Optimizing Genioplasty: Advanced Techniques, Candidate Selection, and Soft-Tissue Preservation
- jessilyntanhy9
- 11 minutes ago
- 5 min read
Genioplasty remains a cornerstone procedure in maxillofacial surgery, offering both aesthetic and functional enhancement of the chin. While skeletal modification is central to the procedure, proactive management of the overlying soft tissue is equally critical for achieving predictable, long-lasting results.
Recent advances in the field—highlighted by Lee and Kim (2025)—emphasize the importance of integrating soft-tissue preservation into contemporary genioplasty to optimize both skeletal and aesthetic outcomes. Similarly, Lee (2025) underscores the value of adjunctive intraoperative techniques such as chin muscle suspension, fascial tension sutures, and buccal fat modulation to reduce postoperative sagging and maintain lower facial definition.
For surgeons, the key to consistent success lies in meticulous patient assessment, precise osteotomy planning, and preventive soft-tissue strategies guided by these evolving principles.
Candidate Selection and Preoperative Planning
Comprehensive evaluation of skeletal and soft-tissue characteristics, combined with patient expectations, is crucial. Selecting the right candidate and tailoring the procedure accordingly ensures predictable outcomes.
Ideal Candidates
Microgenia / Chin Deficiency – Retruded chins with robust soft-tissue envelope; ideal for advancement genioplasty.
Broad or Short Chin – Patients benefit from narrowing and elongation techniques, including pedicled interpositional grafts.
Good Mentalis Muscle Tone – Ensures soft-tissue support for skeletal movement without sagging.
Stable Occlusion / Minimal TMJ Dysfunction – Can tolerate skeletal modification without functional compromise.
Mild-to-Moderate Soft-Tissue Laxity – Allows integration of soft-tissue preservation adjuncts without requiring full lifting procedures.
Patients Requiring Caution or Modified Approach
Advanced Soft-Tissue Laxity – Jowling or chin ptosis may necessitate suspension sutures, mini-lifts, or staged procedures.
Thin or Atrophic Soft Tissue – Higher risk of postoperative irregularities; requires conservative osteotomy and adjunctive soft-tissue support.
Severe Skeletal Asymmetry / Complex Orthognathic Needs – Consider multi-jaw surgery rather than isolated genioplasty.
High Functional Demands – Patients with bite, airway, or TMJ issues require careful integration with orthognathic planning.
Unrealistic Expectations – Preoperative simulations help align goals with anatomical limitations.
Preoperative Assessment Essentials
Skeletal Analysis: Chin height, width, projection, symmetry via cephalometry and 3D imaging.
Soft-Tissue Evaluation: Mentalis muscle tone, submental volume, and ptosis severity.
Functional Assessment: Occlusion, airway, TMJ.
Surgical Strategy: Decide on single-plane vs multi-plane osteotomy, narrowing, or augmentation.
Adjunctive Soft-Tissue Planning: Determine need for muscle suspension, fascial tension sutures, or buccal fat modulation.
Key Takeaway: Ideal candidates have moderate skeletal discrepancies, good soft-tissue quality, and minimal sagging; borderline or high-risk patients require modified techniques or staged procedures.
5 Genioplasty Techniques: Tailored to Anatomy and Goals
Selecting the appropriate genioplasty technique is critical for both aesthetic harmony and functional stability. Below, each technique is paired with ideal patient profiles, stepwise execution, and soft-tissue considerations.
1. Sliding Genioplasty
Indication: Moderate chin advancement or setback, contour refinement.
Steps:
Intraoral incision 5–7 mm below attached gingiva.
Mark horizontal osteotomy line, keeping ≥5 mm below mental foramen.
Perform osteotomy using a reciprocating saw or piezoelectric device.
Mobilize segment anteriorly (advancement) or posteriorly (setback).
Fixate with pre-bent titanium or absorbable plates.
Reattach mentalis muscle to maintain lower lip competence.
Patient Profile: Moderate chin deficiency or mild prognathism with robust soft tissue.
Tips / Pitfalls:
Avoid over-advancement to prevent tissue overstretching.
Use interpositional grafts if minor gaps exist.
2. Advancement Genioplasty
Indication: Microgenia or retruded chin.
Steps:
Same as sliding genioplasty steps 1–3.
Advance chin segment to planned projection.
Anchor mentalis muscle to fixation plate or segment.
Verify occlusion and lower-lip competence.
