Chin Ptosis: Etiology, Classification, Diagnosis and Surgical Management-A Literature Review

Background/Objectives: Chin ptosis is a heterogeneous deformity characterized by inferior displacement of the presymphyseal soft tissues and may reflect abnormalities of skeletal support, the mentalis muscle, the submental crease, the soft-tissue envelope, or facial animation. This narrative review aimed to synthesize the anatomy, etiology, classification, diagnostic assessment, and the management of chin ptosis and to translate the available evidence into a component-based clinical framework. Methods: MEDLINE via PubMed was searched from inception to 6 October 2026 and yielded 62 records. Targeted Google Scholar searches and backward citation searching identified 22 additional unique sources not retrieved by the PubMed strategy. Forty-two publications were included. Anatomical studies, technical reports, clinical series, comparative studies, reviews, and relevant book chapters were evaluated. Evidence was classified as direct when it concerned diagnosed chin ptosis and as indirect when it concerned related conditions such as chin retrusion, macrogenia, facial aging, or mentalis hyperactivity. Results: The four-category classification of illusory, developmental, iatrogenic, and dynamic chin ptosis derives from the framework of Garfein and Zide and was retained with additional clarification. The categories are not mutually exclusive. Diagnosis should integrate history, examination at rest and during animation, skeletal and dental assessment, standardized photography or video, reproducible soft-tissue measurements, and patient-reported outcomes. Structural mentalis detachment generally requires anatomical reattachment, whereas crease abnormalities, skeletal mismatch, redundant soft tissue, or generalized cervicofacial laxity require component-specific correction. Nonsurgical treatments mainly address projection deficiency or muscular hyperactivity and should not be presented as definitive treatment for true structural ptosis. Conclusions: Mechanism-based diagnosis and treatment selection are essential. Current evidence remains dominated by technical reports and small retrospective series; standardized diagnostic criteria, complication reporting, and comparative prospective studies are needed.