Too Deep Labio-Mental Fold after Large Advancement Genioplasty: A Proposal for Its Effective Correction

Objectives: When advancement genioplasty exceeds 3-4 mm, an unpleasant fold between lower lip and chin may arise, especially in thin-skinned patients.
An original technique to resolve this inconvenience is presented.

Methods: In order to flatten the labio-mental fold, a solid graft is inserted into the concavity between alveolar process and chin prominence (i.e. cephalometric B point). Graft can be cartilage, cortico-cancellous bone or commercial chin prosthesis. Graft is fixed with stitches (cartilage) or compression screws (bone/prosthesis)
Graft is positioned before suturing, mucosa must be then perfectly closed: when this procedure is planned, initial incision must lie far in the lower lip mucosa, so enough stuff will be later disposable for suture.
20 patients were treated with the aforementioned technique to prevent/correct too deep labio-mental fold after huge advancement genioplasty in the last 2 years.
The technique was sometimes used simply to fill an existing deep fold, although a genioplasty was not performed.

Results: The operation did not present any major complications so far (infections, failure). When a cortical bone graft was used, the fixation screw was removed after 6 months because the superficial cortical bone adsorbed and the screw head was perceptible by the patient. In these cases is advisable to cover the screw head with a sheet of septal cartilage.

Conclusion: Flattening a deep labio-mental fold via a solid graft is a simple and effective technique. It takes a few minutes and presents lowest risks of complications.
This is, to the best of the author’s knowledge, the only published technique directed to solve this problem.