What is genioplasty and who is it for?
Genioplasty refers to the range of surgical procedures designed to modify the shape, position, or volume of the chin. It is a precise and well-established surgery, performed for several decades, that can have a significant impact on facial balance and profile perception. Although often overlooked, this anatomical region plays a crucial role in facial harmony. A systematic review of 5,218 patients confirms that 20% of craniofacial problems require correction of chin size, shape, or position.
Genioplasty is suitable for individuals with microgenia (chin too small), macrogenia (chin too prominent), retrogenia (receding chin), progenia (chin too far forward), chin asymmetry, or vertical disproportion of the lower third of the face. This procedure can be performed in isolation for aesthetic purposes or integrated into a broader orthognathic surgery plan to correct functional and occlusal abnormalities.
Data from the scientific literature indicate a very high satisfaction rate among operated patients, with over 90% of patients satisfied with their results when genioplasty is performed alone or in combination with other maxillofacial procedures.
Clinical indications for chin surgery: Which patients are suitable?
The indications for genioplasty are multiple and involve both aesthetic and functional abnormalities. A comprehensive preoperative evaluation, including cephalometric analysis and three-dimensional imaging, helps determine the most appropriate type of intervention.
The main indications include:
- Microgenia: insufficiently sized chin (under-projected) relative to other facial structures, creating profile imbalance
- Retrogenia: chin positioned too far back, resulting in a receding profile, sometimes associated with skeletal Class II malocclusion
- Macrogenia: excessively developed chin, giving an impression of heaviness to the lower third of the face
- Progenia: excessive forward projection of the chin, disrupting profile harmony
- Chin asymmetry: lateral deviation of the chin from the midline, visible from the front
- Vertical abnormalities: chin too long or too short relative to ideal proportions of the lower facial third
- Obstructive sleep apnoea syndrome: advancement genioplasty can improve upper airway patency when combined with mandibular advancement
- Post-traumatic or congenital reconstruction: correction of acquired deformities or those present from birth
Isolated genioplasty may be an option for patients with skeletal malocclusion affecting the aesthetics of the lower facial third who decline comprehensive orthognathic surgery but wish to improve their profile appearance.
How genioplasty works: Surgical techniques and mechanisms of action
Two main categories of techniques exist to modify chin appearance: osseous genioplasty (sliding osteotomy) and implant augmentation. From a practical standpoint, the goal is not simply to "project" the chin, but to achieve a stable, natural result that is consistent with the overall face. Each approach has specific advantages and limitations.
Osseous genioplasty by sliding osteotomy
The gold standard technique remains the horizontal sliding osteotomy (sliding genioplasty), first described by Trauner and Obwegeser. This procedure involves sectioning the lower part of the chin symphysis and then repositioning the bone fragment according to the desired corrections: advancement, setback, elevation, lowering, rotation, or recentring.
The osteotomy is performed via an intraoral approach, at the level of the lower vestibule, thus avoiding any visible scarring. The horizontal cut line is positioned at least 5 to 6 mm below the dental root apices to preserve the inferior alveolar nerve. Once the bone segment is mobilised, it is fixed in its new position with titanium plates and screws, ensuring optimal stability for bone healing.
This technique allows three-dimensional correction of the chin with highly predictable results. Cephalometric studies report a soft tissue to hard tissue translation ratio between 0.85:1 and 1:1 for advancements, meaning that 85 to 100% of bone movement translates into an equivalent change in soft tissues.
Chin implant augmentation
Implant augmentation represents a less invasive alternative for cases of mild to moderate microgenia. A silicone or porous polyethylene (Medpor®) implant is positioned on the anterior surface of the chin symphysis, either via an intraoral approach or an external submental approach.
This technique offers shorter operative time and faster recovery, but has limitations: it does not allow correction in all three spatial dimensions and is not suitable for asymmetries or vertical excess. The soft tissue to implant predictability ratio is lower than that of osseous genioplasty (66% versus 85%).
Osseous genioplasty versus chin implant: Comparing surgical approaches
The choice between osseous genioplasty and implant augmentation depends on several factors: the nature of the deformity, the extent of correction required, the patient's history, and the surgeon's preferences.
A recent systematic review comparing both approaches in 1,126 patients (740 osseous genioplasties and 386 implants) highlights significant differences in terms of complications and satisfaction.
Regarding complications, the infection rate is significantly higher in the implant group, as are the risks of dehiscence and need for reoperation. Conversely, osseous genioplasty is more frequently associated with transient neurosensory disturbances.
In terms of satisfaction, patients who underwent osseous genioplasty have significantly higher satisfaction scores, with a clinically significant difference in favour of this technique. A study using a visual analogue scale found an average score of 7.8/10 for osseous genioplasty versus 6.6-6.7/10 for implants.
Osseous genioplasty offers better tissue predictability: 85% of bone advancement translates into soft tissue projection, compared with only 66% for implants. Furthermore, osseous genioplasty allows functional corrections impossible with implants, particularly improvement of airway space in sleep apnoea syndrome.
