Q: Dr. Eppley, I am thinking about using bone cement on my jawline. The mid-portion of my jawline goes up and then back down. Would you be able to attach bone cement there to lower it ? I like the way it looks when its straight, a good lower vector (jawline) I think compliments the upper vector (cheek line) and gives a very nice defined look. Also the advancement in projection I morphed for my chin augmnetation is about twice as far out as most sliding genioplasties I have seen. Would you be able to just cut the bone further back to slide to further forward ? I don’t know if you noticed but I pulled the upper part of my chin out a great amount and then really pulled out the bottom part because I don’t like the way it looks if you were to just pull the bottom out which is what I see most of the time. I know my teeth are there so you would have to put something almost on top of the sliding genioplasty that would give that area the projection I want, would that be bone cement or would you be able to use part of my chin bone?
A: Based on your projected imaging, I see no problem making the sliding genioplasty advance as much as you have shown. This is about a 10 to 12mm advancement which is well within the range of a genioplasty movement. Filling out the labiomental sulcus (upper part of the chin) does require that the step in the genioplasty be filled out with some material. Whether that is an hydroxyapatite cement, hydroxyapatite block or another material would depend on cost issues for you. When it comes to filling out/smoothing out the jawline behind the chin (other than the step-off in the back part of the osteomy cut), that can not be done with bone cement or any other intraoperatively fashioned material as that will simply not work. Short of making a whole chin-jawline implant from a 3-D model, which can certainly be done to accomplish all of these goals instead of a genioplasty, the jawline behind the chin can not be treated any other way.
Dr. Barry Eppley