The chin is the predominant feature of the lower face. Whether it is too short or too long affects the overall look of one’s face. While short chin deformities make up the vast majority of corrections, long chin problems also exist. The overly prominent chin can exist in two dimensions, too far forward (horizontal excess) or too long. (vertical excess)
Chins that are too long vertically are the result of excess bone development. Unlike chins that are too long horizontally, this is usually not an overgrowth problem of the entire lower jaw where a bite deformity (underbite or malocclusion) may also be present. The bone height of the chin (mandibular symphysis) is simply too long from below the tooth roots downward.
Vertical chin reductions are all about having to remove bone. It would be less common to consider removing bone by simply shaving down the bottom part of the chin because of the submental scar. But in the right patient who desires an overall three-dimensional chin shape alteration, the ‘inferior’ approach can be quite successful. The historic and most common method of vertical chin reduction is done by removing a wedge of bone between the upper and lower portions of the chin. This does not disturb the soft tissue attachments and the approach is through the mouth so there would be no external scar. The chin bone is put back together in a shortened position with very tiny titanium plates and screws.
Any chin reduction procedure must consider the potential effects of the soft tissue envelope. Much like changing a breast implant to a smaller one, what happens to the expanded or stretched out soft tissue afterwards? In my Indianapolis plastic surgery experience, this is a more significant issue with horizontal reduction but it still must be considered with vertical reductions as well. In either case, the mentalis muscle must be shortened and resuspended tightly. Vertical chin reduction by interpositional wedge removal genioplasty does not require skin shortening by excision unlike most horizontal chin reductions. The finesse part of any bony chin procedure is the management of its soft tissue attachments. Failure to do so will likely result in secondary chin problems.
Dr. Barry Eppley
Indianapolis, Indiana