GENIOPLASTY

INTRODUCTIO
N
INTRODUCTION
While patients seeking about facial cosmetic
surgery often focus on structures such as the
nose, the eyes, and the laxity of their skin, but the
lower third of the face is an area that could be
surgically modified to improve overall facial
appearance and harmony. The profile of a patient
can be significantly altered with either a chin
augmentation or reduction procedure. This, in turn,
has a significant effect on overall facial symmetry.
DEFINITION
 DEFINITION
Chin augmentation, known as genioplasty, is
performed to enhance chin projection and
improve facial proportions and esthetics. It is
performed through incisions hidden in the mouth
by using either alloplastic materials (a chin
implant) or by creating a bone cut in the chin and
sliding the chin forward (osteoplastic
genioplasty). These procedures may be done alone
or in combination with other cosmetic
procedures.
Synonyms and related keywords:
Mentoplasty,
Alloplastic implant of the chin
Osseous movement of the chin
Sliding genioplasty
Alloplastic augmentation
Mentum reduction
Chin implant
Chin augmentation
RELEVANT ANATOMY
The depth of labiomental fold may dictate which
technique is suitable.
Alloplastic implants tend to deepen the
mentolabial sulcus.
The mentolabial sulcus becomes less pronounced in
a vertical lengthening of the chin.
Position of mental foramen is utmost importance
during surgery.
The mentalis muscle elevates the chin at a place
just below the tooth roots.
 INDICATIONS

Surgical goals include creating an aesthetically

pleasing facial contour and establishing
proportionate facial height. This may entail
reduction of a prominent chin or augmentation
of a poorly projected chin.
 CONTRAINDICATIONS

Carefully evaluate the teeth and the height of

the mandible prior to surgery.

Having long teeth with a short mandibular

height is a relative contraindication for an
osseous genioplasty or an aggressive bony
reduction.
Imaging Studies:
lateral cephalometric study.
Anteroposterior (AP) skull radiograph.
occlusal radiograph.

Other Tests:

Standard facial photographs.

In addition to the facial analysis, study dental
occlusion and skeletal structures with the aid of
preoperative photography as well as cephalometric and
panoramic radiographs.

If skeletal or dental deformities are present, dental

model analysis should be done.
 
Preoperative
evaluation
The preoperative consultation includes
A complete history and physical examination,
including dental history with occlusal
evaluation along with standard facial
photographs.

Functional and cosmetic goals should be

discussed with the patient.

If a skeletal abnormality exists, suggest

orthodontic realignment and orthognathic
surgery.
PROCEDURE
S
BONY PROCEDURES OF THE CHIN
1)Horizontal augmentation:- to improve the
prominence of the chin in the anteroposterior
direction.

2)Vertical augmentation:- to increase the

length of the chin in a superoinferior direction.

3)Horizontal reduction:- to reduce the

projection of a protruded chin.

4)Vertical reduction:- to reduce the length of

the chin.
 SLIDING
GENIOPLASTY
 SLIDING GENIOPLASTY
Procedure is done for horizontal augmentation &
reduction.
Can be done intraorally or extraorally.
Can be performed under LA but general anesthesia is
preferred.
Intraorally
A translabial incision is placed & the chin prominence
is degloved.
The mental nerve is identified & protected.
Three points are marked 4-5mm below the mental
foramina on both sides & in the midline.
These three points are connected using a burr or a
Stryker saw. . with a 30-degree bend to facilitate
an even cut while minimizing soft tissue trauma.
The fragment is mobilized taking care to preserve
the lingual soft tissue attachment as it provides
the blood supply to the osteomised fragment.

FOR AUGMENTATION:-
The fragment is slided forward & fixed using
transosseous wiring.
FOR REDUCTION:-
The fragment is reduced & fixed in place.
FOR VERTICAL REDUCTION:-

A similar osteotomy is performed with two

parallel cuts & the bony segment present in
between is removed.

The lower fragment is augmented superiorly &

fixed in position.
FOR VERTICAL AUGMENTATION:-

Bone grafts may be placed between the 2 bony

fragments.

The wound is closed in layers & a mild pressure

dressing placed.
 KOLE’S
PROCEDURE
KOLE’S PROCEDURE
The procedure is done for the correction of an
anterior open bite.

A standard anterior subapical osteotomy is

performed after which a portion of the lower
border is removed as in a genioplasty & wedged
into the space produced between the
dentoalveolar segment.

This newly formed chin is then reshaped & wound

closed in layers.
 ALLOPLASTIC
AUGMENTATION
Alloplastic augmentation

For alloplastic augmentation, surgical approach

options include a submental or an intraoral sulcus
approach.

With either approach:-

Carry the dissection down to the level of the

periosteum.
Take care to preserve and not traumatize the
mental nerves.
Mark the midline with a suture and place the
lateral third of the implant subperiosteally .
Once the implant is in proper position:-

Close the soft tissue in layers.

Paying special attention to the reattachment of

the mentalis muscle to avoid a ptotic lower lip (ie,
witch's chin deformity).

Redrape the soft tissue with tape.

Schedule a follow-up visit with the patient within

one week of surgery.

The procedure take around 15 minutes to

complete
ALLOPLASTIC
MATERIALS
ALLOPLASTIC MATERIALS

Historically, various materials have been used to

augment the chin, including paraffin, ivory, and
methylmethacrylate, to name a few.

Alloplastic implants such as silicone,

polytetrafluoroethylene, and polyester mesh.

Autografts such as iliac crest and rib cartilage

have been used more frequently for chin
augmentation in the past. Nasal bone and
cartilage have been used as well.
Materials used now a days are:-

Alloplastic implants materials include Supramid,

Mersiline, Gortex, and silicone.

Other options include autogenous or

homologous (cadaveric) cartilage or bone
Postoperative details:

Redrape the skin at the level of the labiomental

fold.

Advise patients to stay on a soft diet.

Rinse frequently with saline solution until the

first postoperative visit.

The surgical time for the osseous genioplasty

procedure ranges from 15-105 minutes, with an
average surgical time of about 45 minutes. The
alloplastic implantation is roughly 25% shorter in
operative time..
Follow-up care:

Schedule a follow-up visit with the patient on

postoperative days 7 and 14.

COMPLICATIO
NS
COMPLICATIONS:-
Alloplastic mentoplasty may cause:-
1. Infection
2. Extrusion
3. Dehiscence of wound
4. Overprojection or underprojection
5. Asymmetry
6. Displacement, migration of implant.
7. Capsular contraction
8. Lower-lip retraction
9. Chin ptosis
10.Foreign body reaction to the implant material
11.Unpleasant sensation when exposed to
extremely cold environment.
12) BONE RESORPTION

One study showed up to 5 mm of resorption at

48 months after surgery. Resorption has been
attributed to subperiosteal placement of the
implant.

Tension in the soft tissue pocket due to

pressure from the overlying skin or mentalis
musculature has been thought to cause this
pressure resorption. The overall soft tissue
profile, however, is not usually affected by this
bone resorption.
COMPLICATION OF GENIOPLASTY
1. Mental nerve injury
2. malunion
3. nonunion
4. bonyIrregularities
5. step-type deformities
6. lip drop
7. overcorrection or undercorrection
8. Chin ptosis
9. Gingival recession
OUTCOME &
PROGNOSIS
 OUTCOME & PROGNOSIS

Whether an alloplastic implant or an osseous

implant is used, more than 90% of the patients
are satisfied with their results.

Complications observed with genioplasty are

minimal, and benefits are readily evident to
both patient and surgeon.