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Archive for the ‘chin augmentation’ Category

Plastic Surgery Case Study – The Reversal Sliding Genioplasty

Monday, February 16th, 2015


Sliding Geniop[asty intraop technique Dr Barry Eppley IndianapolisBackground: Chin augmentation can be done by using either an implant or actually moving the chin bone.  A chin implant is by far the most common genioplasty method because it is simpler, less invasive and easily reversible. While the sliding genioplasty method can be done alone, it is almost always used when other facial bone surgery is being done. (i.e., orthognathic surgery) Its use is also highly influenced by the training and specialty of the treating surgeon.

Sliding Genioplasty result side view Dr Barry Eppley IndianapolisWhile a sliding genioplasty can provide a variety of dimensional changes to the chin, such changes do not always produce a pleasing outcome. Just like chin implants, the new chin can be unsettling because of an unfamiliarity of the ‘new’ face. Preoperative computer imaging can help reduce this risk significantly but it can rarely still occur. A sliding genioplasty can also cause a cascade of symptoms from numbness and tightness of chin tissues that did not exist before surgery. While such symptoms usually resolve within months of the surgery, for some they may not go completely away and their persistence may eventually become intolerable.

Reverting the chin back to its original preoperative position, or to just make it less advanced or lengthened, can be done through a reversal sliding genioplasty procedure. This is merely repositioning the chin bone by making a new osteotomy cut. But in considering to do so, it is important to look at the type of indwelling fixation hardware used (by x-ray) and what soft tissue impact may ensue. These factors along with how likely the aesthetic outcome may be achieved will determine whether a reversal sliding genioplasty is worth it.

Case Study: This 52 year-old male had a sliding genioplasty done seven years ago as part of a mandibular osteotomy to fix a malocclusion. He never really liked how it changed his chin and he had numerous persistent soft tissue symptoms from it including a tight chin and a lower lip sag from it. In addition, he could feel the notch in the jawline at the back end of the original osteotomy lines were the cuts went through the inferior border. After much thought he finally decided to have it reversed.

Sliding Genioplasty Reversal result oblique view Dr Barry Eppley Indianapolis IndianaUnder general anesthesia, an intraoral approach was done using his original vestibular mucosal incision. The chin bone was exposed and the lower end of a metal fixation plate and screws were removed. (the upper end of the plate was grown over with bone) An osteotomy cut was made with a saw at the obvious stair step shape in the chin bone.  Once the bone was downfractured it was able to be pushed back until the outer shape of the chin was flush across the osteotomy. After securing with 1.5mm plate and screws, a mentalis muscle resuspension was performed as well as V-Y mucosal lower lip advancement/closure.

A reversal sliding genioplasty is performed similarly to the original advancement. Preoperative attention needs to be paid to what type of original bone fixation hardware was used to ensure it will not be problematic to remove or is in the way of the new osteotomy cut. Since the chin tissues are stretched forward what happens to the attached soft tissues along the jawline and in the central neck needs to be considered.

Case Highlights:

1) A sliding genioplasty is one method of chin augmentation that creates a natural effect by moving the chin bone below the level of the front teeth.

2) While a bony genioplasty usually leads to a significant chin augmentation effect and a satisfied patient, some can find the effect too much and may yearn for a return to their former self.

3) A sliding genioplasty can be reversed months to years later by recutting the original osteotomy line and setting/sliding the bone back.

Dr. Barry Eppley

Indianapolis, Indiana

Jaw Makeovers for Men and Women

Thursday, January 15th, 2015


Strong Male Jawline Dr Barry Eppley IndianapolisThe jaw makeover seems to be one of the newer requested facial cosmetic procedures. Women and men grab their necks and stroke their jawline looking back on the days when it was much tighter and more defined. Men are particularly focused on their jawline feeling that a more prominent one would improve their appearance as well as other aspects of their life. A small hint of this elevated level of interest in the jawline is shown by the increased number of chin augmentation procedures done over the past decade.

