Step-technique genioplasty: A case report

Genioplasty is the gold standard technique to modify natural chin anatomy based on an inferior border osteotomy of the mandible enabling 3D-repositioning of the chin. Our “step-technique genioplasty” is a modified and improved surgical technique for advancement genioplasty in patients with elusive chin and vertical excess of the lower third. We performed this technique on a 23-year-old female patient with a history of facial trauma that affected the morphology and aesthetics of the lower third. The surgery consisted of two osteotomy lines. The first osteotomy line was a monocortical osteotomy allowing to preserve the integrity of the lingual cortex. About 3 mm below, the second and complete bicortical osteotomy was performed to mobilize the chin segment. A bone fragment containing the vestibular cortex and medullary portion of the mandible was removed preserving the integrity of the lingual cortex and creating a bony step in mandibular symphysis. The osteotomized chin was advanced in the front of the bony step. Compared with known techniques, step-technique genioplasty allowed addressing the vertical chin excess not only at the level of the symphysis but also posteriorly with no over-projection of the chin and no deepening of the labiomental crease, common downsides in other approaches. The aesthetic outcome reflected the preoperative planning: we obtained a smoother transition between symphysis and horizontal branch of the mandible, just the right amount of anterior projection of the chin, greater stability, and predictability of the outcome with satisfying aesthetical results and no complications. •Genioplasty is the gold standard to modify the chin based on a mandible inferior border osteotomy enabling chin 3D-repositioning.•Step-technique is an improved advancement genioplasty, especially indicated on elusive chins with lower third vertical.•Step-technique obtains greater bone contact for better stability of the mobilized fragment, better aesthetics, faster healing.