SIMULTANEOUS OSSEOUS GENIOPLASTY AND MELOPLASTY

A review was done of the records of 50 patients who had osseous geniop lasty performed at the same sitting as face lifting and, in many cases , submental lipectomy over a 20-year period by the senior author. The types of genioplasties were sliding advancement (40), lengthening with interpositional bone graft (17), and reduction (3). In 9 patients, ch in implants were removed, generally because of inadequate chin project ion or implant erosion. Three patients were operated on under local an esthesia, the remainder under general anesthesia. Associated procedure s, done in 46 patients, included rhinoplasty forehead lifting, blephar oplasty, lateral canthopexy, excision of buccal fat pads, reduction ma mmaplasty, and abdominoplasty. In 4 patients, associated maxillofacial procedures were performed, including Le Fort I and III osteotomies, t wo-jaw surgery, mandibular advancement with sagittal splitting, and or bital expansion. The perceived advantages of osseous genioplasty were greater versatility in dealing with problems in other than the sagitta l plane, the possibility of greater chin projection, and a tightening of the submental musculature. Complications occurred in 10 patients. T hese included two hematomas requiring aspiration in the office, a prol apsed submandibular gland requiring later excision, a transient weakne ss of the marginal mandibular nerve, a transient numbness of the lower lip on one side, four revisions of scars resulting from the face lift ing, and one localized wound infection in the parasymphyseal area that resolved with oral antibiotics. The most common complaint, which came from 8 female patients at some time from I month to 3 years postopera tively, was that the chin was ''too strong.'' In 6 of these patients, most of whom were operated on early in the series, some of the chin pr ojection was reduced by burring. Osseous genioplasty can be performed safely along with face lifting and submental lipectomy. The degree of advancement necessary in aesthetic surgical patients is generally less than that required in reconstructive patients. Patient satisfaction i s great unless the chin is overly advanced.