The genioplasty and beyond: an end-game strategy for the multiply operated chin.
BACKGROUND: Genioplasty has been a useful and frequently employed technique. In previous publications, the authors discussed the benefits and versatility of the genioplasty. Here, they briefly examine the entire experience of the senior author, from 1975 to the present. METHODS: The authors examined a series of 580 genioplasties performed in 567 patients over a 28-year period by the senior author. This was done by chart review, which involved collection of demographic data and tabulation of the number of operations and type of genioplasty, as well as inspection of operative notes and clinical photographs. The focus was on the subgroup of patients who required multiple procedures to obtain a final satisfactory result. In one subgroup of patients, largely those with severe developmental or syndromic retrogenia, staged procedures were part of the original plan. A second subgroup included patients who had had problems with alloplastic chin implants; for these patients, further operations were not part of the original plan. RESULTSIn the first group of patients, with severe developmental or syndromic retrogenia, an osseous genioplasty was often associated with orthognathic surgery and could be repeated later as a staged procedure. In the second group of patients, who had multiple problems with alloplastic chin implants, an osseous genioplasty often provided the solution to difficult problems. CONCLUSIONS: In both groups of patients, an autogenous costal cartilage graft may be of great help after one has accomplished as much as one can with an osseous genioplasty. In rare cases, microsurgical free tissue transfer may be required.