EXPLORE
Plastic Surgery
Dr. Barry Eppley

Explore the worlds of cosmetic
and plastic surgery with Indianapolis
Double Board-Certified Plastic
Surgeon Dr. Barry Eppley

Technical Strategies – Hydroxyapatite Block Grafting in Sliding Genioplasty

 

A sliding genioplasty is the autologous alternative to using a chin implant. It is done far less frequently than using implants for chin augmentation, and it should be, but it does have a defined role for lower facial augmentation. It is indicated for large chin movements which standard implants can not achieve, for young patients who need large amounts of chin augmentation and for existing chin implants that have developed complications.

Labiomental Fold Dr Barry EppleyA sliding genioplasty involves a bone cut below the anterior tooth roots and mental foramen which is done at various angles depending on the type of dimensional bone movement needed. As the bone moves forward it is important to appreciate that the labiomental fold will not move with it. The labiomental fold or groove, which is situated about 1/3 the distance from the lower lip to the bottom of the chin, is a fixed structure that is reflective of the attachment of the mentalis muscle to the chin bone over the incisor tooth roots. Its deepest part correlates to the depth of the vestibule on the inside of the lower lip.

Hydroxyapatite Block in Maxillofacial Surgery Dr Barry Eppley IndianapolisHydroxyapatite Prorosity Dr Barry Eppley IndianapolisAs the chin bone comes forward with a sliding genioplasty, the labiomental fold ‘stays behind’. Thus it will get deeper with horizontal chin bone movements. This is due to the now ‘step’ shape of the chin which allows the lower part of the labiomental fold to stay where it is but the chin tissue beneath moves forward.  One historic effort to deal with the deepening labiomental fold effect in a sliding genioplasty is to graft the step of the osteotomy. Many materials have been advocated and used but the hydroxyapatite block graft is one of the most historic. They have long been used in maxillofacial surgery as an interpositional or onlay graft which offers excellent biocompatibility due to its inorganic mineral content and interconnected material porosity.

Hydroxyapatite Block Sliding Genioplasty intraoperative view Dr Barry Eppley IndianapolisHYdroxyapatite Onlay Block in Large Sliding Genioplasty Dr Barry Eppley IndianapolisA carved hydroxyapatite block to fill the step of a sliding genioplasty is an excellent graft choice. Its benefits are when the sliding genioplasty movement is significant, usually 10mms or greater where a large bone step is created. Part of the bone is covered in the midline by the fixation plate but the hydroxyapatite block is placed on top of it regardless. Bone will grow around the fixation plate and into the block.

Grafting the bone step of the sliding genioplasty is not the complete cure for preventing the deepening or for the treatment of the deep labiomental fold. It does, however, have some benefit and is a simple and uncomplicated adjunct to the procedure.

Dr. Barry Eppley

Indianapolis, Indiana

Tags: , , , ,


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.

Read More


Free Plastic Surgery Consultation

*required fields


Military Discount

We offer discounts on plastic surgery to our United States Armed Forces.

Find Out Your Benefits


Categories