Mentoplasty is the surgical reshaping of the chin, and it covers a surprisingly wide range of procedures, from placing a small silicone implant under the skin to sawing through the jawbone and physically repositioning it. The chin is one of the most influential features in facial balance, and even a few millimeters of change in its projection or height can shift how the entire face reads in profile. Because the chin sits at the junction of bone, muscle, fat, and skin, altering it is more complex than it might seem, and the technique a surgeon chooses depends on what exactly needs to change.
Two Main Approaches to Chin Surgery
When surgeons talk about mentoplasty, they generally mean one of two things: placing an implant over the existing bone, or cutting the bone itself and moving it. Implant-based augmentation is the simpler of the two. The surgeon creates a pocket over the front of the jawbone, typically through a small incision either inside the mouth or under the chin, and slides a pre-shaped implant into place. Recovery is faster and the procedure is shorter. Osseous genioplasty, on the other hand, involves making a horizontal cut through the chin bone and physically sliding the freed segment forward, backward, up, or down. It can even be shifted sideways to correct asymmetry.
A systematic review comparing the two approaches found that implants work well for mild-to-moderate chin deficiencies, particularly when the main issue is a lack of forward projection. But for severe underdevelopment or complex three-dimensional problems, bone-cutting genioplasty has clear advantages: it can move in multiple directions at once, and it can increase airway space, something an implant sitting on top of bone simply cannot do.1PubMed Central. Implant-Based Chin Augmentation Vs Osseous Genioplasty: A Systematic Review of Indications and Outcomes A separate study of 80 patients found that those who underwent genioplasty reported significantly higher satisfaction than those who received implants, and the implant group had a higher infection rate.2PubMed. Osseous genioplasty versus chin implants: early complications and patient satisfaction
That does not mean implants are inferior across the board. For someone with a mildly recessed chin who wants a shorter operation and a quicker return to normal activities, an implant is a perfectly reasonable choice. The key is matching the tool to the problem.
Types of Bone-Cutting Genioplasty
Osseous genioplasty is not one single operation. Depending on what the chin needs, the bone segment can be moved in different ways. Sliding genioplasty advances the chin forward and is the most common type. Jumping genioplasty places the freed bone segment as an overlay on the upper portion of the jaw, creating extra projection. Reduction genioplasty shortens the chin vertically, and centralizing genioplasty shifts it sideways to correct deviation or asymmetry.3Nigerian Journal of Clinical Practice. Genioplasty – A Review Surgeons can also combine movements in a single operation, advancing the chin forward while simultaneously raising or lowering it.
This versatility is a big part of why genioplasty remains the gold standard for complex chin deformities. An implant can only add volume in the direction it projects; it cannot shorten a long chin, narrow a wide one, or fix a chin that drifts to one side.
Implant Materials and How They Compare
If you and your surgeon decide on an implant, the material matters. The three most commonly studied options are silicone (often sold under the brand name Silastic), high-density porous polyethylene (sold as Medpor), and expanded polytetrafluoroethylene (Gore-Tex). A systematic review comparing all three found that silicone had the lowest rate of aesthetic dissatisfaction at about 0.3%, compared with roughly 2% for Medpor and Gore-Tex. Gore-Tex had a higher overall complication rate (around 5%) compared with silicone (around 3%), while Medpor fell in between.4PubMed Central. A Systematic Review of Alloplastic Materials Used in Chin Augmentation
Numbness and tingling are another consideration. A separate review found that silicone had the lowest rate of nerve-related numbness at about 0.4%, while porous polyethylene had a much higher rate of around 20%.5Annals of Plastic Surgery. Complications Following Alloplastic Chin Augmentation: A Systematic Review of Implant Materials and Surgical Techniques The likely reason is that porous materials encourage tissue to grow into their surface, which can be an advantage for stability but may also cause more irritation near the mental nerve, the nerve responsible for sensation in the lower lip and chin.
Silicone’s main trade-off is that it sits as a smooth capsule on the bone and can shift position over time if it is not secured. Porous polyethylene integrates with surrounding tissue, making it more stable but harder to remove if revision is ever needed. Gore-Tex sits somewhere in between. No material is perfect, and the choice often comes down to surgeon preference and the specific clinical situation.
