Q: Dr. Eppley, I did the chin advancement at your clinic about three years ago and attached is the current result. The vertical length of the chin is good and my face is now long enough. But I still feel the chin needs to be horizontally moved forward a little bit. You did a very good chin job at that time but my chin was quite short and the advancement was put to the possible limit. My question now is: Is it possible to do another chin advancement?
A: Good to hear from you and thanks for the long-term follow-up. I remember your case well. I do agree that the vertical length is good but it still remains horizontally short. One of the sacrifices for vertical lengthening is that there is a limit as to how much horizontal movement can be obtained. The question now is whether a secondary sliding genioplasty can be done to move it further forward. (or whether only an implant can now be used) Given that it has been three years, good bony fill of the osteotomy gap should have occurred. If there is good bone stock the answer would be yes. But the only way to know that for certain would be to check any x-ray. The best x-ray would be a 3D CT scan. That will definitely answer the question of adequate bone thickness. There is also the question of the indwelling metal plate which could be completely overgrown with bone. It may not be easy to remove to do the osteotomy and that is another factor to consider.
Dr. Barry Eppley