Do you want to learn more about chin surgeries?
We understand that helpful information can be hard to find.
This post provides over a dozen illustrations and provides a significant amount of information (indications, complications, techniques, and outcomes) for chin surgeries (genioplasties, mentoplasties, genial tubercle advancement, double chin surgery, cleft chin surgery and chin augmentation with implants).
An Ear, Nose and Throat surgeon wrote this blog post.
Summary for chin surgery
Chin surgeries are performed for many reasons. In some cases, chin surgeries are performed for cosmetic reasons and in some cases, they are performed to help patients function better.
Cosmetic (plastic) surgeries include double chin surgeries, cleft chin surgery, chin augmentation with implants or repositioning the chin (genioplasties or mentoplasties).
Functional (reconstructive) reasons include congenital deformities and also to help improve the upper airway in the case of obstructive sleep apnea. Chin implants are added to provide additional volume to the chin.
A sliding genioplasty is when the front part of the lower jaw (the chin) is cut and is advanced forward.
Sliding genioplasties can be performed for cosmetic reasons or to help improve the size of the upper airway. A sliding genioplasty is performed to move the tongue (genioglossus muscle) forward.
Typically, a genial tubercle advancement is performed to treat obstructive sleep apnea or other disorders of the head and neck that cause a smaller lower jaw.
What are chin surgeries?
There are several terms used to describe chin surgery.
Mentoplasty means chin (mentum is Latin for chin) shaping (plasty is Greek for shaping). A synonym for mentoplasty is genioplasty.
A genial tubercle advancement also known as a genioglossus advancement is a surgery in which a window is cut in the chin and is moved forward.
Chin augmentation is a procedure in which the chin is shaped to make it bigger or so it is more forward (usually by using a graft or a prosthetic implant).
Are chin surgeries performed through the mouth or through the skin, or both?
Chin surgery can be performed either through the mouth (oral cavity) or by making a cut through the skin under the chin (submental skin incision).
When a chin surgery is performed through the mouth, the lower lip is pulled forward and a cut is made through the mucosa under the teeth. The dissection proceeds directly on top of the bone down to the area that is going to be operated on or where the implant will be placed.
When a chin surgery is performed through a cut through the skin (submental incision), the cut is made to be as small as possible to help with the cosmetic appearance. After the cut is made, the dissection proceeds to the bone of the chin and the surgery is performed.
In general, most of the time a chin surgery can be performed through the mouth and this is often the surgery of choice because it leaves no skin scars. Ultimately, the patient and surgeon will make the decision based on the patient’s specific reason for surgery.
Are chin surgeries performed in the clinic or in the operating room?
Some chin surgeries can be performed in the clinic, such as minimally invasive surgeries.
However, chin surgeries that are more involved, such as moving tissue around or cutting bone are commonly performed in the operating room.
What are the important factors for successful chin surgery?
Drs. Zide, Pfeifer, and Longaker presented a protocol called the Quick Analysis of the Chin which includes:
- Analysis of the lower lip,
- Effect of the lip-chin fold (labiomental fold),
- Evaluation of the chin pad,
- Cleft chin anatomy,
- Special situations, and
- Troubleshooting of three common problems (the implant is too large, the implant is not in the proper position and there can be lip numbness).
What is the relevant anatomy for chin surgery?
The chin is a part of the lower jaw (mandible).
The lower jaw is broken into multiple sub-sites.
The lower jaw sub-sites include the right and left condyles, coronoid processes, ramus, body, parasymphyseal region, symphysis, and the anterior inferior portion is the chin.
The lower jaw has two bony layers (known as bicortical layers). This means that there are an outer layer and an inner layer of bone.
The outer layer of bone is called the outer cortex and is hard and smooth. The inner layer is called the inner cortex and is also made up of hard and smooth bone. Between the inner and outer layers of bone, is a softer bone that is called cancellous, trabecular or spongy bone.
Like the rest of the jaw, the chin is also bicortical.
Where are the genial tubercles located at the chin and why do they matter?
The genial tubercle complex is a group of small round projections or bumps (tubercles) that are located on the lower jaw, on the inside of the chin. There are two upper tubercles (superior tubercles) and two lower tubercles (inferior tubercles).
The upper two tubercles are where the tongue muscle (genioglossus muscle) attaches.
The lower two tubercles are the attachments for the muscles (geniohyoid muscles) that go between the lower jaw and the hyoid bone.
