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K. Lee and S. Park
Fig. 9.6 Spade-shaped osteotomy
Fig. 9.7 Bird-shaped osteotomy
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9 V-Logic Principle forGenioplasty: Logical Approach forBalanced Chin
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Fig. 9.8 Diamond-shape osteotomy+inverted V-shaped osteotomy
Table 9.1 Types of genoiplasty
Normal nerve anatomy Low nerve anatomy
Narrowing Classic T-osteotomy Inverted V-shaped osteotomy
Shortening Two-parallel osteotomy
Bowtie- shaped osteotomy
Lengthening Diamond- shaped osteotomy Diamond-shaped osteotomy+inverted
9.4.3 Patients withNormal Nerve
Anatomy
vertical reduction to the patients with wide chins
who have sufcient space for osteotomy below
Spade-shaped osteotomy
Bird shaped osteotomy
V-shaped osteotomy
mental foramen. This method has both horizon-
9.4.3.1 Classic T Osteotomy
The procedure is called “T-osteotomy.” The
tal narrowing effect and vertical reduction
effect.
design is shown in Fig.9.1. This method is gener-
ally applied for simple narrowing of the chin that
has rather sufcient space for osteotomy with
high mental foramen.
9.4.3.3 Bow Tie-Shaped Osteotomy
The procedure is called “bow-tie shape osteot-
omy.” The osteotomy design is shown in Fig.9.3.
This method is compatible with patients who
9.4.3.2 Two-Parallel Osteotomy
The procedure is also called “Two-parallel osteotomy.” The osteotomy design is shown in
Fig. 9.2. This method is generally applied for
want more pointed chin rather than U-shaped
natural chin. There should be enough space
below the mental foramen because the design
involves diverging linear osteotomy line.
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K. Lee and S. Park
9.4.3.4 Diamond-Shaped Osteotomy
The procedure is so called “diamond-shaped
osteotomy.” The osteotomy design is shown in
Fig.9.4. This method is for vertical lengthening
of the chin without any bone graft. For this procedure, sufcient space below the mental foramen
is necessary. It has both horizontal narrowing and
vertical lengthening effects, so it’s recommended
when patients want longer and more pointed
chin.
9.4.4 Patients withLow Nerve
Anatomy
9.4.4.1 Inverted V-Shaped Osteotomy
This procedure is called “inverted V-shaped osteotomy.” The osteotomy design is shown in
Fig.9.5. This method is for vertical reduction for
patients who don’t have enough space for horizontal osteotomy below the mental foramen.
Through this method, the amount of vertical
reduction can be maximized because separated
segments moves not only medially but also
superiorly.
9.4.4.2 Spade-Shaped Osteotomy
The procedure is called “spade-shaped osteotomy.” The osteotomy design is shown in
Fig.9.6. This method is for vertical reduction.
This method can be applied for patients who
don’t have enough space below the mental fora-
men for horizontal osteotomy because it
involves inverted V-shaped design. And it also
can be applied for patients who want U-shaped
chin rather than pointed chin because medial
parts of separated chin segments rotate
superomedially.
9.4.4.3 Bird-Shaped Osteotomy
The procedure is called “bird-shaped osteot-
omy.” The osteotomy design is shown in
Fig. 9.7. This method is for vertical reduction
and especially for those who want more pointed
chin. This method can be applied for patients
who don’t have enough space mental foramen
for horizontal osteotomy because it involves
inverted V-shaped design. And it also can be
applied for patients who want pointed chin
because medial parts of separated chin segments
rotate inferiormedially.
9.4.4.4 Diamond-Shaped
Osteotomy+Inverted
V-Shaped Osteotomy
This procedure is combination of diamondshaped osteotomy with inverted V-shaped osteotomy. The design is shown in Fig. 9.8. This
method is for vertical lengthening of the chin for
patients with low nerve anatomy.
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b
9 V-Logic Principle forGenioplasty: Logical Approach forBalanced Chin
9.5 Case Study
Case 1
A 24-year-old man complained of decient projection and wideness of chin. He wanted
improvement of the front and side prole. Considering ideal prole through panoramic X-ray
(Fig.9.9a) and AP X-ray (Fig.9.9b), inverted V-shaped osteotomy was performed. The wideness of chin was improved markedly after the surgery (Fig.9.10a, b).
