Of all the features on the face, the chin is the one patients most often misdiagnose on themselves. People come in asking about a neck lift when the real problem is a chin that sits too far back. Others ask for a chin implant when what they actually have is a chin that is too short vertically, or tilted to one side — problems an implant cannot fix.
I've performed chin surgery for 25 years, both with implants and by repositioning the bone itself (sliding genioplasty). Most cosmetic surgeons offer only the implant, because osteotomy — cutting and repositioning bone — requires maxillofacial surgical training that few aesthetic surgeons have. That is exactly why patients get incomplete advice: when the only tool is an implant, every chin looks like an implant case.
This guide explains what each procedure does, what each can't do, and how I decide between them.
What the chin actually does for the face
The chin sets the lower boundary of the facial profile. Its position determines:
- Projection — how far forward the chin sits relative to the lips and nose. A retruded chin makes a normal nose look large and a normal neck look full.
- Vertical height — how tall the lower third of the face is. A short chin compresses the face and deepens the labiomental fold; a long chin elongates it.
- Symmetry — whether the chin's midpoint aligns with the midline of the face.
- The neck — chin projection largely defines the cervicomental angle. Many "double chins" are partly a projection problem.
A chin implant addresses one of these four. A genioplasty can address all four. That is the whole decision in one sentence — the rest of this article is the detail.
Chin implant: what it is and when I use it
A chin implant is a shaped piece of solid silicone or porous polyethylene placed in a pocket directly on the bone, through a small incision either inside the lower lip or in the crease under the chin. It adds forward projection and can add some width along the jawline.
Best for
- Mild to moderate lack of projection in a chin that is otherwise the right height and symmetric
- Patients who want a shorter procedure and the simplest recovery
- Adding jawline definition alongside a facelift or neck lift
What it can't do
- It cannot shorten or lengthen the chin vertically
- It cannot correct asymmetry or rotation — an implant on a crooked base is a crooked implant
- It cannot correct a significant retrusion without looking like a lump on the front of the bone
Risks specific to implants
- Malposition or shifting, especially in the first weeks
- Infection, which usually means removing the implant
- Bone erosion beneath the implant over years — usually minor, occasionally significant
- Visible or palpable edges in thin-skinned patients
My Preferential Incision Placement: For both chin implants and genioplasty, I preferentially use an intraoral incision inside the lower lip vestibule. This gives me direct access to the chin bone and helps me evaluate the contours of the chin bone itself. Asymmetry is the rule, not the exception. If we are placing a chin implant and there is an asymmetry, the implant will not lie flat and could lead to an asymmetrical placement or subsequent migration of the implant. It also allows me direct access to the position of the mental nerve, which is a sensory nerve giving feeling to the lower lip and chin, so that I can place the implant safely without damaging the nerve.
Finally, in ALL cases, I fixate the implant with at least two titanium screws to the chin bone to prevent migration. Most surgeons try to suture the implant in place which fails 100% of the time. It is literally impossible to precisely place a chin implant and get it to stay exactly where you want it unless you screw it into place. This is not possible using an incision below the chin.
We close the incision by repairing the mentalis muscle first and then with a dissolving 4-0 Chromic suture that lasts 10-14 days. Infection rate with this technique is exceedingly low provided that the patient follows all of our post-operative instructions regarding soft diet for 4 days and meticulous oral hygiene during the healing phase.
A case that shows the limits of an implant
This patient came to me with a retruded chin, early jowling, and a heavy neck. Her lateral cephalogram tells the story: the chin sits well behind the vertical line dropped from her upper lip. My recommendation was a sliding genioplasty combined with a facelift, because her problem was skeletal and her neck needed to be addressed. She chose a chin implant alone. The profile improved — the implant did exactly what an implant does — but look at the neck and jowls: essentially unchanged. An implant adds a shape to the front of the bone; it doesn't carry the neck muscles forward with it. This is the most honest illustration I can offer of why the choice matters.