The reality is that there is not really one jaw makeover procedure or technique. Rather there is a large number of procedures that can be done that offer some degree of jawline enhancement. They range from minimally invasive procedures like skin tightening ultrasound and radiofrequency treatments, injectable fillers, liposuction, fat injections, standard preformed chin and jaw angle implants and custom total wrap around jawline implants. Conceptually they create a more prominent jawline through either skeletal augmentation or to reshape the soft tissues around the existing jawline.

But it is important to understand that not all jaw makeover treatments are created equal. One should not expect that a little skin tightening and filler or fat injections will create the same jawline effect as chin and jaw angle implants. Of course it all depends on where one starts and how deficient the underlying jawline anatomy is.

Superman Jawline Dr Barry Eppley IndianapolisThe motivation for the increase in jaw makeover procedures is multifactorial. Stronger jawlines have also been desirable for men and dates back to antiquity. Actually there has never been a time when a weak chin or obtuse neck angle has been in demand or shown to enhance one’s appearance. But recent fashion and style does have an impact which leads one to look at the influence of the many recent superhero movies in the past decade or so. These comic book characters now on display on the big screen inadvertently suggest a relationship between a strong jawline and ‘enhanced powers’. It has also long been established that stronger facial features in men (as well as height) have an advantage in the work place and for job advancement.

Strong female jawline Dr Barry Eppley IndianapolisWhile women historically have been aesthetically pleasing with a softer jawline, stronger jawlines through increased definition and angularity has become more popular. This trend of female jaw aesthetics can be seen in contemporary models and some actresses and celebrities. Why stronger jawlines in women are appealing is a matter of debate. But strong skeletonized facial features in a woman suggest strength, fitness and a strong will.

Fillers and skin tightening procedures can create a better jawline but it is important to understand that these results are more modest and are only temporary. A lower facelift unmasks the ‘old’ jawline that once existed and has become obscured with sagging jowl and neck skin. It creates an improved jawline by unmasking the old one. Bone implants create the strongest change in jawlines that are permanent and the most visible. With a stronger push to the overlying skin due to the material, greater angularity and definition can be achieved. Younger jaw makeovers are usually skeletally based while ‘older’ ones incorporate some soft tissue management as well due to aging.

Dr. Barry Eppley

Indianapolis, Indiana

The Step-Off Deformity in a Sliding Genioplasty

Monday, December 1st, 2014


The sliding genioplasty is a well known chin reshaping procedure. Unlike its cousin, the chin implant, it has a much greater versatility than simply increasing horizontal projection alone. It can be done to create a multidimensional effect from increasing or shortening vertical height, increasing or dereasing chin width and in some cases even moving the chin backwards for horizontal shortening.

The sliding genioplasty is a pedicled bone flap that maintains muscular attachments from the tongue and neck muscles which keeps the bone alive. While some perceive that it is a free bone graft,. it is not nor would it work if it was. Any bone gap created by the cut bone movement heals because the bone is alive and can make new bone to heal the gap without the need for bone grafting.

Sliding Genioplasty step off front view Dr Barry Eppley IndianapolisThe basis premise of the sliding genioplasty is that it is created by a horizontal full-thickness bone cut through both cortices. The angle of the horizontal bone cut historically controlled how the bone could move since it was wired together and had to maintain some degree of bone contact. But with today’s titanium plate and screw fixation techniques, the angle of the bone cut is less important.

Sliding Genioplasty step off Dr Barry Eppley IndianapolisBut no matter how the bone is cut, the back end of the bone cut goes through the inferior border of the mandible. This usually occurs somewhere behind the level of the mental foramen in the mid body of the mandible. Since the cut chin bone is usually moved forward to some degree, this creates a step-off or inferior edge deformity. The more the chin moves forward, the more than an inverted V step off deformity may be felt. Depending on the patient’s soft tissue thickness, such a step off may even been seen along the edge of the bone.

