Genioplasty Surgery

Genioplasty/Mentoplasty is a type of cosmetic surgery that is used to improve the appearance of a person's chin. This can take the form of chin height reduction or chin rounding by osteotomy, or chin augmentation using implants.
A particular process, known as a sliding genioplasty, involves mobilizing a horseshoe-shaped piece of the bottom part of the chin bone by osteotomy and sliding it either backwards or forwards, finally fixing it in place with a titanium step plate using titanium screws. This type of surgery is usually performed by an oral and maxillofacial surgeon or a plastic surgeon.
 
IT IS Also called "Chin Advancement", this procedure is yet another option for chin enlargement.  This procedure can be performed through an intra-oral or an intra-dermal (or extra-oral) incision.  Regardless the bony chin and mandible is exposed and a section of the jaw is removed with an oscillating bone saw.  The bony piece is then moved forward and secured with metal plates and screws.   Do know that you will be able to feel an abrupt "shelf" of sorts both underneath the jaw and in the anterior part of the new "chin" -- where it was slid forward.  However, tissue will cover your new chin and look very natural. 

Genioplasty has more of an incidence of nerve damage (especially the inferior alveolar and mental/menton nerves) than chin augmentation via alloplastic implants.  It is the most difficult or time-consuming for the surgeon to perform and has more down time, but less risks in the long run.  The advancement can be very slight or more dramatic, depending upon your needs.

The results can appear very natural when performed correctly.  The results may be comparable to a chin implant.  The choice of an implant or bone advancement is up to the patient and neither one is risk free.  Please discuss this with your surgeon and be sure the technique details, risks, complications and contraindications are fully explained to you.

In some cases a sliding genioplasty may be conducted in conjunction with advice from a dentist. A smile makeover may be in order as the newly more pronounced chin may provide the opportunity for a better smile. Visit our sister site to find a dentist and learn more about Invisalign cost or to answer questions like “How much do dental implants cost?

Introduction

lthough patients who seek advice about facial cosmetic surgery often focus on structures such as the nose, the eyes, and the laxity of their skin, the facial plastic surgeon's assessment frequently identifies the lower third of the face as 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.

Several surgical options exist for the treatment of chin deformities. Alloplastic chin implants and sliding genioplasty represent the 2 currently accepted methods of chin augmentation. However, to debate whether alloplastic augmentation or osseous genioplasty is the superior choice is beyond the scope of this article. Techniques for chin reduction include genioplasty and direct chin reduction. Skeletal surgery has been through the test of time, and still remains a valued procedure for the facial surgeon. Recent articles from variety of publications confirm the utility of the sliding genioplasty. Wolfe published a 28-year period series in 2006,¹ and Hoenig published a 10-year experience in 2007

History of the Procedure

Surgeons in the mid 1940s started using bony osteotomy techniques to address the retruded mentum. Currently, the sliding genioplasty is performed by physicians from several surgical subspecialties. For the protruding chin, options include a sliding genioplasty or an open reduction with a rotary burr.
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 have gained a great deal of popularity through the years as a result of patient and surgeon satisfaction, as depicted in the image below. In the 1980s, Beekhuis and Johnson popularized Mersilene mesh (Ethicon, Somerville, NJ). A recent 14-year study showed Mersilene mesh to be safe and well tolerated for chin augmentation. Alloplasts, in general, are easy to place and are less time consuming than a sliding genioplasty, but their application is limited to the mild to moderately retruded chin.
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. Unfortunately, their use appears to be associated with an increased rate of infection, even after as many as 40 years.

 

 

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Problem

When facial analysis identifies a patient's profile with facial dysharmony, determine whether an underlying occlusal and skeletal deformity or merely a poorly or overprojected mentum is present. When the poor projection is skeletal in nature, the situation is considered an Angle class II skeletal deformity. The Angle skeletal classification is based on the position of the first molar. In retrognathia, the mesiobuccal cusp of the maxillary first molar is mesial (or anterior to) the buccal groove of the mandibular first molar. If only a hypoplasia of the mandible exists, the term micrognathia is more accurate and should be used.
When no skeletal malformation is present, the terms for a recessed chin include retrogenia, microgenia, retruded chin, hypoplastic mentum, and horizontal mandibular hypoplasia. The same holds true for the overprojected chin, eg, prognathia, protruded chin. In the literature, all these terms have been used interchangeably. In general, genioplasty implies an osseous movement, whereas mentoplasty suggests the use of an alloplastic implant. However, the two terms are currently used in a synonymous fashion.

Imaging Studies

When chin abnormalities are present, obtain additional studies. Perform a lateral soft tissue study, lateral cephalometric study, anteroposterior (AP) skull radiography, and occlusal panoramic radiography.

Other Tests

• Obtain 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 radiography.
• If skeletal or dental deformities are present, order dental models to be fashioned.

Surgery Costs

Chin surgery costs consist of three fees: the anesthesia fee, the hospital or facility fee, and the surgeon's fee. Costs vary depending on the complexity of the procedure. For example, more complicated surgery may take several hours: this factor increases surgical, anesthesia, and facility time, significantly affecting the total cost of the procedure.
If general anesthesia is administered and an overnight hospital stay is required, the costs will be greater than if local anesthesia is used, without a hospital stay. The facility where the surgical procedure is performed impacts cost as well. A comprehensive treatment plan may include more than one procedure. If multiple procedures can be performed at the same time, then certain fees may be combined.
Average fees for the mentoplasty or genioplasty procedures can range from $3,000 to $10,000. These costs vary based on the extent of the procedure, expertise of the surgeon, and the length of recovery.
Benefits vary among insurance carriers. Insurance may pay all or a portion of the procedure if the procedure is deemed medically necessary as the result of a birth defect or traumatic injury. Consult your surgeon about whether your insurance carrier will be responsible for the medical bills.