Symphysis Resection and Soft Tissue Suspension for the Long and Prominent Chin: An Alternative to Conventional Genioplasty.

Abstract

Various surgical options exist for correcting long, hyperprojected chins, including modified genioplasty techniques, pogonion burring, soft tissue rejuvenation, and custom implants. These can be performed as standalone procedures or in conjunction with orthognathic surgery. Among these, lower chin border resection combined with meticulous soft tissue suspension offers a reliable method for enhancing mandibular contour and cervicomental definition. From 2018 to 2024, 24 patients with elongated, protrusive chins underwent genioplasty with symphysis resection and soft tissue suspension. The technique involved segmental resection of the mandibular symphysis, typically extending from the mandibular angle or first molar. Muscle insertions, including platysma and medial pterygoid, were carefully released with electrocautery. The inferior chin periosteum was sutured and repositioned. Contouring of the mandibular edge was achieved using a round bur, followed by precise hemostasis and suspension of the cervical soft tissues, including the platysma. In 14 patients, the genioglossus and digastric muscles were also anchored to the resected symphysis to enhance submental support. Mandibular reductions ranged from 5 to 10 mm. No major complications were observed. All patients expressed high satisfaction with aesthetic and functional outcomes, with a mean FACE-Q score of 96.02. This technique proved particularly valuable in cases where standard advancement or setback genioplasty alone would not sufficiently address vertical excess or soft tissue laxity. Genioplasty with symphysis resection and soft tissue suspension is a safe, reproducible technique for treating long, hyperprojected chins. The integration of soft tissue suspension is critical to optimize cervicomental angle definition and overall facial harmony. Further comparative studies are warranted to refine indications and validate long-term outcomes. (1) Genioplasty with symphysis resection and soft tissue suspension is a safe and effective alternative to conventional techniques for correcting long and prominent chins, offering aesthetic and functional results when standard genioplasty is insufficient. (2) 3D imaging and CAD/CAM surgical guides enhance precision, reduce intraoperative risks, especially nerve injury, and are recommended for complex asymmetric patients and resections exceeding 5 mm. (3) Soft tissue suspension is essential for optimal outcomes. Proper muscular reattachment (mentalis, platysma, digastric, and optionally geniohyoid/genioglossus) reassures long-term soft tissue adaptation and aesthetic 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 .