Osseous Chin Surgery (Chin Bone Alterations)

Bone is what gives the chin its generalized projection. The overlying soft tissue as a significant part of the final contour is not changed. Therefore, it makes sense that bone altering options are used for changing one’s chin profile and chin size. Two bone shifting approaches for chin augmentation need to be understood. First, there is the re-formation of the patient’s normal chin-bone (or even the mandible as a whole) in order to provide additional projection or lengthening of the bone. This procedure is called “sliding genioplasty”. In a genioplasty, strategic bone cuts allow to change the chin anatomy without interfering with the patient’s normal dentition or relationships of the upper and lower teeth to each other. A mandibular osteotomy will change the relationship, the orientation and alignment of the dentition to each other and therefore is much more involved.

A) Sliding Genioplasty

The surgery can be performed through an incision placed inside the mouth where the internal lining of the lips meets the gingiva. Alternatively, in the external approach an inconspicuous incision underneath the chin can be employed in order to gain access the chin bone. No matter which incision is used, the execution and location of the bone cuts will determine the final results. Avoiding the roots of the teeth, that chin-bone is disconnected from the remainder of the jawbone and moved in specific directions. Most commonly, the chin-bone is simply moved forward for added projection. This alteration of the chin will be primarily noticed on profile. Implant screws and plates are used in order to fix the bone in its new position. One advantage of a genioplasty using bone cuts is that the length of the chin can be changed meaning that the vertical chin dimension can be reformed. This enhancement is reserved for the rare specific patient situation and is not a common request or need. For instance, if the chin dimension is short from the lower lip to lower edge of the chin, this distance can be increased by tilting the chin-bone downward after the bone cuts have been made. If the length of the chin is felt to be too large, a wedge of bone can be removed and the remaining chin tilted upwards.

The final result will be that the chin height is decreased. In Dr. Fechner’s experience, sliding genioplasty provides true added benefits in the rare patient situations. Often, additional procedures (such as fat grafting or injectable fillers) will be necessary in order to obtain the pleasing jawline contour without depressions or voids.

Sliding Genioplasty Surgery

The sliding genioplasty is the simplest of chin surgery. The chine bone is cut with a surgical saw allowing it to be advanced forward. Fixation of the chin requires screws and plates, commonly made of titanium.

B) Mandibular Osteotomies

This surgical technique is significantly more involved than any other surgery of the chin. These mandibular bone cuts are reserved for situations when the relationships of the upper and lower teeth to each other need to be altered. Because the surgery is performed for treatment of deformities of the upper and lower jaw, mandibular osteotomies are primarily performed as functional procedures were aesthetic benefits represent a secondary concern. Post-operative recovery is prolonged and the need for maxillo-mandibular fixation (“Wiring the jaw shut”) with the application of various devices and implants is frequent. Dr. Fechner does not perform maxillo-mandibular osteotomies.

C) Bone Grafts

The use of free bone fragments for augmentation of the chin has first been performed decades ago. These bone grafts can originate from other parts of the patient (also known as autografts), for instance the hipbones or the skull. The issues of using boney autografts for chin augmentation are multifold including the pain in the areas of bone harvest. In addition, the bone graft needs to be attached to the chin bone using screws and plates. Because some aspects of resorption commonly occurs, a reduction of the oval overall enhancement will be the result. Because bone grafts are associated with poor accuracy and prolonged healing, Dr. Fechner does not use bone grafts for chin enhancement.

Alternatively, cadaveric bone can be used, a technique referred to as an allografting. Because this bone originates from deceased and fully tested donors, the disadvantages associated with the donor site are not an issue. The bone allograft is usually treated with radiation before implantation. A higher rate of bone absorption leads to limited predictability; therefore, Dr. Fechner does not use bone allografts for chin surgery.

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