Genioplasty Research Articles

Various Applications of Sliding Genioplasty

An adequately balanced proportion and symmetry of all facial features are the requisites for a beautiful face, and the chin plays an important role on facial aesthetics. Sliding genioplasty (SG) is a well-established method for changing the position, size or shape of the mandibular symphysis using autogenous material. We report our result from a 10-year review of our experience with SG. 18 patients (11 retrognathia/microgenia, 3 asymmetry, 1 mucoepidermal cancer of submandibular gland s/p free iliac bone flap reconstruction, 1 cleft lip and palate, 1 Treacher-Collins syndrome, 1 class Ⅲ malocclusion ), aged 19 to 65 years (mean age, 30.3 years), underwent SG alone (9 patients) or with concomitant facial contouring procedures (9 patients) during the year 1994 to 2004. Mean value of chin advancement was 8 mm. Unilateral mental nerve injury was noted in 2 patients and immediate repair was performed. Paresthesia in the involved area resolved in few months. All patients were very satisfied with the cosmetic result. By performing SG, the chin can be moved not only in the sagittal plane but also in the vertical and transverse planes of space. Our experience demonstrates the versatility and excellent esthetic results with the procedure.

Heterotopic Bone Formation around a Solid Silicone Chin Implant

Objective: Solid silicone implants have been used successfully with few complications in facial cosmetic surgery since the mid 1960s. The objective of this paper is to report an unusual sequela associated with a solid silicone implant placed for chin augmentation. Methods: Case Report Case Presentation: A 28-year-old Caucasian female presented with complaints of changes in her chin appearance for the past 2 years. She had a mandibular solid silicone implant placed 11 years prior and was happy with the results for 9 years when she began to notice enlargement of the right inferior border which progressed over 2 years prompting a consult at my office. Clinical examination revealed a mild enlargement of the right anterior mandibular border when compared with the left. She had good chin projection and no noticeable mobility of the implant. Radiographic studies revealed a heterotopic bone along the right anterior border of the mandible. Under intravenous sedation and local anesthesia, the inferior mandible and implant were exposed via the previous extra-oral approach. The bone was exposed and removed from the chin implant, which was stable, and without infection. The wound was closed and the patient was discharged and did well at her postoperative appointment. Discussion: Solid silicone facial implants have been used with great success for a few decades by different specialties. A variety of complications have been reported, such as displacement, early and late infections, patient dissatisfaction with the result, bony resorption, and prolonged edema. This is the first reported case of heterotopic bone formation around a solid silicone implant to this author's knowledge. Conclusion: Heterotopic bone formations around a solid silicone implant likely result from an intact periosteum in conjunction with the nature of the silicone capsules.

Treatment of Chin Deformities

Facial beauty depends on the form, proportion and position of its various units. The chin is the most prominent element of the lower third of the face, both in the frontal view and in profile. The surgical approach to chin deformities did not start until the second half of the twentieth century. The development of silicone prostheses and the emergence of sliding genioplasty offered surgeons a whole new range of options to modify the size and position of the chin. We have performed a historical review of chin surgery, the multiple aesthetic analyses available and the advantages and disadvantages of the different alloplastic materials and osteotomies. To do so, a comprehensive search through current scientific literature on the topic has been carried out, focusing on large series, long-term follow-up studies, research in animal models and medical evidence. As happens in almost any topic in facial plastic surgery, no strong evidence useful in ENT practice for handling chin deformities can be found in today's scientific literature. Ethnicity influences the aesthetic analysis; the type and degree of deformity to be corrected will determine the allo-plastic augmentation of the chin or the suitability of osteotomy. Porous polyethylene (Medpor, Porex Surgical, Newman, Ca, USA) and solid silicone (Silastic, Michigan Medical Corporation, Santa Barbara, Ca, USA) show a clear advantage over other alloplastic materials. Moderate-to-severe retrogenia benefits from sliding genioplasty strategies rather than prosthetic enlargement.

Genioplasty and Chin Augmentation with Medpore Implants: A Report of 650 Cases

Genioplasty is an old and useful technique. Chin augmentation with Medpore has become popular in recent years. The authors briefly examine their experience with the two techniques. From 2000 to date, 500 genioplasties and 150 chin augmentations with Medpore have been performed. The versatility and benefits of the two techniques are discussed. Most of the patients achieved satisfactory results with few complications. Genioplasty is recommended for severe developmental or complicated retrogenia and for deviated chin. Both techniques can be used for mild to modest retrogenia. Medpore is especially useful for patients who need a meticulous revision of the chin shape or contour. Chin shape and contour are as important as the chin position. Although genioplasty has the widest range of indications, chin augmentation with Medpore has the advantage of minimal risk for some patients who need to change the chin shape or contour. Medpore is totally different from other alloplastic chin implants such as silicone.