While step-offs in sliding genioplasties are common, the question is whether they should be managed at the time of the initial surgery. In most cases it is not necessary as the bone remodels over time and their prominence will become less or even completely become non-existent with enough healing time. There is also the issue that their management may potentially cause as many problems as it is intended to solve. Trying to fill the defect at the time of the initial genioplasty with some type of filler (e.g., hydroxyapatite granules) could result in a lump or clump of material that would be just as bothersome as a bone indent may be.

Dr. Barry Eppley

Indianapolis, Indiana

Sliding Genioplasty Modification for Jawline/Lower Facial Reshaping

Sunday, November 9th, 2014


In facial reshaping surgery, it is important to appreciate the differences between a Western vs an Asian type face. While a strong jawline is attractive by Western standards, a more narrow lower face that makes an oval or a v-line look is preferred. To achieve this Asian form of mandibular contouring surgery, various forms of sliding genioplasties and lower border mandibular ostectomies have been developed.

The greatest variance amongst the various forms of mandibular contouring has been that of the chin. And the chin also makes the greatest contribution for most patients to the lower facial shape. Reducing the horizontal width of the chin through a central segment bone resection is the most common technique used with a horizontal sliding genioplasty. However this method does not specifically reduce the height of the chin unless a horizontal wedge resection of bone is done at the same time.

In the October 2014 issue of Plastic and Reconstructive Surgery Global Open issue, the article entitled ‘Inverted V-shape Osteotomy with Central Strip Resection: A Simultaneous Narrowing and Vertical Reduction Genioplasty’ was published. In this paper, the authors introduce a simple but very effective method to reduce the chin width and length simultaneously with an inverted V-shaped osteotomy and central segment resection instead of a horizontal osteotomy and central segment resection. Over a three year period, nearly 550 patients (75% female) underwent mandibular contouring surgery of which over 300 were treated with this narrowing and vertical reduction genioplasty technique. No significant complications occurred other than about 1/3 of the patients experienced transient mental nerve numbness which went on to full recovery.

While there are different ways to change the bony shape of the chin, this ingenious method is a clever geometric modification of a traditional linear approach to a sliding genioplasty.The square and long face can be effectively changed into a more slender oval shape as the chin is similarly changed. It also requires a minimal amount of plate and screw fixation and appears very stable for optimal healing.

Dr. Barry Eppley

Indianapolis, Indiana

Technical Strategies in Plastic Surgery – Combining Chin Implant and Sliding Genioplasty for Large Chin Augmentations

Friday, October 10th, 2014


Chin augmentation can be done by a variety of surgical methods including a chin implant and a sliding genioplasty. Each of these aesthetic chin techniques has a role to play and they have their own advantages and disadvantages. But both have the same limitation…a limit to how much the chin can be horizontally projected. Chin implants are not made with standard thicknesses that are greater than 10 to 12mms. A sliding genioplasty can only be moved as far as the thickness of the bone will allow which can vary between 10mm to 16mms.

The horizontal movements provided by standard chin implants and sliding genioplasties are sufficient for the vast majority of patients with chin/jaw deficiencies. But they can be inadequate for the few patients that have horizontal chin projection deficiencies that exceed 15mm and may be as significant as 25mms.

Sliding Genioplasty and Chin Implant Dr Barry Eppley IndianapolisChin Implant and Sliding Geniplasty in Large Chin Augmentations Dr Barry Eppley IndianapolisCombining a sliding genioplasty with an implant is a novel method to achieve larger amounts of chin projection that I have done for years. Through an intraoral approach, which is needed for a sliding genioplasty, the implant is placed on the chin bone just one would normally do. It does need to be secured into placed by screw fixation otherwise it would easily become displaced. A chin implant with long wings also has the advantage of covering over the bony step-off that often occurs at  the back end of the osteotomy.

Very large chin deficiences can be managed by the creation of a custom implant but combining an implant and a sliding geniplasty may be sufficient in some of these cases. In my experience there has been no higher infection risk when placing an implant on top of a sliding genioplasty than when using a chin implant alone.