What Happens to the Bone Under an Implant
One concern that comes up frequently is bone resorption: the idea that an implant pressing on the chin bone will gradually erode it. A long-term follow-up study using lateral chin X-rays found that most patients did show some bone erosion beneath silicone implants, but the amounts were small. Of 15 patients followed over time, 14 had some erosion at the upper edge of the implant, but only 3 had erosion greater than 1.5 millimeters, with the maximum measured at 2 millimeters. All patients were asymptomatic.6PubMed Central. Bone Resorption after Use of Silicone Chin Implants, Long-term Follow-up Study with Lateral Chin Radiography So while resorption is real, it tends to be clinically insignificant for most people. The bone adapts to the pressure without losing enough structure to undermine the cosmetic result or weaken the jaw.
Nerve Injury and Other Complications
The mental nerve runs through the chin area and supplies feeling to the lower lip, chin skin, and gums. Any surgery in this region puts it at some risk. Temporary numbness is fairly common after both implant placement and genioplasty, though it usually resolves within weeks to months. Persistent numbness is rarer. Unusual complications can occur, including delayed nerve pain from implant displacement months after the original surgery.7PubMed Central. Delayed Mental Nerve Neuralgia following Chin Augmentation
Infection, wound separation, and implant shifting are the other main risks, and they tend to be somewhat more common with implants than with genioplasty, particularly when the implant is placed through an incision inside the mouth.8PubMed. Osseous genioplasty versus chin implants: early complications and patient satisfaction An external approach, with the incision hidden under the chin, appears to lower the wound-separation rate for implants.
How Soft Tissue Follows the Bone
A question that matters for surgical planning is how faithfully the skin and soft tissue follow the bone when it moves. If you advance the bone by 5 millimeters, does the chin surface also move 5 millimeters forward? The answer is close but not quite. Three-dimensional imaging studies have found that soft tissue at chin landmarks tracks bone movement at a ratio of roughly 0.9 to 1 in advancement.9PubMed Central. Soft Tissue Changes Measured With Three-Dimensional Software Provides New Insights for Surgical Predictions A systematic review confirmed a horizontal ratio of about 0.9 to 1 for forward movements and a vertical ratio of about 0.95 to 1 for downward movements.10PubMed. A systematic review on soft-to-hard tissue ratios in orthognathic surgery part II: Chin procedures
Setback and vertical reduction are a different story. When the bone moves backward or upward, soft tissue follows much less predictably, with ratios closer to 0.5 to 1 or even lower.11PubMed. A systematic review on soft-to-hard tissue ratios in orthognathic surgery part II: Chin procedures Soft tissue bunches up rather than retracting neatly, which is part of why reducing a chin carries a higher risk of an unnatural appearance or sagging than augmenting one.