85
a
Fig. 9.9 (Case 1) Preoperative panoramic X-ray (a) and AP X-ray (b)
a
b
Fig. 9.10 (Case 1) Postoperative panoramic X-ray (a) and AP x-ray (b)
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b
b
Case 2
K. Lee and S. Park
A 28-year-old woman complained of shortness of chin. She wanted improvement of the front
prole. Considering ideal prole through panoramic X-ray (Fig. 9.11a) and AP X-ray
(Fig.9.11b), diamond + inverted V-shaped osteotomy was performed. The shortness of chin was
improved markedly after the surgery (Fig.9.12a, b).
a
Fig. 9.11 (Case 2) Preoperative panoramic X-ray (a) and AP X-ray (b)
a
Fig. 9.12 (Case 2) Postoperative panoramic X-ray (a) and AP x-ray (b)
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b
9 V-Logic Principle forGenioplasty: Logical Approach forBalanced Chin
Case 3
A 25-year-old man complained of excessive length of chin. He wanted improvement of the front
prole. Considering ideal prole through panoramic X-ray (Fig. 9.13a) and AP X-ray
(Fig.9.13b), two-parallel osteotomy was performed. The length of chin was reduced markedly
after the surgery (Fig.9.14a, b).
a
Fig. 9.13 (Case 3) Preoperative panoramic X-ray (a) and AP X-ray (b)
87
a
Fig. 9.14 (Case 3) Postoperative panoramic X-ray (a) and AP x-ray (b)
9.6 Discussion
Balanced chin shape is determined by vertical
to horizontal ratio. V-logic is a principle to have a
Lower face contour has been thought to be
important for decades because it plays an important role in facial impression. Particularly,
Asians prefer slim V-shaped lower face rather
than wide lower face. For slim V-shaped lower
face, genioplasty is as important as mandibular
reduction itself. But classical genioplasty had
limitations that it could not be applied for all the
patients.
balanced vertical/horizontal ratio of chin. To
manage the shape of the chin, not only the verti-
cal length but also width is important. Some want
more pointed chin, and others want natural
U-shaped chin. This balance may vary greatly
and differ from people to people, nation to nation.
However, we should consult with patients about
general and individual balance. Ideal vertical to
horizontal ratio is usually 1:1.3.
b
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K. Lee and S. Park
It is not possible to fulll all these various
needs of the patients with only one classical surgical method. That is why various surgical methods are necessary. Genioplasty gets more and
more complex to pursue perfection and usually
involves both vertical and horizontal corrections
together. The amount of central resection usually
ranges 6mm to 12mm on average, while amount
of vertical reduction ranges 2 mm to 6 mm.
Lengthening genioplasty using central segment
as a buttress provides sufcient amount of lengthening. It also remains stable with minimal resorption comparing bone graft.
The location of mental foramen and course of
inferior alveolar nerve is the critical anatomical
factors. Variations such as low mental foramen
and low course of inferior alveolar nerve impose
a limitation in both vertical reduction and horizontal narrowing. On the given condition of anatomic variation, how to make a most desired and
still balanced result is the surgeon’s mission.
Laterally down oblique osteotomy is the variation for low mental foramen. Laterally up oblique
osteotomy is the variation for more pointed chin
shape.
It is necessary to dene anatomic variations
and decide the operation design preoperatively.
To decide the proper surgical plan according to
the current shape of the chin, anatomical variation, and patients’ request is the key point for
patients’ satisfaction.
Additional consideration should be taken in
detail to correct the asymmetry and AP relationship during surgery. Bilateral bony step-off
should also be corrected with contouring of the
mandible.
There were no cases of permanent nerve
injury. During the preoperative planning phase,
particular attention was given to the positioning
of the inferior alveolar nerve, emphasizing the
importance of minimal disruption to this area. To
further mitigate risk, the soft tissue surrounding
the mental foramen was carefully preserved from
excessive dissection or retraction. Postoperatively,
some patients required ancillary procedures to
address soft tissue drooping, including lifting and
liposuction of the cheek and submental area.
Additionally, for cases presenting with a bulky
and hyperactive mentalis muscle, botulinum
toxin injections were employed as an effective
postoperative intervention.
The chin is pivotal in shaping the overall
impression of the face. A slim, V-shaped chin of
appropriate length signicantly enhances the
attractiveness of the lower facial contour.
The V-logic principles, aimed at creating a
balanced chin, are outlined as follows:
1. The current state of the chin is thoroughly
analyzed across vertical, horizontal, and
anteroposterior dimensions, with special
attention to any asymmetry.
2. The desired shape of the chin is determined
based on the ideal vertical to horizontal ratio
and the patient’s specic requests, ensuring a
harmonious balance.
3. Attention is given to anatomical variations,
such as the positioning of the mental foramen
and the course of the inferior alveolar nerve.
4. Considering these variances, a spectrum of
surgical options is contemplated to address
individual needs effectively. Eight different
strategies are suggested according to the location of mental foramen, patient’s need, and
balanced chin shape.
5. Genioplasty is recognized as a multifaceted
procedure that encompasses horizontal narrowing, vertical adjustment (either reduction
or lengthening), and either advancement or
setback of the chin. These elements are tailored and synergistically combined for each
patient, aiming to transcend anatomical constraints and achieve optimal outcomes.
