ORI GI NAL ARTI CLE AESTHETIC

Gliding Mentoplasty: A New Technique

Fausto Viterbo

Ryane Schmidt Brock
Received: 14 February 2013 / Accepted: 6 September 2013 / Published online: 19 October 2013
Springer Science+Business Media New York and International Society of Aesthetic Plastic Surgery 2013
Abstract
Background The goal of mentoplasty is to improve chin
projection. Traditionally, this is accomplished by either
mandibular osteotomy or alloplastic implants. However,
these procedures are not free of complications. This report
describes gliding mentoplasty, a novel, simple technique
for chin projection.
Methods The 12 patients in this study underwent gliding
mentoplasty. By means of a 2-cm intraoral incision, a
subcutaneous dissection was made in the caudal direction.
The dissection then proceeded in the subperiosteal plane,
leaving a 1-cm cuff of muscle attached to the bone, and
advanced toward the lower border of the chin. Subse-
quently, the dissection was extended laterally, and the
whole mental area was dissected from the surrounding
tissue. Three 2-0 monolament nylon sutures were placed
in the submandibular periosteum and connected through
the remaining muscle cuff to the periosteum. These key
sutures allowed the submandibular region to slide forward,
project the subcutaneous tissue and mentalis muscle, dene
the labiomental fold, and improve the pogonion projection.
Results Gliding mentoplasty resulted in a symmetric
projection of the chin in all cases. In two patients, a sub-
mandibular dimple developed, which spontaneously
resolved in 1 month. No revision surgery was performed,
and no tissue relapse was noted. The mean follow-up
period was 24.7 5.17 months (range 1933 months). All
the patients were satised with the result.
Conclusion Gliding mentoplasty is a simple, easy-to-per-
form, rapidsurgical technique of chinprojectionthat produces
low pain, rapid recovery, and excellent cosmetic results.
Level of Evidence IV This journal requires that authors
assign a level of evidence to each article. For a full
description of these Evidence-Based Medicine ratings,
please refer to the Table of Contents or the online
Instructions to Authors www.springer.com/00266.
Keywords Gliding mentoplasty Chin projection
Submandibular
The chin is the most prominent feature in the lower third of
the face in both the frontal and prole views [1]. Micro-
genia may occur alone or in combination with mild,
moderate, or severe mandibular retrognathia [2].
Some authors have recommended mandibular advance-
ment in all cases of retrognathia [3]. We reserve mandib-
ular advancement for severe retrognathia. Patients with
mild or moderate retrognathia or microgenia are treated
with gliding mentoplasty.
The goal of mentoplasty is to improve pogonion pro-
jection and create an aesthetic contour of the chin with
proper facial height and harmony among the lower lip,
labiomental fold, submental area, lower border of the
mandible, and cervicomental angle. Mentoplasty with
alloplastic implants or by osteotomy is one of the most
used techniques for chin projection [46].
Alloplastic implants became popular in the 1950s because
of their ready availability and lack of donor-site morbidity.
Many materials including solid silicone, acrylic, polyamide nylon
mesh, polytef, porous polyethylene, polytetrauoroethylene,
F. Viterbo (&)
Sao Paulo State University Julio de Mesquita Filho, UNESP,
Rua Domingos Minicucci Filho, 587, Botucatu,
Sao Paulo 18607-030, Brazil
e-mail: [email protected]
R. S. Brock
Brazilian Plastic Surgery Society, Sao Paulo, Brazil
1 3
Aesth Plast Surg (2013) 37:11201127
DOI 10.1007/s00266-013-0226-x
and Mersilene mesh have been used in chin augmentation.
However, each implant has its own disadvantages [6, 7].
Acrylic and silicone are palpable and cause bone absorption
[711]. Solid silicone may cause bone absorption, remain
mobile, and migrate due to muscle movements, resulting in
attening of the labiomental fold, which becomes less visible
[1215]. Porous polyethylene is an expensive, inexible
material that may require titaniumscrews for implant xation,
making the procedure even more expensive [16]. Polytetra-
uoroethylene is too soft and pliable for use in chin augmen-
tation [8, 9]. Mersilene mesh is a nonabsorbable polyester ber
that has high tensile strength, durability, and host tolerance but
is expensive [16]. All implant procedures require extensive
dissection and identication of the mental nerve and therefore
may lead to nerve injuries [8].
Autologous grafting procedures for chin augmentation
using Gore-Tex [17], nasal osteocartilaginous grafts [18],
bone grafts [19], and conchal cartilage grafts [20] also have
been described. The use of conchal cartilage grafts is
limited by availability [20]. Mandible advancement oste-
otomies are not free of complications, especially nerve
injury [2124].
This report aims to describe gliding mentoplasty, a new,
simple, easy-to-perform, and rapid technique for chin
projection that produces low pain, rapid recovery, and
excellent cosmetic results.