Chin Surgery VII: The Textured Secured Implant—A Recipe for Success

Silicone chin augmentation remains a popular treatment for microgenia because its placement appears deceptively simple. However, when extrusion, displacement, capsular contracture following implant removal, overaugmentation, or malposition occurs, a revision operation may be required. Secondary chin surgery is challenging because (1) implant removal alone may produce a disfigured chin; and (2) placement of a new implant in an oversized misshapen pocket demands precision, control, and reliability. The textured implant may be placed by means of an intraoral or extraoral route. The extraoral route is usually chosen except when transoral procedures (e.g., mentalis suspension) are required. The superior 30 to 50 percent of a standard textured implant is always removed and then tapered anteriorly at a 45-degree angle to reduce its sharp front edge. The lateral wings are also reduced and tapered. Two pilot holes are drilled in each half of the implant and then it is divided in the midline. Each half is inserted and secured individually. The medial screw is placed first and nearly fully tightened. Then, holding the implant exactly along the inferior border of the mandible, the distal screw is placed and both screws are tightened completely. The lower border of the implant should be exactly along the lower border of the mandible. The soft tissues are closed in three layers over a drain. This technique has been used to treat more than 100 patients. Selected photographs illustrate this technique. This article explains how to place a textured implant efficiently and effectively under light premedication and local anesthesia.

Chin Surgery V: Treatment of the Long, Nonprojecting Chin

Correction of the long, nonprojecting chin requires both vertical reduction and sagittal augmentation. Wedge excision-based therapy reduces chin height and allows for advancement of the distal segment, but it is associated with at least a 10 percent incidence of mental nerve injury. The authors propose two innovative ways to correct the long, nonprojecting chin. There are two approaches, intraoral and extraoral. With the intraoral approach, following a gingivobuccal incision, a single horizontally oblique osteotomy is made at least 6 mm beneath the mental nerve foramina. The vertically long genial segment is freed and the posterior edge is contoured with a side-cutting burr. The contoured jumping genial segment is secured to the mandible with countersunk screws and contoured in situ to preserve the lower 8 to 10 mm. With the extraoral approach, following a submental incision, the anterior and posterior surfaces of the symphysis are cleared (a double-armed suture is placed through the posterior musculature). A reciprocating saw is used to remove the lower border of the symphysis to reduce the vertical excess. The tagged musculature is resuspended, and a tapered, textured implant is secured to the new symphysis. Aesthetic outcomes using these two techniques were good and there were no complications. Representative patients, operated on by the senior author, illustrate these techniques. Both the intraoral one-cut in situ contoured jumping genioplasty and the extraoral vertical reduction/sagittal augmentation genioplasty reduce excess chin height, control sagittal advancement, provide pogonion projection, and avoid the risks of a standard wedge. Both techniques provide custom projection at the lower pole of the new symphysis.

Chin Surgery VI: Treatment of an Unusual Deformity, the Tethered Microgenic Chin

Although the condition is rare, some children are born with cervical clefts or masses that require repair during infancy. The scarring in the submental region can tether the developing mandible at the menton, producing a developmental microgenia or "tethered chin." A retrospective review of the senior author's (B.M.Z.) patient records was performed; three cases of tethered chin were identified. In each case, a staged surgical approach was used. In two cases, previous unsuccessful surgery complicated the initial presentation. In all cases, the underlying soft-tissue anomalies were addressed and the microgenia was corrected. Satisfactory aesthetic and functional results were obtained. The tethered chin represents a rare entity. Correction of the tethered chin requires a comprehensive understanding of the underlying abnormality and an appreciation of the multiple factors that contribute to chin function and aesthetics.

Chin Surgery IV: The Large Chin???-Key Parameters for Successful Chin Reduction

Treatment of macrogenia can be a challenging problem. In this article, the authors provide novel insights for treatment of a previously poorly treated problem. The authors have developed anatomical insights that facilitate the subtly difficult preoperative evaluation of the large chin and, when applied appropriately, will provide uniformly pleasing results. A retrospective review of the senior author's (B.M.Z.) patient records was performed. More than 50 cases of macrogenia were identified. As previously described, almost all of the cases were performed under local anesthesia with oral premedication only. This article demonstrates why prior modalities such as intraoral burring and lower border setback failed to treat the variety of large chins properly. The nine critical factors the surgeon must consider in developing a successful surgical plan are outlined. The surgical plan is not primarily based on radiographs as much as on direct tactile and visual analysis of the sublabial structures both in repose and while smiling. Crucial aspects of the operative technique are highlighted. The large chin can be approached with confidence if nine parameters are appreciated. The authors have outlined these key variables that facilitate proper preoperative topographic analysis of the large chin. Once these variables are appreciated, an appropriate surgical plan can be formulated.

