Introduction
Genioplasty is chin surgery performed under general anesthesia that reshapes the facial profile while correcting functional disorders (lip closure, breathing, tongue posture). Dr Serge Ketoff and his co-authors have published a state-of-the-art review in the journal L’Orthodontist: indications in children and adults, 3D surgical planning and current techniques (mini-wing, chin-wing).
What is genioplasty?
Genioplasty consists of an osteotomy of the chin symphysis: the bony segment of the chin is cut, repositioned (advancement, lowering, asymmetry correction) and then fixed by osteosynthesis (titanium plates and mini-screws).
Beyond its aesthetic effect on the profile, this procedure acts on the perioral and cervical muscles:
- geniohyoid and genioglossus muscles → airway and tongue position;
- mentalis muscle → tension of the lower lip and chin;
- digastric muscle → head/neck contour, cervicomental distance.
It is the functional treatment of choice for lip incompetence when the cause is a retrusive chin (retrogenia) or a lack of chin support.
In children: mouth breathing and facial growth
When to consider it?
The “mouth-breathing” child often presents with adenoid facies: a long face, pinched nose, retrusive chin, lip incompetence at rest, and “orange-peel” puckering of the chin (contraction of the mentalis muscle). A low tongue position promotes vertical growth and maxillary constriction.
The consequences can affect sleep, attention, ENT infections, mandibular growth, posture and oral health.
At what age should surgery be performed?
There is no strict minimum age. In practice, genioplasty can be offered from age 11–12 once the canines have erupted into the arch — adapting the osteotomy line to the position of the roots (cone beam imaging or CT scan).
Performed early (growth stage T3CMV3), it can redirect mandibular growth (anterior rotation) rather than block it. Post-operative periosteal bone apposition at the symphysis is more favorable before age 15.
Expected benefits
- Resolution of lip incompetence;
- A more favorable breathing / swallowing pattern;
- Easier orthodontic treatment and myofunctional therapy;
- Documented positive impact on quality of life and schooling.
Historical reference: Precious & Delaire (1985) — “interceptive orthopedic treatment to restore craniofacial morphofunctional balance”.
In adults: aesthetics and function
Aesthetic indications
Re-tensioning of the soft tissues of the chin and cheeks, redefinition of the jawline, a reverse-lift effect. The procedure can be combined with submental liposuction where appropriate.
Functional indications
- Persistent lip incompetence;
- Relapse of the anterior segment after age 30 (tongue thrust, mouth breathing);
- Periodontal disease of the mandibular incisors aggravated by mentalis muscle strain.
Sulcular approach
In adults, the sulcular approach (inspired by periodontal surgery) is often preferred: it limits scar banding and allows an alveolar bone graft in the incisor region in case of root fenestration (allograft + collagen membrane or PRF), to restore periodontal support before or during orthodontics.
How is a genioplasty planned?
Cephalometric and 3D analysis
Classic cephalometric tracings place the pogonion below the maxillary incisors to ensure harmonious lip closure. Planning also takes the facial vertical dimension into account (hyperdivergence, anterior facial height).
3D imaging (cone beam) secures the osteotomy line relative to the mental nerve (minimum distance of ~5 mm below its emergence, with a variable terminal loop).
Guided surgery
For asymmetries or large bone movements, 3D surgical planning with a cutting guide and a custom-made osteosynthesis plate improves accuracy — including for mild asymmetries that are difficult to quantify freehand.
Mini-wing and chin-wing
- Mini-wing: extension of the osteotomy toward the molars — smoother chin/mandible transition, lateral widening.
- Chin-wing: extension to the mandibular angles — harmonization of the lower border and the angles.
These variants complement classic genioplasty and broaden the range of morphological corrections.
Chin implants
Silicone, Medpor or porous titanium implants are of limited value in young patients (no action on the geniohyoid/genioglossus muscles, foreign body, possible bone resorption). Bony genioplasty remains the functional gold standard.
Recovery and safety
Piezosurgery and advances in anesthesia have improved post-operative comfort. The risk of floor-of-mouth hematoma, once feared, has become rare with current protocols.
In children, the procedure is generally painless, with only a short absence from school. The titanium osteosynthesis hardware does not need to be removed.
Orthodontist – surgeon collaboration
Genioplasty is almost always part of a combined orthodontic-surgical treatment plan:
- the orthodontist identifies the lip incompetence, the relapse or the morphological need;
- the maxillofacial surgeon plans the bone surgery (2D/3D, guides);
- rehabilitation (physiotherapy, speech therapy) consolidates the functional result.
It is in this spirit that the June 2026 issue of L’Orthodontist brings together several state-of-the-art reviews, including the Chantons 1-2-3 initiative by Dr Mathieu Laurentjoye (IACV) on nasal breathing and tongue posture — complementary to the management of facial growth disorders.
Key takeaways
- Genioplasty is a safe, well-codified procedure that can be performed from adolescence onward and in adults.
- It treats lip incompetence and a retrusive chin in a functional way, not just aesthetically.
- 3D surgical planning and guided surgery improve accuracy, especially in cases of asymmetry.
- The mini-wing and chin-wing techniques broaden the morphological indications.
- Success relies on collaboration between orthodontist, surgeon and rehabilitation therapists.
Reference publication
Dujoncquoy J-P, Esnault O, Ketoff S. La génioplastie de l’enfant et de l’adulte : à quel âge ? quelles indications ? quelles techniques ? L’Orthodontist. 2026; vol. 15, no. 3.
Journal: L’Information Dentaire — L’Orthodontist