In treating chin implant asymmetries the decision is between implant revision vs. sliding genioplasty. This is how to think about that choice in a structured manner.s
Decision Tree: Implant vs. Sliding Genioplasty (Revision Cases)
Step 1: Is the implant malpositioned?
- YES
Proceed with implant revision (reposition ± pocket correction ± fixation) - NO go to Step 2
Step 2: Is the chin bone symmetric?
(Assess with clinical exam ± imaging)
- YES (bony symmetry present)
Problem is soft tissue or implant-related
Implant revision or exchange - NO (bony asymmetry present) go to Step 3
Step 3: Severity of bony asymmetry
Mild asymmetry
- Can be camouflaged
- Options:
- Extended/custom implant
- Implant reposition + contouring
- Implant-based solution reasonable
Moderate to Severe asymmetry
- Chin point deviated
- Inferior border irregularity
- Vertical or transverse discrepancy
Sliding genioplasty preferred
- Allows:
- True midline correction
- Vertical adjustments
- Rotational correction
Step 4: History of failed implant revisions
YES
Strong indication for genioplasty
-
- Repeated implant failure = unstable soft tissue/pocket environment
- NO implant revision still reasonable
Step 5: Soft tissue considerations
- Significant soft tissue asymmetry
- YES ?
- Genioplasty + adjuncts (fat grafting, muscle resuspension)
- NO ?
- Either option depending on bone
Step 6: Patient goals & anatomy
- Wants:
- Subtle contour change implant
- Structural correction genioplasty
- Thin soft tissue envelope
- Favor genioplasty (implant edges more visible)
Quick Clinical Summary
Choose Implant Revision if:
- Malposition is the main issue
- Bone is symmetric
- Asymmetry is mild
- First-time revision
Choose Sliding Genioplasty if:
- True bony asymmetry exists
- Chin point is off midline
- Prior implant revisions failed
- Need 3D control (horizontal, vertical, rotational)
High-Yield Rule
If the problem is positional ? implant
If the problem is structural ? genioplasty
Dr Barry Eppley
Plastic Surgeon