Dr. Barry Eppley

Indianapolis, Indiana

Case Study: Sliding Genioplasty for Obstructive Sleep Apnea Improvement

Sunday, September 7th, 2014


Background: Chin augmentation with a sliding genioplasty is a well known aesthetic technique. It is not done as commonly as a chin implant but in the right patient has its own advantages. One of its benefits is that it brings the chin forward with its attached tongue-side musculature as well as lengthening the jawline. By so doing it can help smooth out the neck better than an implant which just pushes out the soft tissue chin pad and has no direct effect on the neck muscles behind it

genioglossus and geniohyoid muscles attached to the chinThe main muscles that a sliding genioplasty pulls forward is the genioglossus and geniohyoid. The genioglossus is a fan-shaped tongue muscle which comprises most of the tongue. Its origin is the spine on the back side of the chin bone and inserts into the hyoid bone and the bottom of the tongue. Its contraction enables one to stick their tongue out as well as enlarges the upper airway behind the base of the tongue. The geniohyoid muscle lies below the genioglossus but above the mylohyoid muscle. It runs from the back of the chin down to the hyoid bone and its contraction dilates the upper airway as it pulls the hyoid bone upward and forward.

Because of the attached muscles that accompany a sliding genioplasty, it could have an effect very similar to a direct muscle procedure used to treat obstructive sleep apnea. A genioglossus muscle advancement is an intrachin procedure where the genioglossus muscle is brought forward by using a window of bone in the chin. It is usually part of other obstructive sleep apnea procedures and is rarely done alone since obstructive sleep apnea almost always involves various structures at different areas of the airway. It is limited to a forward muscle movement that is no further than the thickness of the chin bone.

Case Study: This 46 year-old male presented with symptoms of obstructive sleep apnea and a short lower jaw.  He wore CPAP at night. He had a class II malocclusion and an overall heavy face appearance. He was overweight but certainly not obese. He had significant daytime sleepiness. A sleep study showed multiple apneic episodes greater than 10 seconds and a drop in oxygen saturations to 84%. His apnea-hypopnea index (AHI) was 25. He did not want a maxillomandibular advancement.

Sliding Genioplasty Technique for Obstructive Sleep Apnea Dr Barry Eppley IndianapolisUnder general anesthesia, an intraoral approach was used to deglove the chin. A mid-level near horizontal osteotomy bone cut was made through the chin keeping the muscles attached to the lingual side of the chin. The chin was brought forward 16mms and stabilized with central step plate as well as two side plates due to the magnitude of the movement.

Obstructive Sleep Apnea Sliding Genioplasty result sidew view Dr Barry Eppley IndianapolisAfter surgery he had a significant increase in chin horizontal position and an improved facial profile. Despite the very large chin movement, his chin projection was not excessive. He had improvement in his sleep apnea symptoms but not a complete cure of it as was expected before surgery. His sleep study numbers improved to an AHI of 15.

Obstructive Sleep Apnea Sliding Genioplasty result front view Dr Barry Eppley IndianapolisFor a genioglossus movement to be effective, its forward movement must be considerable. (greater than 15mms) This is not usually possible with the traditional technique of moving the genial tubercle alone. This sliding genioplasty was beneficial for this patient’s sleep apnea symptoms because of the magnitude of its movement. His initial lower jaw retrusion permitted a large sliding genoplasty movement.

Case Highlights:

1) One type of occipital skull deformity is that of the prominent nuchal ridge which forms a raised horizontal ridge across the back of the head.

2) The prominent nuchal ridge should not be confused with the occipital knob which is a raised button of bone at the center of the nuchal ridge.

3) Nuchal ridge reduction is done through a small horizontal incision over the central part of it.

4) Some patients with a prominent nuchal ridge have intermittent occipital headaches due to tight neck muscle attachments.