Relapse rates are comparable between the two techniques, with variations depending on the extent of correction (2.63-27.21% for osseous genioplasty versus 5.36-25.07% for implants), particularly for significant advancements exceeding 8 mm.
The procedure: Stages of chin surgery
Preoperative assessment
The presurgical evaluation includes a complete facial clinical examination, cephalometric analysis on lateral radiographs, and increasingly a cone beam CT scan (CBCT) enabling three-dimensional virtual surgical planning. This imaging allows precise assessment of dental root positions, the course of the inferior alveolar nerve, and the bony anatomy of the symphysis.
The surgeon also performs a general health assessment and looks for any contraindications to general anaesthesia. It is recommended to stop smoking four weeks before the procedure and to discontinue anticoagulant or anti-inflammatory medications two weeks before surgery.
Anaesthesia and surgical approach
Genioplasty is generally performed under general anaesthesia with nasotracheal intubation, although some simple cases may be operated under local anaesthesia with sedation. It is normal to feel apprehensive about general anaesthesia, but it is now extremely safe. A dedicated consultation with the anaesthetist allows assessment of individual risks and answers to all questions before the procedure. The operation takes an average of 45 minutes to 1.5 hours depending on complexity.
The incision is made via an intraoral approach, in the lower labial vestibule, between the canines. This approach avoids any visible scarring and provides optimal access to the chin symphysis.
Performing the osteotomy
After mucoperiosteal elevation, the horizontal osteotomy is marked while maintaining a minimum distance of 6 mm below the mental foramen to protect the nerve. The bone cut is made using an oscillating saw or piezotome, the latter offering increased precision and reduced risk of nerve injury.
The bone segment is then mobilised and repositioned according to the pre-established plan. Fixation is achieved with preformed titanium plates and monocortical screws, providing immediate stability and consolidation in the correct position.
Closure and immediate postoperative care
Closure is performed in two layers with absorbable sutures. A compressive chin dressing may be applied for 48 to 72 hours to limit swelling. The patient is generally allowed to return home the same day or the following day.
How to choose between chin implant and osseous genioplasty?
The choice between a chin implant and osseous genioplasty depends primarily on the nature of the correction required, but also on patient expectations and individual anatomical constraints. It is not a matter of one option being "better" than the other in absolute terms, but rather finding the solution best suited to each situation.
A chin implant is generally considered when:
- the chin is mildly to moderately under-projected (mild microgenia),
- there is no marked asymmetry or vertical abnormality,
- the patient wants a simpler procedure with faster recovery,
- the goal is essentially aesthetic, with no associated functional concerns.
Osseous genioplasty is preferred when:
- the correction required is moderate to significant,
- asymmetry, vertical excess or deficit needs to be corrected,
- a precise and stable three-dimensional result is sought,
- functional improvement is desired (for example in obstructive sleep apnoea syndrome),
- long-term predictability and maximum satisfaction are priorities.
In practice, osseous genioplasty offers greater freedom of correction and better correspondence between bone displacement and the visible result on soft tissues. Chin implants nevertheless remain a valid option in well-selected indications.
A specialist consultation allows analysis of facial morphology, discussion of realistic expectations, and determination of the most appropriate technique in a safe medical environment.
Genioplasty results: Timeline and durability
Chronological progression of results
Genioplasty results become apparent gradually as postoperative swelling subsides. Swelling peaks during the first 48 to 72 hours, then decreases significantly over the first two weeks. At this stage, the patient can appreciate a notable improvement in their profile, although residual swelling persists.
Between the second and sixth week, most of the swelling resolves and the chin contours become more defined. However, complete stabilisation of soft tissues and definitive bone consolidation require three to six months. It is at this point that the final result can be evaluated.
Predictability and long-term stability
Cephalometric studies confirm excellent predictability of results in the short and medium term. The soft tissue to hard tissue translation ratio is around 0.89:1, meaning that for every 1 mm of bone advancement, soft tissues progress by an average of 0.89 mm.
Bone stability is satisfactory with an average resorption of 10.7% of the initial advancement at six months, with no visible impact in the vast majority of cases. For significant advancements (greater than 8-10 mm), more marked resorption of approximately 24% has been documented, justifying slight overcorrection during planning.
Results are considered permanent, although physiological changes associated with ageing may affect facial appearance in the very long term.
Satisfaction data
Studies report very high satisfaction rates: 86 to 98% of patients report being satisfied or very satisfied with their result. In a series of 43 patients followed for five years, 37 declared themselves extremely satisfied, 5 very satisfied, and only one dissatisfied due to associated occlusal changes.
Recovery after genioplasty: Phases and practical advice
First postoperative week
This period is marked by significant swelling, submental bruising, and a sensation of tightness in the chin area. Pain generally remains moderate and well controlled by prescribed analgesics. Ibuprofen is often recommended as first-line treatment for its dual analgesic and anti-inflammatory effect.
Diet is limited to liquids and pureed foods during the first few days. Antiseptic mouth rinses are used after each meal to maintain optimal oral hygiene and prevent incision infection.
Rest is recommended with the head elevated, including during sleep, to promote drainage of swelling. Intense physical activities are strongly discouraged.