Sliding Osteotomy Genioplasty for Facial Aesthetic Balance: 10 Years of Experience

The chin, one of the most obvious facial structures, plays an important role in the perception of the face as an instrument of communication. To alter the chin contour in a reliable manner, horizontal sliding osteotomy of the mandibular symphysis with advancement of the mobilized segment is the technique of choice for correction of the anterior posterior deficiency. This study describes surgical techniques used in aesthetic and functional surgery of the chin as well as the outcomes. Over a 10-year period, 474 patients underwent orthognathic surgery for correction of their malocclusion. Of these 474 patients, 155 were treated in combination with a sliding genioplasty (SGP) and 37 (29 women and 8 men; average age, 32 years; range, 18-47 years) had an isolated SGP. Of these patients, 33 had chin advancement and 4 had chin reduction. The mean chin advancement was a modest 4.5 mm (range, 2-7 mm), and the mean chin vertical displacement was 3.9 mm (range, 2.5-4.1 mm). All the patients in the mandibular deficiency group had a residual sagittal disproportion of the progonion relative to the subnasale (mean, -7.6 mm) and a newly created vertical disproportion, with mean lower face heights of 67.8 mm compared with mean midface heights of 65.3 mm. The surgical outcome was evaluated by analysis of pre- and postoperative photographs, analysis of pre- and postoperative measurements, and patients' self judgment. All the patients healed uneventfully without any major postoperative problems. Paraesthesia of the mental nerves occurs to some degree in almost all patients measured by the Simmon Weinstein diagnostic device. In the single sliding chin osteotomy group, no major branches of the mental nerves were transacted. Paraesthesia was only transient, usually lasting for only a few weeks. At least 1 year after the operation, normal sensitivity of the lower lip and both sides of the chin was reported by almost all of the patients (93.1%). All who had only a single genioplasty recovered totally from a neurosensory deficit. The level of satisfaction was significantly high for all the patients. The results were judged to be excellent in 73.2% and good in 23.6% of the cases. Only in 3.2% of the cases was it considered to be poor (bimaxillary surgery combined with SGP). The current findings strongly suggest that SGP is a reliable procedure for achieving harmony of the lower face. In addition, it permits a simplification of facial reconstruction and rejuvenation. The combination of chin advancement and submental recontouring can have a positive effect on facial appearance, provided the increased chin projection is appropriate.

Customized design and manufacturing of chin augmentation implant based on reverse engineering and rapid prototyping

目的 探讨应用反求工程与快速成型技术对小颏畸形进行整复设计和置入体制作的可行性.方法 对2例小颏畸形患者,利用X线头影测量方法分析患者畸形类型和严重程度,并计算出需要恢复的数据,在计算机上用反求工程软件在患者下颌骨颏部点云数据上恢复出正常的骨性外形,快速成型制作个体化置入体,并实施衬垫颏成形术.结果 手术过程顺利,置入体精密就位,术后外形达到了术前设计的预期效果.术后X线头影测量对比分析显示:上唇高度与下唇颏高度之比为0.45.面中与面下1/3之比为0.94,颏颈角、FH-N'-Pg角、颏唇沟深度、面形角等面部测量参数改善明显.结论 反求工程与快速成型技术可用于小颏畸形整复的设计和置入体的制作,为面部类似畸形整复开辟了新的途径。

Posttraumatic temporomandibular joint ankylosis: clinical development and surgical management

To investigate the patterns of condylar fractures associated with temporomandibular joint ankylosis (TMJA) and treatment methods and results based on the different types of ankylosis. Forty-two joints of ankylosis in 31 patients with were categorized to four groups according to Sawhney's classification and undergone surgical treatment as follows: a joint release and disc reposition for Type I ankylosis, a dissection of bony block and disc reposition for Type II; a dissection of full-joint and employment of the temporal myofascial flap as interposition for Type III; a radically dissection of full joint followed by ramus distraction osteogenesis and genioplasty for Type IV. All of patients were followed up for 9 to 54 months with an average of 30 months. The range of mouth opening and temporomandibular joint (TMJ) function were assessed. Condylar fractures were retrospectively investigated on the patterns and the course of ankylosis development. Macroscopical visualization on the osseously ankylosed sites and disc displacement were analyzed in comparison with the radiological findings. Condylar sagittal and comminuted fractures were most susceptible to TMJA. Early fibrous ankylosis occurred usually at the 4th or 5th month post-traumatically with an average month opening of 18.3 mm. The articular discs were found displaced in all cases and early bony bridge formed at a limited area where there was no disc as cushion. During fellow-up, considerable improvement in mandibular movement was attained with a stable joint function and mouth opening range of over 30 mm except for two cases in which ankylosis relapsed. Condylar sagittal and comminuted fractures are most likely to cause ankylosis. Early surgical intervention could reduce the disc and avoid the later ankylosis.

