Why Did My Sliding Genioplasty Not Work?
Q: Dr. Eppley, I had previously two chin implants which failed to give the length I desired. So I had an sliding genioplasty two months back with implant removal. As the swelling has gone down I look almost same as I did with implant. My surgeon said he advanced my chin 6 mm downwards and 5 mm horizontally. Is it the maximum advancement possible with sliding genioplasty? Your wise thoughts will be very much appreciated.
A: I have several thoughts about your chin surgery history and your question. Did you and your surgeon have a good understanding before surgery using computer imaging as to your desired chin goals? Changing the chin is one of the most predictable of all aesthetic structural facial procedures as the bone/implant change is 1:1 with the overlying soft tissues. It seems very pecular to me that you could have had three chin surgeries, none of them with large chin changes, and still end up inadequate. The bony genioplasty movement of 5mms horizontally is not very significant and, regardless of whatever size chin implant was in before, I am not surprised that you look no different now. You essentially swapped out the change provided by an implant for that of an osteotomy but no more. (other than some vertical increase) When one trades out an implant for an osteotomy it is because the osteotomy can make dimensional changes that an implant can not. While chin implants are not capable of providing more than a few millimeters of vertical height increase, they are capable of 9 to 10mms of horizontal lengthening. The amount that a bony chin can be advanced is based on the thickness of the bone but in most cases the amount of lengthening can be 10 to 12mms as the back edge of the downfractured chin segment touches the front edge of the intact upper chin bone.
Dr. Barry Eppley