Sliding genioplasty (OIBM): what it is and when I use it
The procedure I perform is an osteotomy of the inferior border of the mandible (OIBM), commonly described as a sliding genioplasty. It repositions your own bone. Through an incision inside the lower lip — no external scar — I make a planned cut through the inferior border of the mandible, extending posteriorly beneath the first/second molar region, below the tooth roots and the nerve that supplies feeling to the lip. That segment of bone is then moved: forward for projection, backward for reduction, up or down to change height, or rotated to correct asymmetry. It is fixed in its new position with a small titanium plate and screws that stay permanently and are not felt.
Explore the OIBM animation above.
Because it's your own bone, the result is stable, it integrates completely, and the soft tissue drapes over it naturally. Advancing the bone also pulls the muscles of the chin and neck forward with it, which is why a genioplasty improves the neck in a way an implant does not. Specifically there are attachments of muscles behind the chin bone to a bone in the neck called the hyoid. This muscle is called the geniohyoid muscle. Then from the hyoid to the base of the tongue there is a muscle called the hyoglossus muscle. Therefore the advancement of the chin with a genioplasty permits pulling the hyoid bone superiorly and the base of the tongue forward. The cosmetic result is a better neck jaw angle and the functional improvement results in a better airway and improvement in sleep apnea in some patients.
Sliding genioplasty alone: patient results
Best for
- Moderate to significant lack of projection
- A chin that is too short or too tall vertically
- Asymmetry or a chin that deviates from the midline
- Patients who prefer repositioning their own bone rather than adding a chin implant
- Combining chin correction with neck lift or facelift when the underlying skeleton is the real problem
What it can't do
- It doesn't add width along the jawline the way an implant can — for that, an implant or fat transfer may be added
- It doesn't change the position of the teeth or bite; if the bite is the issue, that's orthognathic surgery, not genioplasty
Risks specific to genioplasty
- Temporary numbness of the lower lip and chin — common, almost always resolves over weeks to months; permanent numbness is uncommon
- Infection or hardware problems — rare
- Damage to tooth roots — avoided by planning the cut on imaging
After the bone cut is precisely made, we determine the proper advancement of the cut chin bone and set it on facial midline. We fixate the chin using a Synthes Maxillofacial chin plate. They come pre-bent in 4mm, 6mm, 8mm and 10mm sizes. How far your chin can come forward is limited to the thickness of the chin bone itself, the position of your lower anterior teeth and the pre-existing depth of the labial mental fold (which we do not want to exacerbate by chin advancement). This is truly an artistic decision made from over 31 years of experience (I started performing this procedure in my residency training in 1995).
The chin plate is usually permanent and there is no indication to remove it unless in the rare instance (less than 1% in my hands) it gets infected. It does not set off metal detectors in the airport and patients cannot feel it at all.
Within 3 months the bone is well healed and stable. Within one year the bone is completely remodeled such that you can barely see the bone cuts on a radiograph of the jaw. The results are permanent and very stable
When the whole jaw is behind: mandibular advancement plus genioplasty
Sometimes the chin is not the only thing that is retruded — the entire lower jaw sits back, and the bite reflects it. In those patients, advancing only the chin would improve the profile but leave the jaw and bite where they are. The complete correction is a mandibular advancement (moving the whole lower jaw forward at the angles) combined with a sliding genioplasty. This is orthognathic surgery, and it is the most powerful neck and jawline procedure I know of — the two patients below had nothing done to the neck at all. No liposuction, no neck lift, no skin tightening. Every bit of the change you see under the chin came from moving bone.
I mention this not because most patients need it — most don't — but because a surgeon who cannot move bone cannot even put it on the list of options. If your lower jaw is significantly behind, you deserve to hear about it.