Facial Liposuction and Submentoplasty

Achieving a beautiful and youthful jaw line and neck contour is a common desire for many cosmetic surgery patients. Certain patients are candidates for isolated facial or neck liposuction if their skin tone and muscle tone are adequate. In addition, the role of chin augmentation to improve a weak chin projection is critical to obtain good facial proportion as well as maximum neck aesthetics particularly when a patient has an anterior or low hyoid position. Often, isolated facelift surgery performed by an assortment of lateral pulling or lifting techniques is performed as an isolated procedure to improve the jowls and neck.

Injectable Hyaluronic Acid Implant for Malar and Mental Enhancement

The use of a thicker injectable implant version of one of the hyaluronic acid dermal fillers (Restylane SubQ, Q-Med, Uppsala, Sweden) is described. A group of treated patients has been studied for more than 1 year. Restylane SubQ was injected to the submuscular plane of the upper cheeks and chin to observe efficacy of augmentation and side effect profile, and further observations were made of the duration of benefit. Patient details--72 patients were treated, 68 for upper cheek augmentation, 2 for chin augmentation, and 2 for both areas. Four patients received second injections 8 weeks after the first to increase augmentation. Patients all showed a persistence of benefit during the posttreatment observation period of up to 64 weeks. Four patients had minor side effects that resolved with local treatment and time. Four patients had second injections to complete augmentation without complications. Restylane SubQ is a useful injectable agent to augment and lift upper cheeks and recontour chins. Further efficacy studies seem justified.

Injectable Hyaluronic Acid Implant for Malar and Mental Enhancement

BACKGROUND The use of a thicker injectable implant version of one of the hyaluronic acid dermal fillers (Restylane SubQ, Q-Med, Uppsala, Sweden) is described. OBJECTIVE A group of treated patients has been studied for more than 1 year. Restylane SubQ was injected to the submuscular plane of the upper cheeks and chin to observe efficacy of augmentation and side effect profile, and further observations were made of the duration of benefit. METHODS Patient details—72 patients were treated, 68 for upper cheek augmentation, 2 for chin augmentation, and 2 for both areas. Four patients received second injections 8 weeks after the first to increase augmentation. RESULTS Patients all showed a persistence of benefit during the posttreatment observation period of up to 64 weeks. Four patients had minor side effects that resolved with local treatment and time. Four patients had second injections to complete augmentation without complications. CONCLUSIONS Restylane SubQ is a useful injectable agent to augment and lift upper cheeks and recontour chins. Further efficacy studies seem justified.

Horizontal osteotomy combined with augmentation mentoplasty for serious chin microsomia

目的 介绍一种治疗严重小颏畸形,重塑颏部外形的有效方法.方法采用口内切口颏部水平截骨前移固定后,再联合利用在颏部置入合适假体的隆颏术,以进一步增加颏突度和颏长度,改善颏部形态.结果共治疗9例,术后患者颏部形态均得到明显改善,重塑的颏部外形符合美学标准,达到患者术前的预期要求.随访6个月至2年,效果稳定满意,无明显并发症出现.结论利用颏水平截骨联合置入假体的颏成形术治疗严重小颏畸形,使重塑的颏部形态达到了美学标准,面部轮廓比例协调,效果显著。

The Genioplasty and Beyond: An End-Game Strategy for the Multiply Operated Chin

Genioplasty has been a useful and frequently employed technique. In previous publications, the authors discussed the benefits and versatility of the genioplasty. Here, they briefly examine the entire experience of the senior author, from 1975 to the present. The authors examined a series of 580 genioplasties performed in 567 patients over a 28-year period by the senior author. This was done by chart review, which involved collection of demographic data and tabulation of the number of operations and type of genioplasty, as well as inspection of operative notes and clinical photographs. The focus was on the subgroup of patients who required multiple procedures to obtain a final satisfactory result. In one subgroup of patients, largely those with severe developmental or syndromic retrogenia, staged procedures were part of the original plan. A second subgroup included patients who had had problems with alloplastic chin implants; for these patients, further operations were not part of the original plan. RESULTSIn the first group of patients, with severe developmental or syndromic retrogenia, an osseous genioplasty was often associated with orthognathic surgery and could be repeated later as a staged procedure. In the second group of patients, who had multiple problems with alloplastic chin implants, an osseous genioplasty often provided the solution to difficult problems. In both groups of patients, an autogenous costal cartilage graft may be of great help after one has accomplished as much as one can with an osseous genioplasty. In rare cases, microsurgical free tissue transfer may be required.

