While the most common chin augmentation dimension is forward or in the horizontal dimension, the most under diagnosed chin augmentation patient is the one who needs some vertical lengthening as well. Vertically elongating the chin typically means a forward and down direction of augmentation in profile (45 degrees in the side view) and not a true vertical lengthening. (90 degree drop with no horizontal) They are recognized as patients whose lower third of the face is vertically short and violates the facial thirds relationship. Adding a horizontal chin implant improves projection but keeps the lower face compressed and still disproportionate.
Vertically lengthening chin implants styles do exist but they are somewhat dimensionally limited. Most such patients are better served by either a bony genioplasty or having a custom chin implant design. Too many times surgeons ‘force’ a horizontal projecting style of chin implant onto these patients. An opening wedge bony genioplasty performed intraorally can either do a pure vertical elongation or a combined vertical and horizontal augmentation. The trade-off for doing so is to create a bit of a more narrow chin which can be disadvantageous for men but an aesthetic advantage for women.
A custom chin implant design, while capable of creating vertical elongation only, is better served for a combined vertical and horizontal effect. Such an implant design brings the chin down and forward as well as provides vertical augmentation back along the jawline to keep a smooth inferior border line. Placed through a submental incision it relies on being able to pull the soft tissue chin pad back over it for closure. If the combined vertical and horizontal augmentation millimeter numbers exceed 15, an intraoral bony genioplasty should be performed instead to avoid not being able to get the soft tissue pad over the implant and creating the ‘double bubble’ chin. (soft tissue pad sits higher than the front edge of the implant) Combined vertical land horizontal lengthening creates an expansion that exceeds what a linear movement in one dimension alone can do.
Dr. Barry Eppley