Aesthetic refinements in genioplasty: the role of the labiomental fold.

The vast majority of patients requesting aesthetic enlargement of their chins have a class II skeletal deformity secondary to a small mandible. Class II skeletal patterns are frequently associated with abnormalities of lower face height, which, in turn, affect labiomental fold morphology. Of 68 patients who were to undergo sagittal advancement of their chins, 88 percent were considered to have abnormal labiomental fold morphology that was closely related to abnormalities of the facial height. Patients with decreased lower face height (40 percent) had exaggerated, deepened folds with acutely closed angles between the lower lip and chin pad, whereas those with increased lower face height (25 percent) had shallow, effaced folds. Patients with normal lower face height had variable fold morphology. Isolated sagittal advancement and/or simultaneous advancement and vertical shortening deepened the labiomental fold and closed the angle between the chin pad and lower lip. Simultaneous advancement and lengthening tended to deemphasize the fold, making it appear less deep in 20 of 34 patients, or at least mitigated further accentuation of the fold in 14 of 34 patients. Altered labiomental morphology and its relationship to the class II skeletal deformity is discussed. Treatment planning decisions are suggested, taking into account labiomental aesthetics and how they are influenced by advancement genioplasty.