The genial tubercle complex (and the tongue) is sometimes moved forward as part of airway surgery for obstructive sleep apnea.
What is the blood supply to the chin?
The blood supply to the chin (anterior mandible) is the inferior alveolar artery and sublingual artery.
What is the nerve that supplies the chin?
The nerve that supplies the chin is the inferior alveolar nerve which is a branch from the mandibular division of the trigeminal nerve. When the nerve travels through the mental foramen, it then is called the mental nerve and supplies the sensation to the chin.
What are the steps for getting a patient to the operating room right before surgery?
Although there are three main surgeries that can be performed on the chin (sliding genioplasty, genial tubercle advancement, and chin augmentation), the surgeries share the following common components:
First, patients must avoid eating after midnight.
Patients arrive at the preoperative holding area in the hospital or surgical center and an intravenous (IV) catheter is placed.
Patients are then transported to the operating room.
The anesthesia provider induces general anesthesia through the IV or through mask ventilation.
The anesthesia provider will intubate the patient.
If only chin surgery is being performed, then the intubation can be through the mouth (oral intubation) or the nose (nasal intubation).
If jaw surgery (such as a maxillomandibular advancement) is being performed at the same time, then the patient needs to be intubated through their nose.
Once intubated, special mouthwash may be used to help rinse the mouth.
Local anesthetic (such as 1% lidocaine with 1:100,000 epinephrine) is then injected into the inside of the lower lip and up against the bony chin (anterior mandible).
After injecting the local anesthetic, an incision is made in the tissue (mucosa) below the teeth.
The cutting takes place through the mucosa, muscle below the mucosa and through to the tissue that is directly overlying the bone (periosteum).
Once under the periosteum, the dissection proceeds down to the bottom part of the chin (inferior border of the mandible).
Care is taken not to damage the mental nerves, which are nerves that exit the mandible at the level of the chin (on both sides).
The bone of the chin is exposed.
What is an advancement of the chin or a sliding genioplasty?
A surgery in which the chin is moved forward (advanced) is also known as a sliding genioplasty.
In this surgery, the chin is cut and is moved forward and then plates and screws are used to hold the bone forward.
Candidates for the surgery typically have either a chin that is small, a chin that is set back.
Additionally, the surgery is typically performed for either cosmetic reasons or as a treatment for helping improve obstructive sleep apnea.
When the surgery is performed to help obstructive sleep apnea, the cut might be made slightly higher than it normally would in the front part of the chin so that the genial tubercle can be included since the tongue (genioglossus muscle) attaches there.
How is a sliding genioplasty performed?
A sliding genioplasty is performed by cutting the lower border of the lower jaw and chin.
If the patient has obstructive sleep apnea, then the cut is made slightly higher in the central part of the chin so that the genioglossus muscle (and the tongue) can be pulled forward so that the upper airway can be more open.
Once the bone is cut, the surgeon then slides the bone forward so that it can be set into a forward position using plates and screws.
What is a genial tubercle advancement?
A genial tubercle advancement or a genioglossus advancement is a surgery that is performed for obstructive sleep apnea.
During the surgery, a window is made in the chin that includes the attachments of the tongue to the chin.
Why is it important to move the genial tubercle forward when the chin surgery is part of the treatment for obstructive sleep apnea?
Since the genioglossus muscle attaches to the genial tubercle, when the genial tubercle moves forward, the airway can open up more. The optimal genial tubercle advancement surgery incorporates the genioglossus muscle attachment such that the muscle moves forward and contains enough of the genial tubercle for a bony cut (osteotomy).
How is a genial tubercle advancement performed?
During the surgery, a window is made in the front part of the chin. The shape of the window can be square, rectangular or circular.
The window is created in a manner that allows for maximizing the movement of the tongue forward.
How does a genial tubercle advancement help improve obstructive sleep apnea?
The tongue can fall backward during sleep and this can obstruct the upper airway, either partially or completely.
When there is a partial obstruction, this can produce snoring or the airflow can be restricted to the point where oxygen drops (hypopneas). If the obstruction is significant (restricting 90% of the airflow or more), then it is known as an apnea.
Since the tongue is large, it makes sense that when there is a blockage due to the tongue that the airflow can be significantly restricted.
The goal with many obstructive sleep apnea treatments is to move the tongue forward in order to improve airflow.
Because the tongue is attached to the lower jaw (the mandible), anything that moves the lower jaw forward (oral appliances or surgery) also moves the tongue forward.
