Reduction genioplasty for mandibular prognathism and long chin

When evaluating patients' profile, surgeons usually note the lack of the chin projection and may suggest chin augmentation, but they rarely discuss reduction of an over-projecting chin. This is unfortunate, since there are quite many individuals who have macrogenia and would aesthetically benefit from corrective surgery, but the chin reduction is seldom offered. The reason for this is the lack of experience, lack of the technical equipment necessary, or sometimes lack of knowledge. The present study conveys 25 years of experience with the reduction genioplasty.

From 1994 to 2019, 47 patients (39 females, 6 males, and 2 male to female transsexuals) underwent 49 chin reduction procedures. All patients were operated and followed up by the author. The transoral approach was used in 23 patients, and in 24 patients the procedure was done through the straight 4- to 6-cm-long submental incision. The air-driven pneumatic chisel was employed for reduction of the mandibular bone (MicroAire, Charlottesville, VA, USA). Forty-eight operations were carried out under dissociative and local anaesthesia on an outpatient basis, and one procedure was done under general endotracheal anaesthesia.

Both mandibular bone and the soft tissues of the chin were reduced, or modulated according to the needs of each patient. Operations were technically easier when executed by the submental approach because of better exposure of the mandibular rim and the higher precision in the remodelling of the soft tissues. Thirty-six patients (77%) could be followed up for a mean of 2.5 years (range 9 months to 12 years). Twenty-eight of evaluated patients (78%) described the outcome as very good or good. Four patients described the result as acceptable and another 4 as bad. In the majority of cases the evaluation by the surgeon correlated well with the opinion of patients, but in five cases surgeon estimated result with the higher score than the patient. Overall good results were illustrated by the photographs of the clinical examples. Complications were few and manageable. Transient neuropathies were common and more frequent with the transoral approach. Five patients required minor intervention for skin indentations at the jaw line developed during the healing phase.

Skilful chin reduction surgery is safe and the aesthetic improvement could be quite spectacular, which is also rewarding for the patients. Complications in this patient series were few and manageable. More surgeons should include chin reduction in their repertoire.