Dr. Barry Eppley

Indianapolis, Indiana

Case Study: Chin Narrowing Surgery By Lateral Ostectomies

Saturday, June 7th, 2014


Background: The chin has a major impact on the appearance of the lower face. While most think of it as only from a horizontal projection perspective, its frontal shape has a major influence on the gender identification to whom it is attached. Men often have strong more square chin shapes in the front view while it is usually perceived as more feminine to have a narrow and or heart-shaped chin.

It is not rare for either a women or in male to female facial feminization surgery to make an effort to narrow the chin. There are a variety of methods to accomplish the bone removal needed, either by direct lateral bone reduction (ostectomies) or by an osseous genioplasty technique. (wedge reduction) Each has their own advantages and disadvantages but the more extensive genioplasty approach is usually indicated when there are other dimensional changes needed in the chin as well. (vertical and horizontal)

Case Study: This 31 year-old male to female patient was having a variety of facial feminization procedures from brow bone reduction to rhinoplasty. One of the changes that was requested was a narrowing of the jawline to reduce a square chin to a more narrow and softer one.

Chin Narrowing Technique Dr Barry Eppley IndianapolisUnder general anesthesia, an intraoral high vestibular incision was made and the chin bone exposed by muscle and periosteal elevation. A vertical bone cut of 4 to 5mms was made from the mid-body of the mandible to a point just lateral to the center of the chin, protecting the mental nerve on both sides. This removed along strip of bone along the sides of the chin and anterior jawline. Some additional bone smoothing was done with a burr to smooth out any rough edges. The narrowing effect was immediately apparent when the the first side of chin was done.

Chin Narrowing result front viewRecovery from chin narrowing surgery does involve a fair amount of swelling that takes a full four to six weeks to completely resolve. One can tell when all swelling is gone when the feeling in the chin is norma again and it feels soft and supple again.

Chin Narrowing result oblique viewNarrowing of the wide chin or the desire to have a more narrow chin can be done by a by lateral ostectomy technique if no horizontal or vertical changes are needed. This type of ‘bony’ chin procedure is different from the sliding genioplasty as bone is removed rather than cut and relocated. It can be remarkable how a small amount of bone removal can change the shape of the chin in this narrowing technique.

Case Highlights:

1) The wide chin can be narrowed for either a softer jawline or to help feminize a face.

2) The width of the chin can be narrowed without a genioplasty by lateral tubercle ostectomies.

3) The intraoral approach for chin narrowing ostectomies leaves no scar but takes a while to see the final result due to prolonged swelling.

Dr. Barry Eppley

Indianapolis, Indiana

Case Study: Sliding Genioplasty and Chin Narrowing

Sunday, June 1st, 2014


Sliding Genioplasty Indianapolis Dr EppleyBackground: The sliding genioplasty is a powerful changer of chin shape that dates back to its first description in the early 1940s. It is not used nearly as often as a chin implant due to being a more invasive procedure that requires greater technical expertise and experience to perform. But it historically offers the advantages of being able to change the vertical (longer or shorter) and width (more narrow) dimensions that a chin implant can not do.

One of the dimensions to consider in chin augmentation, whether it be an implant or using a sliding genioplasty, is the width of the chin. Nearly every chin implant style (with the exception of the central style) will make the chin wider. Conversely, every sliding genioplasty of more than a few millimeters of advancement will make the chin more narrow. How much the chin will narrowed by moving the bone depends on the extent of the horizontal advancement. But with movements of 8mm to 10mms one should expect the chin to look appreciable more narrow. For women this may be advantageous but for men this could be an undesireable aesthetic change.

A sliding genioplasty can uniquely narrow chin width through either a large advancement or by simultaneously doing a midline ostectomy maneuver. Since the down fractured segment of the chin is really a pedicled bone flap with a good blood supply, the bone can be safely split, a wedge of bone removed and then put back together. This narrows the width of the chin any amount that one needs. Such chin narrowing techniques are common in V-line jawline reduction and in facial feminization jawline reshaping procedures.

