Lower Face Contouring By a Novel Genioplasty Method

Goals/Purpose: It is widely known that a squared facial appearance with a wide and angular jaw line is considered to be unattractive among the Asian population. There is some degree of consensus that a slim and slender face is more attractive and appealing, especially for women. Thus, mandible contouring surgery has become popular in the field of aesthetic surgery, especially in East Asia. Ever since mandible reduction surgery was introduced for cosmetic purposes, various surgical methods have been utilized to improve lower-face aesthetics. When the patient has a short lower face and requires a concomitant lengthening procedure of the chin, the usage of autogenous bone grafts or alloplastic materials are presently the most popular approaches to correct the problem. However, these surgical methods have several inherent disadvantages and to avoid these complications, we devised a novel, simple and reliable method that can correct a short and wide lower face.  

Methods/Technique: Throughout a 3-year period, a consecutive series of 58 patients underwent chin narrowing and lengthening surgery. Before surgery, all patients had thorough consultations with the surgeon to discuss their personal requirements and to understand the practical goals of the surgery. In all cases, the operation was performed via an intraoral approach under general anesthesia using an orotracheal intubation. The newly-designed narrowing and lengthening genioplasty was performed. Then, the mandible lower borders were further contoured in order to diminish the bony steps at the chin-mandible junction and achieve a smooth and slender jaw line. If further narrowing of the mandible body was required, mandibular corticectomy was subsequently performed. The total time necessary to complete the operation ranged approximately between 45 to 90 minutes.

Results/Complications: The novel narrowing and lengthening genioplasty procedure was performed successfully in all cases. Among the 58 patients, 54 were female and 4 were male. The average age at the time of surgery was 26.2 years. The amount of vertical lengthening ranged from 1 mm to 5 mm. The lengthened height was 3 mm in nearly half of the patients. The width of horizontal narrowing ranged from 3 mm to 15 mm with an average of 9.6 mm. The average follow-up period after the operation was 10.3 months. There were no notable severe adverse events during the postoperative period; severe complications commonly seen after typical facial contouring surgery, including hematoma requiring surgical intervention, wound-related problems, unexpected fractures, surgical site infection, permanent neurosensory deficit, facial paralysis or trismus were not reported. Transient neurosensory loss in the lower lip region was reported in 25.9 percent of patients, but all cases resolved spontaneously during the regular follow-up period. The majority of patients were greatly satisfied with the aesthetic outcome of the surgery. However, some cosmetic problems, such as a palpable bony step or irregular margin, jowl redundancy and mentalis hyperactivity were observed in a few cases.

Conclusion: As the lower face plays an important role in the aesthetics and balance of the entire face, the authors' novel surgical tool to narrow and lengthen the chin can provide aesthetically gratifying results when correcting a short and wide lower face. Previous surgical methods used to correct a short chin have several intrinsic problems. Implants have problems, such as extrusion, displacement, bone erosion, implant migration and a relatively high incidence of infection. When considering autogenous bone grafting, the possibility of graft resorption and donor site morbidity is always a concern for surgeons. With our newly devised surgical method, the disadvantages described with previous operative procedures can be avoided. Also, the new technique provides excellent stability to the bone segments during genioplasty. This can accelerate bone healing and lead to prompt recovery after the surgery, along with a fully reliable and predictable aesthetic result. The reliability and safety of this novel method allowed predictable and aesthetically superior surgical outcomes.

 

Fig. 1. Illustration of the narrowing and lengthening genioplasty combined with the mandibular angle reduction procedure.

 

Fig. 2. Intraoperative photographs of the narrowing and lengthening genioplasty.

Fig. 3. Preoperative view of a 24-year-old woman (left). Postoperative view at 6 months after the narrowing and lengthening genioplasty combined with mandible angle reduction surgery (right).

Fig. 4. Preoperative view of a 23-year-old woman (left). Postoperative view at 6 months after the narrowing and lengthening genioplasty combined with mandible angle reduction surgery (right).