Patients and Methods
In this study, 12 patients (5 men and 7 women) with a mean
age of 32 11.8 years (range 1959 years) reporting a
lack of chin projection underwent our technique of gliding
mentoplasty. Most of the patients had combined procedures
(Table 1).
Surgical Procedure
Surgery was performed with the patient under local anes-
thesia using inltration of 0.5 % lidocaine and 1:250,000
Table 1 Patient information
Patients Age
(years)
Sex Postoperative
time
(months)
Associated procedures
1 23 M 21 Rhinoplasty
2 29 F 22 Submental liposuction
3 29 F 28
4 54 F 20 Face-lifting
5 59 F 19 Submental lipoplasty
6 19 M 33 Rhinoplasty
7 31 M 21 Blepharoplasty
8 31 M 20 Blepharoplasty
9 41 M 29 Blepharoplasty,
face-lifting
10 40 F 32 Rhinoplasty, submental
liposuction
11 32 F 27 Rhinoplasty
12 30 F 23 Rhinoplasty, submental
liposuction
Fig. 1 The current authors use this technique and recommend that it
be performed using 2.5- to 3.5-loupe magnication to prevent injury
to small nerve branches
Fig. 2 Intraoral incision performed above the lower gingivolabial
sulcus with maintenance of a free gingival margin to help close the
surgical wound
Fig. 3 The incision was made in the periosteum followed by
periosteal elevation
Aesth Plast Surg (2013) 37:11201127 1121
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adrenaline combined with sedation. The procedure was
performed with loupe magnication to prevent mental
nerve injury (Fig. 1). A 2-cm intraoral incision was made
1 cm above the lower gingivolabial sulcus, with a free
gingival margin maintained to help in closure of the sur-
gical wound (Fig. 2). A dissection was made in the caudal
direction in the plane between the subcutaneous tissue and
the muscular layer. Then the mentalis muscle was incised,
leaving a 1-cm cuff of muscle attached to the bone (Fig. 3).
The dissection proceeded to the subperiosteal plane and
exposed the lower border of the chin (Fig. 4). At this point,
the dissection was extended laterally, and the whole mental
area was dissected from the surrounding tissue. Because
the dissected tunnel was central and medial, the risk of
mental nerve injury was minimized (Fig. 5).
Next, three 2-0 monolament nylon sutures were placed
in the submandibular periosteum and through the muscle
cuff that was left connected to the periosteum (Figs. 6, 7).
Additional sutures may be placed to produce a better
labiomental fold.
The intraoral incision was closed in two layers with
U-sutures of 4-0 plain catgut (Fig. 8). These sutures are
crucial because they allow the submandibular region to
slide forward, project the subcutaneous tissue and mentalis
Fig. 4 With a periosteum dissector, the current authors perform a
subperiosteal dissection that extends to the lower border of the chin
Fig. 5 The entire mental area dissected from the surrounding tissue
Fig. 6 The central suture passed with two layers in the submandib-
ular periosteum and through the muscle cuff. Two Allys forceps were
used to apprehend the periosteum laterally to perform the lateral knots
Fig. 7 Three sutures applied before closure of the incision
Fig. 8 Closed incision
1122 Aesth Plast Surg (2013) 37:11201127
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muscle, dene the labiomental fold, and improve the
pogonion projection (Fig. 9a, b). Micropore tape was
applied horizontally above and below the pogonion to
prevent edema.
The entire procedure required about 30 min. The
patients who underwent gliding mentoplasty alone were
discharged on the same day as surgery, and those who
underwent a simultaneous face-lift were discharged on the
next day.
The patients were instructed to have a full liquid diet for
the rst week after surgery before returning to a normal
diet. They also were advised to avoid facial movements
(e.g., smiling and talking) as much as possible and to avoid
sleeping or applying pressure over the chin during the rst
postoperative week.
Results
In all cases, gliding mentoplasty increased chin projection
and chin symmetry (Figs. 10, 11, 12). Some patients
reported light to moderate pain for the rst week, and
edema was observed for 23 weeks. In two patients, a
submandibular dimple was noted postoperatively but
Fig. 9 a, b Schematic drawing
of the gliding mentoplasty
technique showing the sutures
allowing the submandibular
region to slide forward,
projecting the subcutaneous
tissue and mentalis muscle and
thus dening the labiomental
fold and improving the
pogonion projection
Aesth Plast Surg (2013) 37:11201127 1123
1 3
disappeared 1 month later. No patient required revision,
and no patient had tissue relapse or loss of treatment gains.
The mean follow-up period was 24.7 5.17 months
(range 1933 months). The patients returned to their nor-
mal activities the day after surgery.
Subjectively, all the patients were satised with the
results of their surgery. The objective analysis was per-
formed by comparing facial proles of the patients from
photographs taken before and after the surgical correction
of chin projection, but without the use of a grading scale.
