The position of the chin plays an important role in the overall aesthetic appearance of the face. A “weak” chin or a chin that is positioned too far back, can make a facial profile look unbalanced. Too “strong” of a chin or a chin that is positioned too far forward can also create an unnatural and overly masculine appearance.
The goal of chin surgery is to put the chin in a position that looks natural and creates an aesthetically appealing profile. In a woman, the position of the chin should ideally be at, or just behind, a line drawn obliquely along the face touching both the upper and lower lip. In a man, the position of the chin should be at, or just beyond, this line.
The aesthetically ideal chin position for a woman based on a line that touches both the upper and lower lips and the tip of the chin
Bone Advancement vs. Implant
It is possible to change the position of the chin by either moving one’s own bone or by inserting an artificial implant. There is a general principle in plastic surgery, however, that states that a patient’s own tissue should be used whenever possible. In the case of chin surgery, it is almost always possible to use a patient’s own tissue. This allows the surgeon to permanently move the chin in 3 different directions. Chin implants are not the preferred method of changing the chin position due to the lifetime risk of implant infection, malposition and exposure. Procedures that change the position of one’s own bone either significantly reduce or eliminate these risks. As a result, Dr. Morin does not use chin implants. He only performs chin procedures that use a patient’s own tissue.
Sliding Genioplasty – A sliding advancement genioplasty involves the use of a saw to cut the lowest part of the chin bone. Once the bone is cut, it is advanced forward the correct number of millimeters in order to correct the facial profile. Once in the correct position, a titanium plate and screws are used to rigidly fixation the bone in it’s new position. All incisions are made inside of the mouth, therefore, there are no scars on the skin from this procedure.
Reduction Genioplasty – The position of the chin can also be reduced if it is determined to be too far forward. The same technique is used to cut the bone but instead of advancing the detached segment forward, a second cut is made and the intervening excess bone is removed. The two remaining bony segments are then rigidly fixated using plates and screws. Again, all incisions are made in the mouth.
Jumping Genioplasty – The position of the chin is moved forward by advancing the cut segment the complete length of the bone. The advanced segment is then transposed so it is sitting on top of and in front of the remainder of the mandible. The bone is then fixated in the new position with plates and screws. This technique gives a large advancement and can also be used to shorten the length of the chin.
Genioplasty with interpositional bone graft – The position of the chin can be both advanced and lengthened by placing a bone graft in between the two segments of cut bone. The size of the graft determines the amount of downward advancement. Once the bone graft is in position, the two segments of bone are rigidly fixated with plates and screws.
Centering Genioplasty – An asymmetric chin can be centered by either reducing one side of the chin more than the other side or by placing a thicker bone graft on one side of the chin as compared to the other side. The position of the chin is then effectively centered.
Two-tier Genioplasty – The two-tier genioplasty results in the greatest amount of advancement possible. By making two separate cuts in the bone, two free bony segments can be advanced in a step-like fashion. Each segment is then secured in place with plates and screws.
More before and after genioplasty and chin surgery pictures can be seen by clicking on the photograph below.