Background: There are numerous surgical methods to aesthetic augmentation of the lower jaw which are typically performed by either all implants or a near complete bony movement. (chin wing osteotomy) One mixture of these two methods is a sliding genioplasty and standard jaw angle implants. The most comtemporary approach to this jaw augmentation version is a sliding genioplasty with custom jaw implants that fully connect to the advanced chin bone and crosses over the back end of the osteotomy lines for a smooth lower edge of the jawline.
This dual autologous-alloplastic approach to jawline augmentation is done when the amount of dimensional changes needed for the chin exceed the overlying soft tissue pad’s tolerance for a high implant load. Such tolerances are much greater with less risk with a bony genioplasty. A custom implant design approach can then be used to make extended jaw angle implants to complete the total jawline augmentation.
Some patients may potentially decide later, based on then result, that they desire a greater chin augmentation effect. Should that occur the augmenting the sliding genioplasty with an implant can always be done secondarily. Some additional horizontal and/or vertical implant augmentation can be achieved. But it is important to appreciate that the soft tissue chin pad will be tight and the augmentation should thus not be too ambitious.
Case Study: This male previously had a total jaw augmentation with a combined vertical and horizontal lengthening bony genioplasty. (7mms vertical and 5mms horizontal. Custom extended jaw angle implants were placed to complete the augmentation. He healed uneventfully with good placement of the implants as seen on a postoperative 3D CT scan.
After six months he decided that some additional chin augmentation would be aesthetically beneficial. A custom chin implant was then designed to provide an additional 3mms of horizontal and 2mms of vertical lengthening with extension along the inferior border to merge with the previously placed implants.
Under general anesthesia and using a horizontal submental skin crease the custom chin implant overlay was placed. As was anticipated the soft tissue chin pad was tight so it was good that the design was not more aggressive.
Like even an isolated sliding genioplasty a chin implant can almost always be added to it secondarily for some additional chin refinement. Such a chin implant must be relatively modest in size as the soft tissue chin pad has been expanded/stretched along with the bone movement. As a result the overlying soft tissue will be thinner and tighter than normal. In this case a custom chin implant was used to get the proper shape and fit to both the chin bone and the jawline implant behind it.
Case Highlights:
1) One uncommon technique for total jaw augmentation is the combination of a sliding genioplasty with custom jawline implants.
2) When additional chin augmentation is desired with this type of aesthetic jaw augmentation procedure an implant can used to provide the additional augmentation amount.
3) A custom chin implant can be used as an overlay on the bone and out along the sides with the understanding that the overlying chin pad will be tight given the prior bone movement.
Dr. Barry Eppley
World Renowned Plastic Surgeon