Chin Ptosis and the “Witch’s Chin”
One complication specific to genioplasty is chin ptosis, where the soft tissue droops below the bone, creating a hanging or “witch’s chin” appearance. This can happen when too much soft tissue is stripped off the bone during surgery, leaving the mentalis muscle (the muscle that gives your chin its normal shape) unsupported. There are actually multiple types of chin ptosis with different underlying causes, and diagnosing the specific type matters for choosing the right fix.12PubMed Central. Chin ptosis: classification, anatomy, and correction
A technique called “no-degloving” genioplasty was developed to address this. Instead of stripping soft tissue completely off the bone, the surgeon works through a smaller exposure while using a 90-degree plate with lag-screw fixation. Compared with the traditional technique, patients in a study of this approach had significantly less soft-tissue drooping and zero cases of witch’s chin, versus six cases in the traditional group. Satisfaction scores were also higher on multiple quality-of-life scales.13PubMed. Osseous Genioplasty: Prevention of Witch’s Chin Deformity with No-Degloving Technique For cases where ptosis has already occurred, repair options range from a minimally invasive suture technique, using a U-shaped stitch placed through a small intraoral incision to gather and elevate the soft tissue, to more extensive surgical correction.14Plastic and Reconstructive Surgery. A Minimally Invasive Approach for Correction of Chin Ptosis
Combining Chin Surgery with Rhinoplasty
Surgeons have long observed that many patients seeking a nose job would benefit from chin work at the same time. A recessed chin exaggerates the appearance of a large nose, and fixing the nose alone can leave the overall profile looking unbalanced. Several profile analysis methods exist for identifying this relationship, most of them comparing the position of the chin to other facial landmarks.15Archives of Otolaryngology–Head & Neck Surgery. Chin Position in Profile Analysis: Comparison of Techniques and Introduction of the Lower Facial Triangle
A long-term follow-up study of combined rhinoplasty and genioplasty reported high patient satisfaction and a chin bone recurrence rate of less than 1 millimeter, meaning the bone stayed very close to where it was placed.16PubMed. Combined rhinoplasty and genioplasty: long-term follow-up A larger study of 426 rhinoplasty patients proposed a broader approach, arguing that the nose, midface, and chin should all be assessed together rather than treated in isolation. About 17% of those patients also underwent orthognathic surgery including genioplasty.17Journal of Craniofacial Surgery. Profileplasty: Comprehensive Facial Profile Management Algorithm Based on 426 Patients
Chin Surgery in Facial Feminization
Mentoplasty plays a central role in facial feminization surgery. The chin is one of the features that differs most between masculine and feminine facial structure: male chins tend to be wider, taller, and more squared off, while female chins tend to be narrower, shorter, and more tapered. For transgender women seeking facial feminization, reduction genioplasty is by far the most commonly performed chin procedure, often combining work in both the sagittal and transverse planes to narrow the chin while also shortening or setting it back.18PubMed. Surgical techniques used in chin feminization: Literature review and knowledge update A systematic review found that reduction genioplasty appeared in the vast majority of facial feminization studies, with sliding genioplasty used in some cases and augmentation only rarely.19PubMed Central. A Comprehensive Analysis of Genioplasty in Facial Feminization Surgery: A Systematic Review and Institutional Cohort Study
Newer techniques are emerging in this space. A telescopic genioplasty technique studied in 22 transgender women combined chin narrowing, dimensional reduction, and sagittal repositioning in a minimally invasive fashion, using virtual surgical planning and custom 3D-printed cutting guides and titanium plates.20PubMed. Telescopic Genioplasty: A novel technique for chin feminization in facial feminization surgery Similarly, 3D-printed surgical guides have been developed specifically for multiplanar chin reduction, allowing precise cuts in the vertical, transverse, and sagittal dimensions through a single guide.21PubMed. A Novel 3D-Printed Surgical Guide for Multiplanar Chin Reduction in Facial Feminization Surgery These digital planning tools reduce guesswork in the operating room and appear to improve the consistency of results.
Non-Surgical Chin Augmentation
Not everyone wants or needs an operation. Injectable fillers, primarily hyaluronic acid and calcium hydroxylapatite, can add projection and contour to a mildly deficient chin without any incisions. A systematic review comparing surgical and non-surgical chin augmentation found that fillers provided rapid results and high short-term satisfaction, with side effects mostly limited to temporary swelling, bruising, and soreness. Rare but serious vascular complications can occur if filler is accidentally injected into or compresses a blood vessel.22PubMed. Surgical vs Non-surgical Chin Augmentation: A Systematic Review of Techniques Satisfaction, and Complications
The main limitation of fillers is durability. Hyaluronic acid typically lasts 6 to 18 months before it is naturally absorbed, and calcium hydroxylapatite may last somewhat longer but still needs periodic touch-ups. Over time, the cumulative cost of repeated sessions can rival the one-time cost of surgery, and the results are never as dramatic. Fillers cannot change bone position, narrow a wide chin, or correct asymmetry. They are best thought of as a low-commitment trial run for someone unsure whether they want a permanent change, or as a standalone option for people who need only modest enhancement.
