Genioplasty, the surgical modification of the chin, is a fundamental procedure in craniofacial and maxillofacial surgery that addresses both aesthetic and functional deformities. Initially used to correct microgenia and mandibular asymmetry, genioplasty is now frequently integrated with orthognathic surgery to achieve comprehensive facial profile improvement. Advances in digital imaging have revolutionized these techniques through innovations such as computer-assisted planning, virtual surgical simulations, and pre-bent fixation plates, all of which enhance precision and predictability. With the increasing incorporation of three-dimensional (3D) printing technology and artificial intelligence (AI)-assisted planning, genioplasty is evolving into a more refined and personalized approach. This article reviews genioplasty techniques, indications, advancements, and emerging trends [1,2].

Genioplasty has a long history dating back to the 19th century when Hullihen [3] first performed mandibular osteotomy for skeletal prognathism. Hofer [4] later introduced extraoral approaches for genioplasty. In the 1950s, Trauner and Obwegeser [5] refined these methods by developing intraoral techniques, which significantly reduced invasiveness and improved postoperative outcomes. Over the decades, improvements in osteotomy design, fixation methods, and 3D imaging have led to greater predictability and enhanced aesthetic and functional results.

Genioplasty procedures are categorized based on the specific skeletal modifications performed. In sliding genioplasty, a horizontal osteotomy is used to reposition the chin anteriorly or posteriorly, thereby improving projection and contour [6]. Advancement genioplasty, employed for microgenia, moves the chin forward to enhance prominence (Fig. 1) [7]. Setback genioplasty decreases chin projection and is effective for patients with mandibular prognathism [8]. Vertical augmentation genioplasty utilizes bone grafting or distraction osteogenesis to lengthen the chin and improve lower facial balance [9]. Conversely, vertical reduction genioplasty addresses excessive chin height by removing surplus bone [10]. Narrowing genioplasty, which is common in Asian aesthetic surgery, contours the chin to produce a more tapered appearance (Fig. 2) [9]. Recent studies have described a technique that combines narrowing genioplasty with a pedicled interpositional bone graft; this method repurposes the discarded central segment to elongate the chin and enhance facial harmony [11]. Surgical precision is critical in genioplasty. Preserving the mental nerve is essential to avoid neuropraxia and sensory deficits [6]. Rigid fixation using pre-bent absorbable plates or titanium screws enhances stability and minimizes the risk of relapse [10]. Moreover, proper soft tissue management—particularly adequate tensioning of the mentalis muscle—is crucial in preventing chin ptosis and lower lip incompetence [7].

A recent study by Hwang et al. [2] proposed a strategic categorization of genioplasty procedures based on the complexity of skeletal movements. The study divided 208 patients into three groups: those requiring horizontal segment osteotomy without significant vertical alterations; those undergoing both vertical and horizontal segment osteotomy for chin narrowing and reshaping; and those needing additional bone grafting for structural augmentation and stability. This classification provides a framework for customizing surgical approaches to meet individual patient needs, thereby enhancing predictability and optimizing outcomes. The study reported a 92.8% patient satisfaction rate, with a minimal complication rate of 5.8% attributable to temporary sensory loss [2]. Another study investigating soft-tissue responses following genioplasty with anterior segmental osteotomy analyzed 62 patients, categorizing them into advancement, setback, and no sagittal change groups. The results demonstrated stable outcomes with no significant relapse and a strong correlation between soft- and hard-tissue movements, particularly in setback genioplasty, supporting its use as an alternative to two-jaw surgery for bimaxillary prognathism with macrogenia [12]. Furthermore, research on narrowing and lengthening genioplasty has introduced a technique using a pedicled interpositional bone graft derived from discarded bone during narrowing genioplasty to elongate the chin in patients with a short and wide lower face. This method minimizes complications typically associated with free bone grafts, such as infection and resorption, while providing satisfactory aesthetic outcomes [11]. Beyond this categorization, genioplasty is indicated for various clinical conditions, including microgenia, macrogenia, facial asymmetry, and obstructive sleep apnea [8]. When combined with mandibular advancement, genioplasty has been shown to improve airway patency in obstructive sleep apnea patients. A comprehensive preoperative evaluation—including cephalometric analysis, 3D imaging, and virtual surgical planning—is essential for ensuring optimal patient selection and surgical accuracy.

Technological advancements have greatly enhanced genioplasty procedures. Virtual surgical planning facilitates precise 3D modeling and improves the accuracy of osteotomy execution [8]. The advent of 3D-printed cutting guides enables customized bone resection and fixation, thereby reducing intraoperative errors. Additionally, pre-bent absorbable plates promote bone healing, provide stability, and minimize implant-related complications [7]. AI has further advanced orthognathic surgery by improving preoperative planning, surgical precision, and postoperative outcome predictions. Through AI-assisted radiographic tracing, 3D modeling, and intraoral scanning, clinicians can accurately identify clinical landmarks, optimize implant design, and predict surgical outcomes [13].

Genioplasty has consistently demonstrated high success rates in terms of both aesthetic enhancement and functional improvement. Studies report that over 90% of patients are satisfied with their outcomes, particularly when genioplasty is performed in conjunction with orthognathic surgery or complementary procedures such as fat grafting. Long-term results remain stable with minimal relapse when appropriate fixation techniques are utilized. The integration of virtual surgical planning and advanced fixation methods has further enhanced postoperative predictability [7].

Continued technological advancements are shaping the future of genioplasty. AI-driven customization is poised to offer predictive analytics for personalized surgical outcomes and simulation [13]. Robotic-assisted surgery is expected to further enhance the precision of osteotomy execution and fixation placement [10]. Bioprinting of bone grafts has the potential to revolutionize chin augmentation by providing patient-specific biomaterial implants with improved integration properties. Additionally, the development of minimally invasive techniques— including endoscopic and robotic-assisted genioplasty—is under exploration with the aim of reducing surgical morbidity and shortening recovery time [8].

Genioplasty remains a fundamental procedure for modifying chin morphology in maxillofacial surgery. Ongoing advancements in surgical techniques, digital planning, and biomaterials have improved accuracy, safety, and patient satisfaction. The incorporation of AI, robotics, and bioprinting is expected to further refine genioplasty, making the procedure more precise and less invasive. As technology continues to progress, genioplasty will evolve to offer patients increasingly safe and effective treatment options.