How is a genial tubercle advancement different from a sliding genioplasty?
A genial tubercle advancement only moves the central portion of the mandible forward compared to a sliding genioplasty, which moves the central portion as well as the lower portion of the chin forward.
When should a chin surgery also include hyoid surgery (hyoid myotomy or hyoid suspension)?
The hyoid bone is a part of the upper airway that has attachments to the tongue.
In the early studies reporting about genial tubercle advancement surgery, the studies reported that the hyoid bone was also operated on at the same time.
If the surgeon and patient agree that a hyoid suspension is a good option, then the hyoid can:
- Be brought closer to the mandible by putting sutures, or
- Be brought closer to the tissue below it (thyroid cartilage) so that the airway becomes shorter.
Why do some chin surgeries (sliding genioplasties) cut the chin high enough that it includes the genial tubercle?
Because the genial tubercle includes the tongue muscle attachments, a surgery that moves the genial tubercle forward should help to move the tongue forward.
Therefore, since the tongue is moved forward, the surgery can help improve obstructive sleep apnea.
What is double chin surgery?
A “double chin” is when there is extra fatty tissue and/or extra skin below the chin that causes the appearance of a second chin.
A double chin can be treated by surgeons who are trained to perform facial plastic surgery procedures. Surgeons who can specialize in facial plastic surgery are typically otolaryngologists, plastic surgeons and/or oral-maxillofacial surgeons.
The techniques to help treat the double chin include tissue removal, minimally invasive tissue reduction techniques, and tissue repositioning, such as the following:
- Partial lipectomy,
- Radiofrequency lipolysis,
- Injection of medications that help break down fatty tissue,
- Neck-lift, and
Tissue removal includes partial lipectomy and liposuction.
In partial lipectomy, the surgeon cuts into the fat and removes a portion of the fat.
In liposuction techniques, a cannula (a device that has a small tube) that is inserted into the tissue below the skin and the device suctions away fat under the neck.
Minimally invasive tissue reduction techniques include injecting medications that cause a reduction in the amount of fatty tissue, using devices that heat tissue, or using devices that heat up tissue.
Medications that have been injected to reduce the double chin deformity include phosphatidylcholine, a combination of phosphatidylcholine and organic silicium and deoxycholic acid.[8, 10, 11]
Radiofrequency ablation is an example of one of the minimally invasive techniques that heat up the tissue.
The tissue repositioning techniques include either local tightening of the tissue of the chin and neck (neck-lift procedures) or a more regional tightening of the skin (face-lift and neck-lift procedures).
What is cleft chin surgery?
Cleft chin surgery is a procedure to either add or to help remove a cleft chin. A cleft chin is when there is a dimple in the middle of the lower chin.
The type of surgery will depend on the patient’s anatomy and goals.
What is pointy chin surgery?
When patients have a pointy chin (a chin that has a pointy appearance), some may desire to have cosmetic surgery to help remove it.
The surgery to remove the pointy chin can include a chin reduction in which the excessive amount of chin is cut away.
If the chin is small and pointy, then sometimes a chin augmentation may be recommended with the placement of an implant.
What are the different types of chin augmentation surgeries?
There are two basic types of chin augmentation surgeries. The first is to use human grafts such as cartilage or bone and the second is to use prosthetic material.
If the cartilage used for augmentation comes from a human donor, then it is called an allograft.
If the cartilage used for augmentation comes a patient’s own body, it is called an autograft. An example of an autograft is when the cartilage is taken from the patient’s ear or rib and is then moved to the chin.
What are the common prosthetic implants used?
Silicone and Medpor are two of the most common implants.
Silicone is a polymer that has silicon, oxygen, carbon, hydrogen and other elements in it. The material is similar to rubber and is flexible.
Medpor is an implant that is made out of porous material (porous polyethylene).
A study evaluating Silicone and Medpor found that Medpor is more common than Silicone.
How are chin implants placed?
There are two main techniques for placing chin implants.
The first technique is when a cut is made inside the lower lip (intraoral incision).
The second technique is when a cut is made through the skin below the chin.
For the intraoral approach, an incision is made inside the mouth, specifically in the gingivobuccal sulcus between the chin and the upper lip.
A pocket is then created in the soft tissues of the chin and
the chin implant is placed inside the pocket.
The incision is then closed.
When the implant is placed through the skin, an incision is made underneath the chin (submental region).
