Decision Tree for Implant vs Genioplasty in Revisions

In treating chin implant asymmetries the decision is between implant revision vs. sliding genioplasty. This is how to think about that choice in a structured manner.s

Decision Tree: Implant vs. Sliding Genioplasty (Revision Cases)

Step 1: Is the implant malpositioned?

• YES ?
  ? Proceed with implant revision (reposition ± pocket correction ± fixation)
• NO ? go to Step 2

Step 2: Is the chin bone symmetric?

(Assess with clinical exam ± imaging)

• YES (bony symmetry present) ?
  ? Problem is soft tissue or implant-related
  ? Implant revision or exchange
• NO (bony asymmetry present) ? go to Step 3

Step 3: Severity of bony asymmetry

? Mild asymmetry

• Can be camouflaged
• Options:
  • Extended/custom implant
  • Implant reposition + contouring
• ? Implant-based solution reasonable

? Moderate to Severe asymmetry

• Chin point deviated
• Inferior border irregularity
• Vertical or transverse discrepancy

? Sliding genioplasty preferred

• Allows:
  • True midline correction
  • Vertical adjustments
  • Rotational correction

Step 4: History of failed implant revisions

• YES ?
  ? Strong indication for genioplasty
  • Repeated implant failure = unstable soft tissue/pocket environment
• NO ? implant revision still reasonable

Step 5: Soft tissue considerations

• Significant soft tissue asymmetry?
  • YES ?
    • Genioplasty + adjuncts (fat grafting, muscle resuspension)
  • NO ?
    • Either option depending on bone

Step 6: Patient goals & anatomy

• Wants:
  • Subtle contour change ? implant
  • Structural correction ? genioplasty
• Thin soft tissue envelope?
  • Favor genioplasty (implant edges more visible)

Quick Clinical Summary

? Choose Implant Revision if:

• Malposition is the main issue
• Bone is symmetric
• Asymmetry is mild
• First-time revision

? Choose Sliding Genioplasty if:

• True bony asymmetry exists
• Chin point is off midline
• Prior implant revisions failed
• Need 3D control (horizontal, vertical, rotational)

? High-Yield Rule

If the problem is positional ? implant
If the problem is structural ? genioplasty

Dr Barry Eppley

Plastic Surgeon