Case Study: This 18 year-old female was undergoing a combined rhinoplasty and chin augmentation change. The amount of chin augmentation that she needed was not great (8mms) but she also wanted a more narrow chin as well.

Sliding Genioplasty Chin Narrowing technique Dr Barry Eppley IndianapolisSliding Genioplasty X-ray Dr Barry Eppley IndianapolisUnder general anesthesia, an intraoral high vestibular incision was made and the chin bone exposed by muscle and periosteal elevation. A reciprocating saw made a low angled horizontal bone cut 5mms below the mental foramen. With the chin bone down fractured,  a midline ostectomy was done removing 5mms of bone. With an 8mm step titanium chin plate, the two-piece chin bone was put back together in the midline and fixed to the upper chin portion. An hydroxyapatite bone cement was applied to fill in the bone gaps and buildup the bony step-off.

Sliding Genioplasty Chin Augmention result side view Dr Barry Eppley IndianapolisSliding Genioplasty Chin Narrowing result front view Dr Barry Eppley IndianapolisNarrowing of the wide chin or the desire to have a more narrow chin can only be done by a sliding genioplasty technique. Chins can be narrowed by lateral ostectomies but only if no horizontal advancement is needed. Bony genioplasties can be remarkably versatile and are dependent on stable plate and screw fixation techniques.

Case Highlights:

1) A sliding genioplasty is a well known chin reshaping procedure that can change the horizontal and vertical dimensions of the chin.

2) The width of the chin can be narrowed as it is brought froward through a midline ostectomy.

3) The width dimension of the chin needs to considered with every sliding genioplasty to determine if it should be aesthetically narrowed or made wider.

Dr. Barry Eppley

Indianapolis, Indiana

Case Study: Juvederm Voluma Injections for Chin Augmentation

Sunday, June 1st, 2014


Botox injectionBackground: Injectable fillers along with Botox has revolutionized facial rejuvenation. While often confused from the public’s perspective, injectable fillers are used for soft tissue enhancement such as softening nasolabial folds and enlarging lips. But as the number and types of injectable fillers has grown over the past decade, their uses has been expanded to include more facial volumizing effects. One of these facial volume effects has been to create skeletal highlights of the bony prominences such as the cheeks, chin, jaw angles and brow ridges.

While no injectable filler can create a permanent facial skeletal enhancement effect, there are some benefits to a temporary one. For those who are interested in having a permanent facial implant but are uncertain that they might like the result, an injectable filler can be a good reversible test. If one does not like the result, the filler will eventually go away…all without ever having to undergo invasive surgery. Conversely, if one likes the effect repeat treatments can be done or one can convert to an actual facial implant.

While any injectable filler can be used for facial skeletal enhancement, many are not appropriate to be so used. To create a facial skeletal enhancement effect the filler must be capable of providing a good soft tissue push as it is injected along the surface of the bone.  The ability of any filler to create this push has been traditionally thought of being due to its G prime factor and its cohesiveness. From a rheologic standpoint this makes sense but has never been proven to be true. A recent study has demonstrated that a good lifting effect of a filler is due more to how its hyaluronic acid chains are manufactured and put together than just its G prime factor alone.

Voluma Injectable Filler Indianapolis Dr Barry EppleySome good injectable fillers for facial skeletal enhancement that provide a good soft tissue push are the newer Juvederm Voluma, Radiesse, and Perlane. All of these are also associated with a longer last effect due to their slower resorption times. Juvederm Voluma has been recently FDA-approved for midface/cheek augmentation but its good soft tissue lifting capabilities indicates that it would be good for other facial skeletal areas as well.

Case Study: This 31 year-old female has been having Radiesse injections into her chin for several years for a chin augmentation effect. They always lasted less than one year. The search for along-lasting effect led to try Juvederm Voluma.

Injectable Chin Augmentation (Voluma) result side view Dr Barry Eppley IndianapolisAs an office procedures, Juvederm Voluma was injected with a 27 gauge needle into the point of her chin in three different locations injecting from the bone outward. The goal was to create a more triangular-shaped chin with a slight increase in horizontal projection. A total of 1cc or one syringe of Juvederm Voluma was used.