Improvement in chin projection was evident in all the
patients.
Discussion
Besides projection, mobility of the chin also should be
considered because it changes when lips are closed at rest
(Fig. 11a) and when the patient smiles (Fig. 11c). Some
individuals show increased chin projection while smiling,
and some have increased projection at rest with the lips
closed.
In our opinion, gliding mentoplasty allows stabilization
of the chin, producing excellent cosmetic results and the
most natural shape for the chin. Although the new chin
position results in a better aesthetic appearance, the con-
sequent immobility of the chin should be carefully
explained to the patient before surgery.
Zide and McCarthy [25] described resuspension of the
mentalis muscles using sutures to hold the soft tissue chin
upward. The sutures are passed through holes drilled in the
alveolar bone. The procedure is indicated for correction of
chin ptosis after surgery in the area and not for correction
of microgenia or retrognathia.
Gliding mentoplasty, a rapid, inexpensive procedure
with a low risk of infection, is less invasive than men-
toplasty with alloplastic implants or by osteotomy. With
the new technique, extensive dissection or mandibular
osteotomy is not necessary, reducing the risk of nerve
injury.
Fig. 10 a Repose prole view of preoperative gliding mentoplasty
and submental liposuction (patient 12). b Repose prole view of
11-month postoperative gliding mentoplasty and submental liposuc-
tion with evident protrusion of the chin. c Preoperative smiling prole
view. d Smiling prole view 11 months after gliding mentoplasty and
submental liposuction with evident protrusion of the chin. e Preoper-
ative repose frontal view. f Repose frontal view 11 months after
gliding mentoplasty and submental liposuction. g Preoperative smil-
ing frontal view. h Smiling frontal view 11 months after gliding
mentoplasty and submental liposuction
b
1124 Aesth Plast Surg (2013) 37:11201127
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Conventional mentoplasty may lead to complications
including neurapraxia associated with hypoesthesia of the
mental area or more severe damage to the mental nerve [22
26]. In gliding mentoplasty, the mental nerves are visualized
and kept away from the surgical eld. Dissection is per-
formed in a 2-cm-wide tunnel, which is extended laterally
only in the lower border of the chin. The use of loupe mag-
nication during the procedure helps to prevent mental nerve
injury, even to small branches lying under the mucosa,
reducing the risk of changes in sensation to the lower lip.
Alatel and Al Majid [27] described a similar technique using
an intraoral incision and mentalis intramuscular tightening.
Although we had no experience with this technique, we believe
that the elevation and attachment of periosteum to muscle
instead of muscle to muscle enables a longer-term result.
The labiomental fold is an important aesthetic feature that
may not be well dened in some individuals. Some chin aug-
mentation techniques, such as those using silicone implants,
may result in attening of the labiomental fold due to superior
migration of the implant [21]. However, with our technique,
additional sutures may be placed to increase the depth of the
labiomental fold, improve the contour of the chin, and promote
pogonion projection, especially in the prole view.
Gliding mentoplasty is suggested for most patients
requiring chin projection. However, mentoplasty with
alloplastic implants or by osteotomy still is recommended
for severe microgenia or retrognathia.
Gliding mentoplasty has the benets of a short operative
time and the ability to be performed using local anesthesia
with sedation. It may be combined with rhinoplasty, rhyt-
idoplasty, and submental lipectomy. It also may be com-
bined with submental liposuction, but gliding mentoplasty
already involves xation of soft tissues, which improves
rejuvenation in the submental area.
Fig. 11 a Repose preoperative prole view of patient who had
gliding mentoplasty combined with submental liposuction. She had
undergone rhinoplasty 5 years previously. The preoperative prole
shows the patient not smiling. In this case, a surgical indication exists
to improve the prole chin protusion when the patient is in a
nonsmiling situation (patient 3). b Repose prole view 2 years and
4 months after gliding mentoplasty combined with submental lipo-
suction. c The same patient as in a but now with a smiling prole
showing protrusion of the chin with the smile. In this case, a surgical
indication exists to improve the prole chin protrusion when the
patient is in a nonsmiling situation. d Smiling prole view 2 years and
4 months after gliding mentoplasty combined with submental lipo-
suction. e Repose frontal view of the patient before gliding
mentoplasty combined with submental liposuction. f Repose frontal
view 2 years and 4 months after gliding mentoplasty combined with
submental liposuction. g Smiling frontal view before gliding mento-
plasty combined with submental liposuction. h Smiling frontal view
2 years and 4 months after gliding mentoplasty combined with
submental liposuction
b
Aesth Plast Surg (2013) 37:11201127 1125
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Conclusion
Gliding mentoplasty is a simple, easy-to-perform, rapid
surgical technique for chin projection that produces low
pain, rapid recovery, and excellent cosmetic results.
Acknowledgments We thank Dr. Antonio Graziosi and Dr. Janna
Joethy for revision of the text.
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