Chicago Chin augmentation is surgically achieved in one of two ways: an alloplastic implant or manipulation of the patient's own bone through sliding genioplasty.
"Genioplasty is a more versatile technique than an implant," Rodger Wade Pielet, M.D., tells
Cosmetic Surgery Times
Although the procedure has been talked about in the literature for decades, few plastic surgeons practice this technique. Dr. Pielet performs a genioplasty approximately twice a month and has performed the procedure in more than 50 patients to date.
WEIGHING OPTIONS "In cosmetic surgery of the chin, the methods of implant and sliding genioplasty both have inherent advantages and disadvantages," says Dr. Pielet, University of Chicago clinical associate.
Although the implant procedure for chin augmentation is more straightforward, potential disadvantages of implants include long-term shift, infection, erosion, and problems with teeth. Furthermore, a deficiency in chin projection is often accompanied by a vertical deficiency and that vertical aspect cannot be addressed by an implant. An implant is more appropriate for someone who wants to effect a small advancement of the chin or for a patient whose oral hygiene precludes eligibility for sliding genioplasty. Implants may also be more appropriate following maxillofacial trauma.
"When sliding genioplasty is an option, it offers the advantage of using the patient's own bone and is associated with fewer subsequent complications compared with an implant," says Dr. Pielet. In addition to augmentation, sliding genioplasty offers the options of reduction and/or vertical manipulation of the mandible. "However, genioplasty is appropriate only if goals are purely aesthetic."
Left, Figure 1: Pre-operative photo of 41-year-old patient with retrogenia and a vertical deficiency with mentalis strain. RIGHT: Digital simulation of expected results following sliding genioplasty procedure.
Because the procedure does not affect occlusion, overbite or underbite is not addressed. Dr. Pielet notes that issues related to oral surgery should be referred to an oral surgeon or an orthodontist.
Although bone resorption after genioplasty has been reported in the literature, Dr. Pielet has not seen this in his patients. In his experience, he has seen only one complication associated with genioplasty. Four to six weeks post surgery, an investigation of persistent swelling in the floor of the mouth revealed that the patient had actually experienced an injury that was not located at the site of the surgical cut for the genioplasty.
ACHIEVING HARMONY According to Dr. Pielet, perhaps the biggest challenge in genioplasty lies in explaining the procedure to patients so that it doesn't frighten them. As a true believer in the personalized approach to the individual patient, Dr. Pielet seeks to describe all the options without bias.
Figure 2: Three sets of pre- and post-operative photos of the same patient showing actual sliding geniopasty results (10 mm advancement and 3 mm vertical lenthening).
Typically, genioplasty is performed in combination with other facial surgery, such as rhinoplasty, to establish facial balance and harmony.
"Computer imaging helps the patient visualize the change in appearance that we think we can achieve," explains Dr. Pielet, who performs the procedure in as many men as women. The ideal candidate is healthy, has good oral hygiene, good teeth and bones, and takes an active part in pre-surgical discussions.