Unlike other simpler but objectionable dimensionally limited, anatomically restricted in their effects, unpredictable and unreliable augmentation genioplasty methods featured by high rates of complications, instability, deformities, asymmetries, fake looks and mid or long term revision procedures like chin burring or shaving, chin implants or facial fillers, the safe sliding genioplasty technique allows a reliable, stable and lifetime lasting worries-free chin depth enhancement with minimal risk of issues and a natural look.
The sliding genioplasty is not at all an aggressive maxillofacial orthognathic surgery of the jaw modifying the patient's bite, requiring preoperative dental braces, postoperative wire immobilization of the jaws and fix the bone fragments with the long term troublesome plates and screws to stand for the mechanical strain of the chewing, swallowing and speaking functions, with life-threatening postoperative ICU management, lots of bruising, painful postoperative and slow recovery; to the contrary the sliding genioplasty is a purely apical or marginal minimally invasive surgical modification of a non functional part of the distal mandible bearing no major mechanical loads, therefore steel wires are sufficient to stabilize the slided fragment at the enlargement desired, steel wires which, unlike plates and screws, do not require future extraction; actually the patients are allowed to and can speak, swallow, drink, eat and chew solids immediately after surgery, with minimal pain and bruising, early hospital discharge and prompt surgical and aesthetic recovery; needless to say the sliding genioplasty is way more affordable than full jaw surgery and considering the lifetime duration and its safety is relatively way cheaper than chin burring or shaving, chin implants or facial fillers.
The sliding genioplasty versatility is unparalleled by other major or minor alternatives in terms of simplicity, safety and costs, and in many cases enlarging the chin is simply unfeasible unless an osseous genioplasty is applied; one of the most useful non-standard sliding genioplasty variations is the so called jumping genioplasty, involving an standard horizontal bone cut or osteotomy of the chin and forward advancement of the slided fragment to an extreme point it is dislocated from the mandible and its posterior face is overlapped on top of the anterior surface of the jaw, therefore achieving the maximum anterior increase possible without supplying bone grafting and, simultaneously, producing a few millimetres slight vertical chin shortening, a combination of great usefulness in certain cases; by means of a non-standard oblique osteotomy of the chin we meet two options, the first is sliding it forwardly and upwardly, thus producing a significant vertical shortening as much as anterior advancement of the chin in combination of deepening of the labiomental fold, something ideal in weak and very tall chin cases; secondly, if we associate the oblique osteotomy with a backwards and downwards sliding movement the effect produced is exactly the opposite, a significant chin deprojection and vertical height increase plus smoothening of the labiomental fold, an indicated maneuver in overprojected but vertically short chin cases; finally remark any standard or non-standard sliding genioplasty may be, if deemed indicated, well combined in association with Chin Reduction and Chin Augmentation procedures, leading to huge number of versatile combinations to fit every particular chin case anatomy and patient's wishes.
There is no injection of any fillers or gels and no foreign bodies inserted to achieve the desired chin size and shape, all the effect is made with osseous tissue mobilization of a perfect biological compatibility, producing no distortion of the natural chin anatomy and mobility; therefore no visibility of internal prosthesis, no grotesque facial expression gestures and no artificial results are expected in this modality of genioplasty, as occurs with other much objectionable methods of burring shaving, implants and injected fillers.
Main disadvantages of chin burring shaving, a technique of medium difficulty thus tempting although not widespread among the surgical community, are the deletion of the labiomental fold, droopy chin deformity, double chin formation, artificial domeless plateau shape of the chin prominence and eventually formation of witch's chin, associated with null facelift effect on the overlying soft tissues; its repair is complex and requires custom carved grafting to restore the missing dome, eventually with some modality of osseous genioplasty.
Main disadvantages of chin implants, a technique of low difficulty thus very tempting and frequently practiced among the surgical community, are their short lifetime, most of them are all out in 2 to 5 years due to varied reasons being the main patient's dissatisfaction, they do easily dislocate down to the neck, twist, spin, flip and become visible, frequently imprint and thin down the outer cortex of the jaw and chin where they lie on, get easily infected prompting extraction, quite often produce visibility during facial expression gestures, are prone to compress and irritate the mental nerves causing chronic pain, reason to remove them and are very limited dimensionally allowing only anterior increase up to a certainly restricted point, associated with null facelift effect on the overlying soft tissues; most carriers of chin implants do sooner or later seek their explantation and immediate replacement by the suitable modality of osseous genioplasty.
Main disadvantages of chin facial fillers, a technique of very low difficulty thus extremely tempting and massively practiced by surgical and non-surgical practitioners, are the inability to shape a nicely contoured chin, insufficient projection or augmentation effect, random effects, dimensionally limited, migration, granulomas, inflammatory reactions, infections, irregularities, pain, eventually local tissues damage and unpredictable mid and long term behaviour, associated with null facelift effect on the overlying soft tissues; should the fillers be temporary patients await its resorption then seek the suitable modality of osseous genioplasty; in long term or permanent fillers the situation is difficult to manage, since they are almost impossible to extract.
Opposed to the former the osseous chin sliding genioplasty gathers all the technical, safety and aesthetic advantages for the patients, however it is a technique of high, very high or extremely high difficulty according to each case and goals thus very or extremely discouraging or even frightening to the vast majority of surgeons, being very few those professionals who master and regularly perform osseous genioplasty procedures, and if anyone performs them they are not complex and multidimensional but the simplest modalities of standard sliding genioplasty.
Advantages of osseous genioplasties are they last for a lifetime and eventually can be repeated to be re-graduated, re-designed or reversed, they don't experience issues, modifications or complications in the mid and long term, they are virtually unlimited dimensionally allowing any deemed suitable combination of standard or non-standard sliding mobilization and augmentation or reduction over any space axis of the chin, they are associated with indirect soft tissue facelift effect, do not produce double chin, witch's chin or droopy chin, don't migrate or dislocate, do not produce any visibility during facial expression gestures, the complications rate is very low and the look of the chin is natural with results which are simply awesome; however, osseous genioplasties do indeed require a very well trained surgeon with excellent aesthetic judgment, a fully equipped safe hospital environment, have longer inflammation period and their price is higher yet within affordable margins.
Dr. Alejandro Nogueira is an outstanding specialist in all the modalities of simple to top difficulty multidimensional osseous genioplasties, gathering vast experience and highly developed skills in such procedures otherwise rarely practiced by any other surgeons.
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