Autologous Grafts as an Alternative to Synthetic Implants
Some patients prefer to avoid synthetic materials entirely. Autologous grafting uses the patient’s own tissue, harvested from elsewhere in the body, to augment the chin. A systematic review identified a wide range of donor materials that have been used: bone from the hip, rib cartilage, coronoid process bone, and even a repurposed nasal hump graft removed during rhinoplasty. The review found that bone and cartilage grafts provided structural support with limited clinically visible resorption, though the evidence base remains small and varied. Soft-tissue grafts, like fat, improved contour but were less predictable in maintaining volume long-term.23PubMed Central. Autologous Tissue Grafts for Chin Augmentation With or Without Genioplasty: A Systematic Review
One creative hybrid approach uses both fat and cartilage from the nasal septum during a simultaneous rhinoplasty. Sliced cartilage grafts are placed in a pocket over the chin bone through a small incision under the chin, while fat is injected into multiple layers above and below the muscle.24PubMed Central. Hybrid Chin Advancement: Combining Fat and Sliced Cartilage Grafts for Chin Augmentation During Rhinoplasty The appeal is that nothing synthetic enters the body, and the cartilage provides a scaffold that may help the fat survive longer than it would on its own. The downside is that grafts from the patient’s body add a second surgical site, with its own healing and potential discomfort.
Chin Advancement and Airway Function
Mentoplasty is not always cosmetic. Advancing the chin forward can pull the tongue base and the hyoid bone (a small bone in the throat that anchors the tongue muscles) forward as well, which opens up the airway behind it. This has real implications for people with obstructive sleep apnea. A review of the evidence on genioplasty and airway volume found that studies reported reductions in the apnea-hypopnea index, a standard measure of sleep apnea severity, from roughly 28 down to 13 in one study and from about 12 down to 4 in another, alongside improvements in snoring.25PubMed Central. Osseous Genioplasty and Its Impact on Airway Volume—What is the Evidence?
This functional benefit is exclusive to osseous genioplasty; an implant placed on the surface of the bone does not pull the hyoid forward and has no effect on the airway.26PubMed Central. Implant-Based Chin Augmentation Vs Osseous Genioplasty: A Systematic Review of Indications and Outcomes For patients whose cosmetic chin deficiency coexists with mild-to-moderate sleep apnea, a single procedure can address both problems at once.
Measuring Satisfaction After Chin Surgery
How do researchers know whether chin surgery actually makes patients happier? Increasingly, they use patient-reported outcome measures rather than just relying on cephalometric X-rays or surgeon assessments. The FACE-Q Aesthetic is one such tool, a validated questionnaire covering appearance, quality of life, and satisfaction with the decision to have surgery. A review of its use across facial procedures found that it had been administered to thousands of patients, with an average response rate of 83% and an average follow-up of about 17 months.27PubMed Central. The Use of the FACE-Q Aesthetic: A Narrative Review The no-degloving genioplasty study referenced earlier specifically used FACE-Q scales and found significant gains in chin appearance and overall satisfaction.28PubMed. Osseous Genioplasty: Prevention of Witch’s Chin Deformity with No-Degloving Technique
This shift toward structured patient feedback is relatively recent in facial surgery, and it means that comparisons between techniques are becoming more meaningful. Older studies often relied on the surgeon’s judgment of a “good result” or on crude before-and-after measurements; newer work captures whether the patient actually feels better about their face in daily life, which is, after all, the entire point.
Congenital and Reconstructive Applications
While most mentoplasty is elective, the same techniques apply when the chin is affected by a congenital condition. Hemifacial microsomia, where one side of the face is underdeveloped, often involves significant chin deviation and jaw asymmetry. A study of 39 patients who underwent surgical correction of mandibular underdevelopment in hemifacial microsomia found that chin deviation was corrected immediately by surgery, though there was some tendency for the deviation to recur over time. About 23% of patients needed a follow-up orthognathic revision. The aesthetic assessment showed significant improvement in chin alignment and lip symmetry.29Journal of Cranio-Maxillo-Facial Surgery. Surgical correction of mandibular hypoplasia in hemifacial microsomia: A retrospective study in 39 patients These patients face challenges that purely cosmetic patients do not, including growing bone, potential relapse, and the need for staged surgeries over many years.