Patient Profile: Retruded chin with adequate mentalis tone.
Tips:
Fascial tension sutures may support thin soft tissue.
Preserve the mental nerve at all times.
3. Setback Genioplasty
Indication: Mandibular prognathism with excessive chin projection.
Steps:
Intraoral incision and osteotomy marking.
Posterior repositioning of chin segment.
Muscle reattachment and soft-tissue draping.
Rigid fixation with plates/screws; symmetry check.
Patient Profile: Excessive chin projection, no severe airway compromise.
Tips:
Avoid excessive setback to prevent double chin or airway issues.
Minimal soft-tissue detachment preserves contour.
4. Vertical Augmentation / Reduction
Indication: Short or tall chin requiring vertical modification.
Steps:
Augmentation: Bone graft or distraction osteogenesis.
Reduction: Remove excess bone with osteotome/burr, maintain smooth contour.
Reattach mentalis muscle and consider fascial tension sutures.
Patient Profile: Short/elongated chin with good soft-tissue envelope.
Tips:
Avoid over-resection in thin patients to prevent droop.
Augmentation requires stable fixation and monitoring for resorption.
5. Narrowing Genioplasty
Indication: Broad or square chin (common in Asian patients).
Steps:
Perform lateral osteotomies converging toward midline.
Remove central wedge (optionally repurposed as pedicled graft).
Medially bring lateral segments; fixate with pre-bent plates.
Reattach soft tissue and mentalis muscle.
Patient Profile: Broad or short chin requiring tapering and elongation.
Tips:
Avoid over-narrowing → unnatural concavity.
Preserve vascularized bone to reduce resorption.
Adjunctive Soft-Tissue Strategies
Chin Muscle Suspension: Anchoring detached muscles to bone/plates.
Fascial Tension Sutures: Prevent lower-face sagging.
Buccal Fat Modulation: Conservatively remove to maintain midface contour, avoid hollowing.
Autologous Fat Grafting: Supports thin or lax soft tissue, especially in older patients.
Key Takeaway: Integrating rigid fixation, soft-tissue suspension, and adjunctive fat management ensures stable skeletal outcomes and prevents postoperative contour irregularities.
3 Soft-Tissue Management in Genioplasty
Soft-tissue preservation is not optional—it is critical for natural, long-lasting results.
Mentalis Muscle Tensioning
Detach and preserve the muscle during osteotomy.
Reattach with absorbable sutures to bone or fixation plate.
Adjust tension for natural lift without dimpling.
Ensure bilateral symmetry.
Buccal and Submental Tissue
Anticipate soft-tissue response to skeletal movement.
Use fascial tension sutures for moderate laxity.
Modulate buccal fat conservatively during combined procedures.
Adjunctive Procedures
Fat grafting in thin tissue areas.
Minor suspension sutures for borderline laxity.
Combine techniques for narrowing or vertical augmentation when needed.
Tip: Over-resection of fat or overtightening muscle can compromise aesthetic and functional outcomes.
Clinical Outcomes
High Patient Satisfaction: Over 90% of patients report satisfactory functional and aesthetic results.
Low Complication Rates: Temporary sensory changes are the most common; relapse is minimal with proper fixation and soft-tissue management.
Soft-Tissue Benefits: Adjunctive muscle suspension, fascial sutures, and buccal fat modulation reduce postoperative ptosis, jowling, and midface sagging.
Functional Improvement: In selected cases, genioplasty combined with mandibular advancement improves airway patency.
Conclusion
Modern genioplasty is a combined skeletal and soft-tissue procedure. Surgeons who integrate precise osteotomies with proactive soft-tissue preservation strategies can achieve predictable, long-lasting outcomes with minimal complications. By leveraging technology, meticulous planning, and intraoperative adjuncts, genioplasty can consistently enhance both aesthetic and functional results, providing patients with natural, harmonious facial profiles.
Reference:
Lee S, Kim BK. Current concepts in genioplasty: surgical techniques, indications, and future perspectives. Arch Craniofac Surg. 2025 Feb;26(1):1-4. doi: 10.7181/acfs.2025.00045. Epub 2025 Feb 20. PMID: 40068622; PMCID: PMC11917404.
Lee T. Minimizing post-operative soft-tissue sagging in facial bone contouring: Adjunctive techniques. CosmoDerma. 2025;5:102. doi: 10.25259/CSDM_104_2025
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