A Stepwise Algorithm for Incorporating the Osseous Genioplasty Into Rejuvenation of the Lower Face
Joseph H. Talbet, BA1, Karina Charipova, MD2, Stephen B. Baker, MD, DDS2
1Howard University College of Medicine, Washington, DC, 2Department of Plastic and Reconstructive Surgery, MedStar Georgetown University Hospital, Washington, DC
Background: The chin plays a critical role in the shape, projection, and soft tissue support of the lower face. The effects of osseous genioplasty on the muscular attachments of the chin allow this procedure to have a significant impact on submandibular soft tissue. Little has been reported in the literature regarding the value of osseous genioplasty in facial rejuvenation. This study presents an algorithm for the evaluation and incorporation of chin position into treatment planning for perioral and neck rejuvenation.
Methods: Eighty-six consecutive patients who underwent cosmetic genioplasty were evaluated. Twenty-three patients (27%) initially sought consultation for neck lift but after physical examination ultimately underwent genioplasty alone or genioplasty with platysmaplasty with or without liposuction to obtain their desired result. Of the 23 patients presenting for a neck lift 17 (74%) were treated with an isolated genioplasty and 6 (26%) were treated with genioplasty in combination with platysmaplasty and/or liposuction.
Results: All patients who underwent osseous genioplasty as an isolated procedure or in combination with liposuction or liposuction with platysmaplasty reported satisfaction. None of these patients expressed a desire for further skin resective surgery. Evaluation of the senior authorís outcomes led to the creation of an evaluation algorithm (Figure 1) that enables the surgeon to predict the benefits of genioplasty in the treatment plan for a specific patient. This algorithm encourages the surgeon to think in three dimensions, considering not only the anterior projection of the chin but also its shape and options for maximizing skeletal support. Even in cases where there is no room to advance the chin, rotation or vertical lengthening may allow the surgeon to significantly improve soft tissue laxity.
Conclusions: The presented algorithm describes the selection criteria for incorporating an osseous genioplasty into the treatment plan for facial rejuvenation as a single surgery or in combination with ancillary procedures. The senior surgeonís outcomes demonstrate that in properly selected cases, excellent results are obtained with much faster recovery with this approach when compared to procedures requiring skin resection. In appropriately-selected patients without severe skin laxity, an osseous genioplasty combined with a platysmaplasty and/or liposuction may even produce a superior result to that of a skin resective procedure because genioplasty not only supports tissue laxity but also optimizes proportion and facial shape, which enhances the overall result. Limitations of the osseous genioplasty as well as its incorporation into traditional facelift and neck lift procedures are reviewed as well.
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