The incision is carried down to the lower border of the chin and the implant is then positioned and stabilized in the proper position.
The incision is then closed in layers with suture material.
What are the side effects of chin surgeries?
Side effects are seen after chin surgeries and can be a normal part of the healing process.
If there are concerns after the surgery, then ask the surgeon who performed the surgery.
In general chin surgeries can cause the following side effects:
- Temporary numbness,
- Mild tingling,
- Mild to moderate pain in the initial healing phases,
- Mild to moderate swelling,
- Mild bleeding from the incision site,
- Feeling the bump in the chin (mandible) where the bone was pulled forward,
- Infection and displacement of chin implants (more common in Silicone than in Medpor), and/or
- Bruising under the tongue.
How long does the chin numbness last after chin surgeries (genial tubercle advancement or sliding genioplasty)?
Because a cut is made inside the lower lip, and there are nerves in the lip and in the mandible that can be affected, and temporary numbness is a common side effect.
Typically the numbness (and tingling) can last a few months. Permanent numbness is rare but possible.
How long does lip numbness last after surgery?
A common problem in patients who have lip numbness is that sometimes the chin implant could be pushing on the mental nerve, which supplies sensation to the lower lip and chin.
Lip numbness should resolve or should start to improve about 2-3 weeks after surgery. Dr. Zide and colleagues recommend removal of the implant or the implant should be trimmed early after surgery (4 weeks at the latest), otherwise, there is a risk of permanent loss of sensation.
What are the possible complications of chin surgeries (genial tubercle advancement or sliding genioplasty)?
Complications are not common, and many of the more severe complications can be rare.
Depending on the complication, a patient may end up needing to have a procedure to correct it, and sometimes it is necessary to go to the operating room with admission to the hospital afterward.
If there is any complication, then the surgeon should be contacted and the patient may elect to seek urgent care or emergency care depending on the situation.
After chin surgeries, some of the more serious problems or complications that can occur include:
- Hematoma (bleeding and swelling) at the chin or under the tongue,
- Infection of the soft tissues (lip, chin, tongue or floor of mouth),
- Infection of the bone that leads to osteomyelitis,
- Fracture or erosion of the bone that was advanced (leading to worsening of obstructive sleep apnea),
- Delayed muscle detachment of genioglossus muscle from the genial tubercle,
- Delayed swelling under the chin,
- Displacement of the segment of bone that was moved,
- Permanent numbness of the teeth,
- Cutting of the tooth roots or damaging the teeth themselves during the cutting,
- Permanent numbness of the skin and tissues of the chin, 
- Persistent or permanent pain in the chin or tongue,
- A cosmetic deformity at the chin from where the genial tubercle was moved forward.
- Chin implants can become chronically infected with biofilm and may need to be removed.
Will chin surgeries make patients look different?
This depends. If the classic genial tubercle advancement is performed, then it is not very likely to make a patient look much different.
When the rectangular window is created in the mandible and the bone is advanced, the part of the bone that is left behind is only a few millimeters thick. This is the reason that patients tend to look the same after surgery as they did before surgery (once the healing has taken place).
However, if the genial tubercle is advanced as part of other procedures such as with a sliding genioplasty, or a maxillomandibular advancement, then the patient will likely look different.
How different the patient will look largely depends on whether the patient’s lower jaw was set back prior to the surgery (retrognathic) or was small prior to the surgery (micrognathic).
How successful is genial tubercle advancement for treating obstructive sleep apnea?
There are two main things that many researchers evaluate when determining how effective or successful treatments are for obstructive sleep apnea based on the sleep study.
The first is the apnea-hypopnea index.
Apneas are blockages of airflow that restrict 90% or more of the airflow, and hypopneas are when the airflow blocks to the point that it also drops the oxygen by 3-4%.
The second is the lowest oxygen saturation, which is determined by measuring how low the oxygen drops during sleep. The lowest oxygen saturation is typically measured by using pulse oximetry that goes onto the patient’s finger during sleep.
Dr. Song et al performed a study and found that the apnea-hypopnea index decreased by approximately 46% (from an average of 38 blockages per hour before to 20 blockages per hour after).
Genial tubercle advancement improved the lowest oxygen saturation by 3% (from 83% to 86%).
How does the success rate of a genial tubercle advancement compare to a sliding genioplasty?
Dr. Song et al found that the improvement in sleep apnea (apnea-hypopnea index) was a similar percentage between a genial tubercle advancement (46% improvement) when compared to a sliding genioplasty (44% improvement).
