Can A Sliding Genioplasty and Zygomatic Sandwich Osteotomy Be Just As Effective As Chin And Cheek Implants?

Q: Dr. Eppley, I’m a huge fan of your work! I am considering two procedures and was hoping to learn more about their logistics, including price, transportation, and recovery. General advice on whether these surgeries are appropriate would also be greatly appreciated.

First, I want to get a sliding genioplasty to increase both the vertical and frontal projection of my chin. Second, I want to get some form of enhancement to add lateral width and overall thickness to my cheekbones. I am intrigued by your “model cheek” implants with long emphasis on the zygomatic arch. However, I have some concerns with implants and was wondering if a zygomatic osteotomy could achieve similar results. I am looking for 5-6mm of augmentation on each side, which I anticipate will look harmonious with an increase in chin length from the genioplasty. I am also hoping the cheek augmentation will provide an upwards lifting effect on the tissue on my face.

So, in conclusion, are these reasonable expectations/desires for surgery?

A: Thank you for your inquiry, sending your pictures and detailing your concerns/objectives. In the spirit of an autologous facial augmentation approach, both the sliding genioplasty and zygomatic sandwich osteotomies (ZSO) are effective procedure for chin and cheek augmentation. The sliding genioplasty is well known and the only aesthetic question are the dimensions of change. (how much forward and how much done) The ZSO is the only autologous option to the extended cheek implant but it will not have the identical aesthetic effects as the bone can never be removed with the same magnitude in the same locations as the onlay augmentation provided by an implant.

The ZSO works by expanding out the posterior bone segment right behind an osteotomy line which is vertically cut through the main body of the zygoma. This allows the anterior arch/cheek to move outward. This adds lateral cheek width although the step off has to be managed for any more anterior cheek fullness. The traditional ZSO does not move out the posterior arch, which limits how much of the arch is seen as it moves posteriorly, but that can be moved out as well if the full arch effect is desired.