Eppley

Indianapolis, Indiana