Side by side
| Chin implant | Sliding genioplasty (OIBM) | |
|---|---|---|
| Corrects projection | Mild–moderate | Moderate–significant; limited by anatomy |
| Corrects vertical height | No | Yes |
| Corrects asymmetry | No | Yes |
| Adds jawline width | Yes | Limited |
| Effect on neck contour | Some | Significant |
| Foreign material | Yes | Titanium plate and screws |
| Scar | Intraoral or under chin | Intraoral only |
| Procedure time | ~45 min | ~60 min |
| Anesthesia | sedation/general | Sedation/general |
| Swelling / return to desk work | ~1 week | 7–10 days |
| Long-term stability | Good; erosion possible | Permanent |
| Reversible | Yes | Effectively no |
Recovery: what to expect from each
Chin implant
Swelling and tightness for a few days, a soft diet for several days, and a chin strap for the first week. Most patients return to desk work in about a week. Avoid pressure on the chin for several weeks while the pocket heals around the implant.
Sliding genioplasty
More swelling in the first week because bone was moved, though patients are consistently surprised that pain is modest. Soft diet for one to two weeks, meticulous oral hygiene because the incision is inside the mouth, chin strap for the first week, and no contact sports for six weeks while the bone heals. Lip numbness is expected early and fades. Desk work at 7–10 days; the final contour is visible at about three months as swelling fully resolves.
How chin surgery changes a neck lift or facelift
This is the part most articles skip. When I evaluate a patient for neck work, I evaluate the chin first. If the chin is retruded, a neck lift alone will tighten the skin but leave the profile blunted, because the angle between chin and neck is set by bone position, not skin. Advancing the chin — by implant in mild cases, by genioplasty in the rest — sharpens that angle and makes every millimeter of neck work more effective.
I frequently combine chin correction with the 4D Facelift or an isolated neck lift, done in the same session. Yes, I often combine chin augmentation/genioplasty with rhinoplasty and I would say that patients with unsatisfactory neck jaw lines need some form of chin augmentation about 10% of the time. I address all of this at the consultation and educate patients to their options.
Why so few cosmetic surgeons offer genioplasty
Cutting and repositioning facial bone is maxillofacial surgery. My training pathway included 11 years of post-graduate surgical training in facial skeletal surgery before I dedicated my practice to cosmetic surgery, and I've performed hundreds of osteotomies. Most aesthetic surgeons train in soft tissue and are appropriately cautious about bone. The practical consequence for you: if you've been told an implant is your only option, it may simply be the only option that surgeon performs. Ask directly whether genioplasty was considered for your anatomy.
How I decide at consultation
- Profile photos and, when the case calls for it, 3D imaging / a lateral cephalogram to measure projection and height against the rest of the face
- Assessment of the bite, lip position, and neck
- Your priorities: projection only, or height and symmetry too; tolerance for foreign material; recovery time available
- Whether other procedures are planned that would change the answer
Frequently asked questions
Is a genioplasty better than a chin implant?
Neither is universally better. An implant is the simpler solution for mild projection deficiency. A genioplasty is the only option that corrects vertical height and asymmetry, and it produces a stronger neck improvement.
Does a sliding genioplasty leave a scar?
No visible scar — the incision is inside the lower lip.
Is genioplasty painful?
Patients consistently report less pain than they expected — mostly swelling and tightness, managed with medication for the first few days.
Can a chin implant fix an asymmetric chin?
No. An implant sits on the existing bone, so asymmetry in the bone remains. Genioplasty corrects asymmetry by rotating the bone segment.
How long does a chin implant last?
Implants are considered permanent, though some bone erosion beneath the implant occurs over time. A genioplasty is your own bone and is permanent.
Will a chin procedure help my double chin?
Often, partly. If the chin is retruded, advancing it improves the chin-neck angle. Excess fat or loose skin still needs a neck procedure — frequently done at the same time.
Considering chin surgery?
Chin surgery is one of the highest-impact, least-discussed procedures in facial aesthetics — when it's matched to the right anatomy. If you've been quoted an implant, or told nothing can be done, a second opinion from a surgeon who performs both is worth an hour. Call 561-834-6682 or request a consultation online. Learn more about genioplasty, facial implants, and the 4D Facelift.
Photos are of Dr. Carlotti's own patients, shared with consent. Results vary; these images illustrate the procedures discussed and are not a promise of any individual outcome.