Background: Treatment of macrogenia can be a challenging problem. In this article, the authors provide novel insights for treatment of a previously poorly treated problem. The authors have developed anatomical insights that facilitate the subtly difficult preoperative evaluation of the large chin and, when applied appropriately, will provide uniformly pleasing results. Methods: A retrospective review of the senior author’s (B.M.Z.) patient records was performed. More than 50 cases of macrogenia were identified. As previously described, almost all of the cases were performed under local anesthesia with oral premedication only. Results: This article demonstrates why prior modalities such as intraoral burring and lower border setback failed to treat the variety of large chins properly. The nine critical factors the surgeon must consider in developing a successful surgical plan are outlined. The surgical plan is not primarily based on radiographs as much as on direct tactile and visual analysis of the sublabial structures both in repose and while smiling. Crucial aspects of the operative technique are highlighted. Conclusions: The large chin can be approached with confidence if nine parameters are appreciated. The authors have outlined these key variables that facilitate proper preoperative topographic analysis of the large chin. Once these variables are appreciated, an appropriate surgical plan can be formulated.
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