A Multicenter Study of the Efficacy and Safety of Subcutaneous Nonanimal Stabilized Hyaluronie Acid in Aesthetic Facial Contouring: Interim Report

Non-animal-stabilized hyaluronic acid (NASHA) gel may offer longer-lasting cosmetic correction and lower antigenic risk than other soft tissue augmentation agents. To assess the efficacy and safety of the NASHA gel Restylane SubQ (Q-Med AB, Uppsala, Sweden) in aesthetic facial contouring. Fifty-seven adult patients seeking cheek and/or chin augmentation received subcutaneous and/or supraperiostal injections of Restylane SubQ (20 mg/mL) at 114 treatment sites; 13 of these patients received "touch-up" injections at 20 sites. Efficacy was assessed subjectively using a 5-grade Global Aesthetic Improvement Scale at 1, 3, 6, 9, and 12 months after the initial treatment. At 3 months post-baseline, patients and investigators independently considered the treatment sites to be improved in 96.4% and 100% of cases, respectively. Patient- and investigator-assessed response rates (proportion of patients showing moderate or better improvement) were 84% and 95%, respectively. The majority of reported adverse events were treatment related (local injection-site reactions, implantation complications, skin tightness, and skin induration), but these were generally of mild intensity and short-lived. Restylane SubQ is well tolerated and maintains aesthetic correction of the cheeks and chin for at least 3 months after subcutaneous and/or supraperiostal treatment.

Atypical cyst formation following chin augmentation using a nasal osteocartilaginous graft

The purpose of this paper is to present a case of an intraosseous mucocele that was detected 5 years after chin augmentation using a nasal osteocartilaginous graft. Although complications of this technique have been described as negligible, the surgeon must be aware of possible long-term side effects and should remove all nasal mucosa from the graft prior to implantation.

Optimizing treatment outcome with Restylane SubQ: The role of patient selection and counseling

Restylane SubQ has been developed to meet the growing demand for minimally invasive cosmetic procedures that correct loss of facial soft tissue volume and provide a nonpermanent solution for facial rejuvenation. This new product in the Restylane product family is based on the same non-animal stabilized hyaluronic acid (NASHA) gel as all other Restylane products, but contains larger gel particles than existing products. This characteristic allows for optimal volume expansion when injected subcutaneously or supraperiostally. Possible indications for Restylane SubQ include cheek augmentation in young patients with flat malar bone as an alternative to cheek implants. Other indications could be midface rejuvenation in patients who either feel it is too early for a face lift, or who are ready for a face lift but are unwilling to undergo surgery. Another possible use could be chin augmentation-pure augmentation as an alternative to chin implantation, or simply rejuvenation of the chin profile to enhance projection in patients with early chin ptosis. A common principle in all these possible indications is that the aesthetic outcome obtained with Restylane SubQ largely depends on appropriate patient selection and counseling. Facial tissue structure is an important consideration when selecting patients for treatment with Restylane SubQ, since treatment success is dependent on adequate soft-tissue cover for the injected product, as well as soft tissue support to prevent mobility.

シリコーンインプラントを用いたオトガイ形成術後に骨吸収がみられた１例

There are two types of operation for chin augmentation. One is augmentation genioplasty by means of horizontal osteotomy, and the other is implantation with alloplastic materials, such as silicone implants and hydroxyapatite blocks. Augmentation genioplasty with silicone implants is easy and can be performed under local anesthesia. However, augmentation genioplasty with silicone implants tends to produce post-operative infection, bone resorption of the chin, and malposition of implants. We report a case of mandibular resorption and infection following augmentation genioplasty with a silicone implant.A 50-year-old female underwent augmentation genioplasty with silicone implantation about 8 years ago in Korea. At 7 years post-operation she noticed swelling and paresthesia in the mental region and so consulted our department. An abscess and an operative scar were observed in the intraoral mandibular incisor region. An implant was observed in the mental region, and some absorption of the bone beneath the implant radiographically. The implant was removed surgically. The implant surrounded by granulation tissue caved in the surface of the chin bone which was absorbed irregularly. These findings suggested that the resorption of surface bone under silastic implant was caused by the continuous pressure of musculus mentalis.