Second to fourth week
Swelling and bruising gradually decrease. Most patients can resume non-physical professional activities between 7 and 14 days after the procedure. Diet progresses to soft textures, then normal foods as tolerated.
A sensation of numbness or reduced sensitivity of the lower lip and chin is common at this stage. This corresponds to transient inflammation of the mental nerve and resolves spontaneously in the vast majority of cases.
Beyond one month
Functional recovery of the chin muscle (mentalis) may take up to three months. During this period, slight stiffness or muscle fasciculations may be experienced. Resumption of sports activities is generally permitted after four to six weeks.
Regular postoperative follow-up ensures proper bone consolidation and absence of late complications.
Genioplasty prices in Belgium: Cost and factors of variation
In Belgium, the cost of genioplasty varies according to several factors: the type of procedure (bone osteotomy or implant), case complexity, the chosen facility, surgeon and anaesthetist fees, and length of hospital stay.
For osseous genioplasty by sliding osteotomy, prices generally start from €4,000 to €6,000. This amount usually includes the preoperative consultation, surgical procedure, anaesthesia, clinic stay, and osteosynthesis material (titanium plates and screws).
Chin implant augmentation, being less invasive, is generally offered at a lower price, starting from €3,100 to €4,000.
These prices are indicative and may vary significantly depending on practitioners and facilities. The cost may represent a significant investment. A transparent discussion during the consultation allows evaluation of the procedure's relevance in relation to expected benefits. It is essential to request a detailed quote during the preoperative consultation, including all costs (follow-up consultations, any additional tests, postoperative medications).
Genioplasty for purely aesthetic purposes is not covered by compulsory health insurance. However, when it is part of an orthognathic surgery plan to correct a maxillofacial dysmorphosis with proven functional impact, partial coverage may be possible under certain conditions.
Risks and complications of chin surgery: What you need to know
Genioplasty is considered one of the safest procedures in aesthetic maxillofacial surgery. A study of 200 cases reported only six complications. Nevertheless, like any surgical procedure, it carries risks that should be understood.
It is important to note that the vast majority of procedures are completed without major complications. The risks presented below exist but remain infrequent when the procedure is performed by an experienced surgeon in an appropriate medical setting.
Intraoperative complications
Complications occurring during the procedure remain rare and include: atypical osteotomy fracture, bleeding (particularly from the highly vascular sublingual region), damage to dental roots if the osteotomy is performed too high, and direct injury to the inferior alveolar nerve or mental nerve.
Early postoperative complications
Neurosensory disturbances: This is the most common complication. Hypoaesthesia (reduced sensitivity) of the lower lip and chin is reported in 6.8 to 10% of patients after isolated genioplasty. This incidence increases to 28.5% when genioplasty is combined with sagittal mandibular osteotomy. In the vast majority of cases, these disturbances are transient and resolve spontaneously within a few weeks to months. Permanent nerve damage is rare (less than 2%) when anatomical precautions are observed, particularly maintaining a minimum distance of 6 mm between the osteotomy and the mandibular canal.
Haematoma: Observed in approximately 8.5% of cases, it generally resolves spontaneously within two to three weeks.
Infection: The infection rate is low, around 3.4% for osseous genioplasty and slightly higher for implants. It usually responds to oral antibiotic therapy.
Late complications
Relapse/instability: Secondary displacement of the bone segment or bone resorption may occur, resulting in partial loss of the result. Reported relapse rates vary from 2.63 to 27.21% depending on studies and extent of advancement.
Chin ptosis: Sagging of the chin soft tissues ("witch's chin") may occur if the mentalis muscle is not properly reattached.
Residual asymmetry: Slight asymmetry may persist or appear in cases of asymmetric consolidation.
Implant-specific complications: Migration, chronic infection, underlying bone erosion, rejection, or need for removal.
Contraindications to genioplasty: When to avoid the procedure?
Certain situations constitute absolute or relative contraindications to performing genioplasty.
Absolute contraindications:
- Incomplete bone growth (procedure recommended after age 16 in boys and 14 in girls)
- Active infection of the oral cavity or chin region
- Progressive bone pathology at the mandibular level (tumour, osteonecrosis)
- Uncompensated contraindication to general anaesthesia
- Major uncontrolled coagulation disorders
Relative contraindications:
- Active smoking (increased risk of scarring and infectious complications; cessation recommended four weeks before and after the procedure)
- Uncontrolled psychiatric condition or body dysmorphic disorder
- Expectations difficult to reconcile with the medical limitations of the procedure
- Certain bone diseases (severe osteoporosis, osteopenia)
- Uncontrolled diabetes (increased infection risk)
- Known healing disorders
- Medications interfering with bone consolidation (long-term bisphosphonates)
A thorough preoperative evaluation identifies these contraindications and allows adaptation of management or deferral of the procedure if necessary.
The decision to consider genioplasty is personal and deserves complete, honest information tailored to each situation. A specialist consultation allows evaluation of the procedure's relevance, discussion of expected benefits, and understanding of its limitations in a safe medical environment.