However, the patients who underwent a sliding genioplasty had a lower apnea-hypopnea index before surgery (19 blockages per hour) compared to those who underwent a genial tubercle advancement (38 blockages per hour).
What are the CPT Codes for chin surgeries?
In general, the CPT Codes for chin surgeries are from 21120-21123.
What is the CPT Code for sliding genioplasty?
The CPT codes for sliding genioplasty are:
- 21121 for one osteotomy,
- 21122 for 2 or more sliding osteotomies, and
- 21123 for sliding genioplasty with the placement of bone grafts.
What is the CPT Code for genial tubercle advancement?
The CPT code is 21199.
What is the CPT Code for genioplasty augmentation (implant)?
The CPT code is 21120 for prosthetic material, allograft (from a human donor) or autograft (using the patient’s graft from another location).
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References for chin surgeries:
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4. Storum, K.A., W.H. Bell, and H. Nagura, Microangiographic and histologic evaluation of revascularization and healing after genioplasty by osteotomy of the inferior border of the mandible. J Oral Maxillofac Surg, 1988. 46(3): p. 210-6.
5. Kim, C.H., et al., Mandibular muscle attachments in genial advancement surgery for obstructive sleep apnea. Laryngoscope, 2019.
6. Jung, S.Y., et al., Anatomical analysis to establish the optimal positioning of an osteotomy for genioglossal advancement: a trial in cadavers. Br J Oral Maxillofac Surg, 2018. 56(8): p. 671-677.
7. Riley, R., et al., Mandibular osteotomy and hyoid bone advancement for obstructive sleep apnea: a case report. Sleep, 1984. 7(1): p. 79-82.
8. Co, A.C., M.F. Abad-Casintahan, and A. Espinoza-Thaebtharm, Submental fat reduction by mesotherapy using phosphatidylcholine alone vs. phosphatidylcholine and organic silicium: a pilot study. J Cosmet Dermatol, 2007. 6(4): p. 250-7.
9. Low, M., Submental Liposuction, in Advanced Surgical Facial Rejuvenation: Art and Clinical Practice, A. Erian and M.A. Shiffman, Editors. 2012, Springer Berlin Heidelberg: Berlin, Heidelberg. p. 267-271.
10. Ascher, B., J. Fellmann, and G. Monheit, ATX-101 (deoxycholic acid injection) for reduction of submental fat. Expert Rev Clin Pharmacol, 2016. 9(9): p. 1131-43.
11. Shridharani, S.M. and K.L. Behr, ATX-101 (Deoxycholic Acid Injection) Treatment in Men: Insights From Our Clinical Experience. Dermatol Surg, 2017. 43 Suppl 2: p. S225-s230.
12. Park, J.-H., et al., Evaluation of safety and efficacy of noninvasive radiofrequency technology for submental rejuvenation. Lasers in Medical Science, 2016. 31(8): p. 1599-1605.
13. Rojas, Y.A., et al., Facial Implants: Controversies and Criticism. A Comprehensive Review of the Current Literature. Plast Reconstr Surg, 2018. 142(4): p. 991-999.
14. Richard, O., et al., [Complications of genioplasty]. Rev Stomatol Chir Maxillofac, 2001. 102(1): p. 34-9.
15. McAndrew, B.P. and R.A. Strauss, Delayed muscle detachment after genial tubercle advancement in a patient with obstructive sleep apnea. J Oral Maxillofac Surg, 2000. 58(9): p. 1040-3.
16. Kelly, J.P., S. Malik, and S.U. Stucki-McCormick, Tender swelling of the chin 40 years after genioplasty. J Oral Maxillofac Surg, 2000. 58(2): p. 203-6.
17. Kim, S.G., et al., Unusual complication after genioplasty. Plast Reconstr Surg, 2002. 109(7): p. 2612-3.
18. Guyot, L., et al., Alteration of chin sensibility due to damage of the cutaneous branch of the mylohyoid nerve during genioplasty. J Oral Maxillofac Surg, 2002. 60(11): p. 1371-3.
19. Ousterhout, D.K., Sliding genioplasty, avoiding mental nerve injuries. J Craniofac Surg, 1996. 7(4): p. 297-8.
20. Song, S.A., et al., Genial tubercle advancement and genioplasty for obstructive sleep apnea: A systematic review and meta-analysis. Laryngoscope, 2017. 127(4): p. 984-992.