The role of combined rhinoplasty and genioplasty in the improvement of the lateral facial profile

Background
Genioplasty and rhinoplasty are complementary procedures, which share in common a similar approach for assessment, diagnosis, and stepwise, targeted treatment, based on the existing deformity and cosmetic goals. Previous studies have shown that Egyptians have a tendency toward the skeletal class II with more retrognathic mandibles and more convex profiles in females, and compared with other races, Egyptians tend to have higher facial convexity than other races. Therefore, we chose to stress on the facial harmony in our rhinoplasty patients.
Aim
The aim was to determine for each patient included in the study the best surgical plan to achieve an aesthetically appealing facial profile with a harmonious nose and chin relationship in a population seeking rhinoplasty. The surgical plan is determined with facial analysis, and a suggested treatment plan for best nasal and chin contouring with its options is discussed with the patient to draw attention to the need for chin remodeling for the patient and observe the magnitude of difference in surgical plan regarding the rhinoplasty. The overall percentage of study sample primarily seeking rhinoplasty in need for chin augmentation and/or contouring is estimated to measure the need for chin contouring procedure as an adjunct to rhinoplasty surgery regarding the aesthetic considerations of the lateral facial profile.
Patients and methods
A prospective study was conducted at Ain Shams University Hospitals from September 2015 to December 2018 that included patients who presented to our clinic seeking rhinoplasty.
Results
There was a statistically significant difference in preoperative Legan angle, Silver method, and chin height for a considerable change in total angle of facial convexity by undergoing genioplasty in addition to rhinoplasty. The clinical significance of genioplasty to change the total angle of facial convexity was positively correlated with the patient satisfaction. Overall, 55% of patients presenting for rhinoplasty needed a genioplasty, comprising 50% of included males and 56% of included females. Among the rhinoplasty procedures done, cephalic trimming, cartilage onlay grafts, and columellar strut use showed a clinical significance to the change in nasal projection. Overall, the extent of genioplasty showed a significance to the change induced by our intervention to total angle of facial convexity, unlike the change in nasal projection, where there was no statistical significance in relation to the change of facial convexity.
Conclusion
The chin plays an important role in overall facial appearance, and aesthetic surgery of the chin is extremely rewarding when performed in carefully selected patients. Chin augmentation may improve facial balance and proportion and may also require less reduction of the nose.