Simultaneous osseous genioplasty and meloplasty

A review was done of the records of 50 patients who had osseous genioplasty performed at the same sitting as face lifting and, in many cases, submental lipectomy over a 20-year period by the senior author. The types of genioplasties were sliding advancement (40), lengthening with interpositional bone graft (7), and reduction (3). In 9 patients, chin implants were removed, generally because of inadequate chin projection or implant erosion. Three patients were operated on under local anesthesia, the remainder under general anesthesia. Associated procedures, done in 46 patients, included rhinoplasty, forehead lifting, blepharoplasty, lateral canthopexy, excision of buccal fat pads, reduction mammaplasty, and abdominoplasty. In 4 patients, associated maxillofacial procedures were performed, including Le Fort I and III osteotomies, two-jaw surgery, mandibular advancement with sagittal splitting, and orbital expansion. The perceived advantages of osseous genioplasty were greater versatility in dealing with problems in other than the sagittal plane, the possibility of greater chin projection, and a tightening of the submental musculature. Complications occurred in 10 patients. These included two hematomas requiring aspiration in the office, a prolapsed submandibular gland requiring later excision, a transient weakness of the marginal mandibular nerve, a transient numbness of the lower lip on one side, four revisions of scars resulting from the face lifting, and one localized wound infection in the parasymphyseal area that resolved with oral antibiotics. The most common complaint, which came from 8 female patients at some time from 1 month to 3 years postoperatively, was that the chin was "too strong." In 6 of these patients, most of whom were operated on early in the series, some of the chin projection was reduced by burring. Osseous genioplasty can be performed safely along with face lifting and submental lipectomy. The degree of advancement necessary in aesthetic surgical patients is generally less than that required in reconstructive patients. Patient satisfaction is great unless the chin is overly advanced.