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Posts Tagged ‘genioplasty’

Profileplasty by Rhinoplasty and Sliding Genioplasty

Saturday, July 13th, 2013

 

While one does not see their face in a profile view naturally (only in pictures), the world sees your face in three-quarter view or in profile. Thus the perception of one’s own facial profile is important and it is stressed in many plastic surgery procedures. The two most important hard structures that make up the profile is the nose and the chin. As such the combination of a rhinoplasty and genioplasty is often done together. When done simultaneously, this combination has even been called a profileplasty.

These two profile structures influence each other even if only one is surgically changed. It is well acknowledged that reducing a large nose makes the chin look bigger and chin augmentation can make the nose look smaller. Certainly it can be a very powerful profile changer when a larger nose and a smaller chin are simultaneously corrected.

While a reduction rhinoplasty can be done by various methods based on the actual deformity, these represent relatively minor technical differences in the manipulation of the bone and cartilages. In contrast, a genioplasty can be done by fundamentally different techniques…an implant or an osteotomy. (sliding genioplasty) There are advantages and disadvantages to either type of genioplasty but most patients undergo the ‘simpler’ implant augmentation. Only a minority of chin augmentations are done by a sliding genioplasty although this is often the common chin augmentation technique for oral and maxillofacial surgeons.

Long-term outcomes of combined rhinoplasty and genioplasty patients are rarely reported probably because most plastic surgeons correctly assume that patients are very happy and there is little to gain by looking at the long-term results. But no studies to my knowledge have ever been reported looking at combined rhinoplasty and sliding genioplasty augmentation.

In the July 2013 issue of the Archives of Facial Plastic Surgery, a study was published entitled ‘Combined Rhinoplasty and Genioplasty: Long-term Follow-up’. In this paper, a total of 90 cases of combined open rhinoplasty and augmentation/reduction genioplasty over a three year period were reviewed to assess the stability of the aesthetic results. Specifically the chin was studied by anthropometric measurements. Soft tissue pogonion projection to the true vertical line and mandibular height (incisor to menton) were measured. The average horizontal augmentation genioplasty had 7mms advancement and the average vertical lengthening genioplasty had 5mms increased height. The measurements shows a 100% stability after three years. In reduction genioplasty, half of the patients had 100% stability after three years. The results of this study showed that there is minimal change (less than 1mm) in the chin position as part of a profileplasty.

While rhinoplasty and genioplasty is common, doing the genioplasty portion by a sliding osteotomy rather than an implant is very uncommon. The only advantage that a bony genioplasty has over an implant in most typical aesthetic patients is when a vertical chin change is needed. Given the average amount of horizontal advancement in this study that movement alone is well within the range of what an implant can do. The stability of the bony movements of a sliding genioplasty has been extensively studied before without being done at the same time as a rhinoplasty. This study corroborates what many studies have shown before, bony chin changes are fairly stable and any relapse or bone resorption is not clinically observable or significant.

Dr. Barry Eppley

Indianapolis, Indiana

Vertical Lengthening of the Short Chin

Sunday, June 7th, 2009

Chin augmentation is a multi-dimensional procedure. While most chin enhancements are for horizontal movements, there is a small subset of people who need vertical lengthening only or a combination of vertical and horizontal increases. When the chin is short in height, the distance between the lower lip and the bottom of the chin is small. Careful inspection will reveal that the lower lip looks is slightly folded over, the crease below the lip (labiomental crease) is deep, and the chin looks small even though it may have good projection.

Vertical chin lengthening can be done by either an implants or actually lengthening the bone. Both can be effective but patient selection is critical.

Minor amounts of chin lengthening can be done with an implant. But the implant must be placed off the front edge, oriented more downward than normal. Because of this positioning on the ledge, so to speak, it is important that it be screwed into place. When an implant is placed in this position, I always use two screws spaced as far apart and as far back as the incision length will permit. To not have the increased chin length look too narrow, an extended or more wrap around chin implant style is used.

It is also possible to make a custom chin/jaw implant that is designed off of a computer model to make for vertical lengthening done completely by an implant….and it can be quite significant. In my Indianapolis plastic surgery practice, I have done this a handful of times but the motivation to custom make such an implant needs to be considerable given the increased expenses to do so. Such ‘motivation’ should be that the change wanted in the chin or jaw shape could not more easily be obtained by a bone procedure. (e.g., vertical lengthening of the jaw from one angle to the other)

When the chin height is more significantly short, a lengthening genioplasty is the proper procedure. From an incision inside the mouth, the chin bone is horizontally cut below the tooth roots. It is then lengthened in a cantilever fashion, making an open wedge of whatever length (bone gap) that one needs. The upper and lower bone edges are secured with small titanium plates and screws across the opened gap. Whether this bone gap needs to be filled with bone or an artificial graft material is a matter of debate. At most, I may put some porous hydroxyapatite blocks in two areas off the midline just to be absolutely sure the gap is maintained forever. Although the plates spanning the opened gap are pretty secure. Graft or no graft, this bone defect will fill in and heal on its own within a year after surgery.

Vertical lengthening of the chin increases lower facial height to make for a more balanced face. It also makes the labiomental crease more shallow and often improves the neck angle as well.

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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