References
1. Lee TS, Kim HY, Kim TH, Lee JH, Park S.Contouring
of the lower face by a novel method of narrowing
and lengthening genioplasty. Plast Reconstr Surg.
2014;133:274–82.
2. Park S, Noh JH. Importance of the chin in lower
facial contour: narrowing genioplasty to achieve a
feminine and slim lower face. Plast Reconstr Surg.
2008;122:261–8.
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3. Lee SW, Ahn SH. Angloplasty revision: importance
of genioplasty for narrowing of the lower face. Plast
Reconstr Surg. 2013;132:435–42.
4. Li J, Hsu Y, Khadka A, Jing H, Wang D, Wang
Q. Contouring of a square jaw on a short face by
narrowing and sliding genioplasty combine with
mandibular outer cortex ostectomy in orientals. Plast
Reconstr Surg. 2011;127:2083–92.
5. Lee JH, Lee SW.Facial contouring surgery– mandibuloplasty: genioplasty and mandible angle correction.
Plast Reconstr Surg Glob Open. 2017;5(10):e1296.
6. Lee TS, Kim HY, Kim TH, Lee JH, Park S.Importance
of the chin in achieving a feminine lower face: narrowing the chin by the “Mini V-line” surgery. J Craniofac
Surg. 2014;25(6):2180–3.
7. Satoh K. Mandibular contouring surgery by angular
contouring combined with genioplasty in orientals.
Plast Reconstr Surg. 1998;101:461.
8. Rosen HM. Aesthetic guidelines in genioplasty: the
role of facial disproportion. Plast Reconstr Surg.
1995;95:463–9.
9. Rosen HM. Aesthetic renements in genioplasty:
the role of labiomental fold. Plast Reconstr Surg.
1991;88:760–3.
10. Chen T, Khadka A, Hsu Y, etal. How to achieve a balanced and delicate lower third of the face in orientals
by mandibular contouring. J Plast Reconstr Aesthet
Surg. 2013;66:47–56.
11. Jin H.Misconceptions about mandible reduction procedures. Aesth Plast Surg. 2005;29:317–24.
12. Lee SW, Kim BK, Baek RM, Han J.Narrowing and
lengthening genioplasty with pedicled bone graft in
contouring of the short and wide lower face. Aesth
Plast Surg. 2013;37:139–43.
13. Uckan S, Soydan S, Veziroglu F, Ozcirpici
AA.Transverse reduction genioplasty to reduce width
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The V-Line Surgery: Narrowing
Genioplasty withMandible
Reduction
SanghoonPark
10
10.1 Pearls
1. Mandible reduction, popular and welldocumented procedure, fails to improve broad
facial impression in some patients. After a
thorough investigation and search for the reason, we nally found the chin shape and wide
mandible body are attributable.
2. Preferences for chin and mandible shapes
vary globally, inuenced by cultural and
regional differences. Surgeons need to be well
versed in these preferences to cater to diverse
aesthetic desires. A comprehensive understanding of a patient’s current chin and mandible shape, alongside their desired outcome,
is essential. This knowledge guides the surgeon to devise a customized surgical strategy
tailored to individual needs.
3. Narrowing the chin and modifying its shape
can be successfully achieved through a narrowing genioplasty with central strip resection. This mid-symphyseal sectioning
procedure is both safe and effective, enhancing the narrowing effect while allowing for
shape modication of the chin by altering the
resection pattern.
S. Park (*)
Center for Facial Bone Surgery, Department of
Plastic Surgery, ID Hospital, Seoul, South Korea
e-mail: spark@idhospital.com
4. Achieving a seamless transition from the
genioplasty segment to the lateral mandibular
contouring area, without leaving any bony
step-offs or protuberances, presents a signicant technical challenge in combined genioplasty and mandibular contouring procedures.
This requires meticulous planning and execution to ensure a harmonious and aesthetically
pleasing result.
10.2 Introduction
A prominent mandible that gives a squared contour to the face is considered unattractive in
Korea and in many other Asian countries, because
it gives the face a muscular appearance and thus
diminishes the appearance of femininity. Many
people who have prominent mandibles are likely
to have broad lower faces. The conventional procedure used to x a square contour into an oval
one is resection of the mandibular angle or reduction of the mandible itself, termed either “mandibular angle resection” or “mandible
reduction.”
However, in some patients, resection of the
mandible alone does not make the face appear
slender [1, 2]. This has been a major source of
patient complaint after mandible reduction.
Surgeons have searched for the reasons and solutions so that nally found that the main reason for
this failure is attributable to a wide, at chin and a
U-shaped lower facial morphology. Therefore, to
© The Author(s), under exclusive license to Springer Nature Singapore Pte Ltd. 2024
S. Park (ed.), Facial Bone Contouring Surgery, https://doi.org/10.1007/978-981-97-4992-8_10
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