Which Chin Reduction Approach Is Best?

Q: Dr. Eppley, I am interested in a chin reduction. have always had a unique chin with over-protruding bone, an excessive soft tissue pad and deep labiomental crease. It almost looks like I have a bottle cap lodged onto my chin. I am very curious as to what you feel would the best approach here. I have had a couple consults with other docs who have suggested a sliding genioplasty and was even shown some pictures of expected results, which I loved, but I am worried about a sagging chin pad after the procedure as they confirmed that they would not do anything to the soft tissue. So I am pessimistic of the accuracy of the pictures they offered. I would definitely prefer an intraoral approach if possible, though I know this could be a complicated procedure that could benefit from an approach via under the chin. Your thoughts?

A: Chin reduction is a much different procedure than chin augmentation due to soft tissue consierations. From a chin reduction standpoint, I would agree that the accuracy of those imaging results is suspect. There is no doubt that the bony chin can be moved back that far, but the question and issue that has to be dealt with in every chin reduction is where is the ‘excess’ soft tissue going to go. With a setback sliding genioplasty, it is not sagging of the chin pad that is the concern as the chin pad soft tissues are not overly detached. It is the tissue under the chin, the submental area, that often can become bunchy or redundant. As the chin moves back, the skin under the neck can bunch up. This is why a submental approach to chin reduction is usually more successful as it deals with the soft tissue redundancies. But I can certainly understand why one would want to try and avoid a submental scar. The good news is that you are fairly thin with no substantive subcutaneous fat so perhaps the soft tissue redundancy concern may be overstated. Therefore one could undergo a setback genioplasty with the understanding that the sub mental tissue issue is unpredictable and may have to be dealt with secondarily if it is an issue. It just depends on how one wants to ‘gamble’…risk a scar revision with the sub mental approach or risk the potential need for a secondary submental tuck up with the sliding genioplasty setback.

Dr. Barry Eppley

Indianapolis, Indiana