Injectable Chin Augmentation (Voluma) result front view Dr Barry Eppley IndianapolisThe use of injectable fillers for chin augmentation can be effective for small reshaping effects. Slight amounts of increased horizontal projection and chin narrowing or widening can be achieved by injection location. One or two ccs (syringes) of a longer-lasting filler should be able to create a chin augmentation that lasts up to one year after injection.

Case Highlights:

1) Injectable fillers can be used for facia skeletal augmentation of the cheeks, chin and jaw angles.

2) The type of injectable filler that works best for facial skeletal augmentation must generate a good soft tissue push based on his G prime factor, cohesiveness and how it is manufactured.

3) Juvederm Voluma injectable filler is approved for cheek/midface augmentation but can be used for chin enhancement as well either as a trial implant test or for a temporary augmentation effect.

Dr. Barry Eppley

Indianapolis, Indiana

Management of the Step-Off in a Sliding Genioplasty

Sunday, March 30th, 2014


A sliding genioplasty is a well known method of chin augmentation. It is often compared to a chin implant when considering aesthetic changes to the chin as a more natural alternative. But the reality is that its indications for use are somewhat different than an onlay bony augmentation. It is often only used when the amount of chin augmentation is considerable, certain dimensional chin changes are needed (vertical lengthening, width narrowing) or some functional improvement is desired. (e.g.,  lower lip incompetence, mentalis muscle hyperactivity, sleep apnea)

Sliding Genioplasty Dr Barry Eppley IndianapolisWhen a sliding genioplasty is performed, unlike a chin implant augmentation, it creates a sharp step-off between the upper fixed and lower repositioned bony edges. Essentially it is a stair-step effect whose degree and angulation depend on what type of bony movement is done. The bigger the horizontal advancement or the amount of vertical lengthening that is done, the more significant this step-off is.

The step-off in a sliding genioplasty can be more than an anatomic observation. This bony area provides support to the overlying upper soft tissue chin pad and part of the labiomental fold or labiomental sulcus. While it does not provide exclusive support to the labiomental fold, a significant bony step-off from a sliding genioplasty can make it deeper or more indented.

Filling in the sliding genioplasty step-off can be a useful aesthetic maneuver to help make for a more natural chin shape. Numerous alloplastic materials have been advocated for this induced bony contour defect from silicone and Medpor implants to even bone grafts. But getting a good adaptation and adequate fill can be challenging not to mention the alloplastic nature of some of these graft choices.

Hydroxyapatite Granules in Sliding Genioplasty Dr Barry Eppley IndianapolisOne of the best and most historic bony replacement/augmentation methods is hydroxyapatite (HA) granules. Composed of either resorbable or non-resorbable calcium phosphate materials, their granular form allows for a complete fill of a bony defect. Packing granules into a bony defect creates a porous graft that allows for extensive vascular ingrowth and some degree of bony ingrowth or even bone replacement. This is an ideal material for the step-off of a sliding genioplasty which can either be used as a simple fill in or can be packed into an overfilled shape for more of a soft tissue augmentation effect.

While not every bony genioplasty step-off needs to be filled in or augmented, large chin movements can prevent adverse overlying soft tissue effects.

Dr. Barry Eppley

Indianapolis, Indiana

Dr. Barry EppleyDr. Barry Eppley

Dr. Barry Eppley is an extensively trained plastic and cosmetic surgeon with more than 20 years of surgical experience. He is both a licensed physician and dentist as well as double board-certified in both Plastic and Reconstructive Surgery and Oral and Maxillofacial Surgery. This training allows him to perform the most complex surgical procedures from cosmetic changes to the face and body to craniofacial surgery. Dr. Eppley has made extensive contributions to plastic surgery starting with the development of several advanced surgical techniques. He is a revered author, lecturer and educator in the field of plastic and cosmetic surgery.

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