The chin can be reshaped in a variety of well known bony maneuvers. The most common is projection increase via the classic sliding genioplasty using a horizontally angulated bony cut. The other now recognized bony chin reshaping is that of the mini V line surgery. This is a reductive procedure to reduce the width of the chin which may also be accompanied by horizontal and vertical changes based on the patients aesthetic desires. But in the end t-shaped osteotomy lines result when put back together.
In either case it requires plate and screw fixation which usually is done by a midline plate with screws above and below the horizontal osteotomy line. This central form of bone fixation is usually more than adequate to enable assured postoperative bony healing.
In rare cases alternative plate and screw fixation strategies must be used. As an example I had a patient who presented for a t-shaped genioplasty (height and width chin reduction) but had an existing large plate in place from a prior jaw fracture through the chin area. In surgery it was discovered that getting this old fracture plate and screws out could not be done.
An initial high horizontal osteotomy line needed to be done to ensure that the separated chin bone fragments were not too small to adequately put back together in a stable manner or became devascularized from the central bone removal. As a result a longer side to side plate was used to overcome the inability to apply a more traditional plate in the midline position.
In the end the method or type of plate used for chin osteotomy fixation does not matter as long as it adequately stabilizes the bone. Because there was a completely vertical chin reduction being done (no horizontal advancement) a curved side to side fixation plate could be used which did not require a central fixation point.
Dr. Barry Eppley
Indianapolis, Indiana