Would An Intraoral Wedge Osteotomy Help Prevent Ptosis in Chin Reduction Surgery?

Q: Dr. Eppley, I have a question regarding the intraoral approach to treating horizontal hyper-projection of the chin.

In your previous discussions, you emphasized that the most effective method for addressing hyper-projected chins in the horizontal plane is bone burring via a submental approach. However, it seems that many plastic and maxillofacial surgeons may lack the experience or training for this procedure and often prefer intraoral osteotomies instead.

I was wondering if a wedge osteotomy could be considered a viable alternative for reducing chin projection, as opposed to a reverse sliding genioplasty. If so, would the wedge osteotomy present similar aesthetic challenges as the reverse sliding genioplasty, such as soft tissue redundancy in the submental region and a boxy chin appearance in the frontal view? Additionally, would this technique inevitably reduce the vertical height of the lower third of the face?

I greatly appreciate your insights and guidance on this matter.

A: The key to any horizontal chin reduction lies in the soft tissue and not the bone. It doesn’t matter how the bone is reduced, what matters is what is going to happen to the excess soft tissue chin pad once its bone support is lessened. Only the submental approach allows for soft tissue removal/tightening. This issue is not going to be overcome by any intraoral osteotomy..

Dr. Barry Eppley

World-Renowned Plastic Surgeon