Tridimensional Genioplasty through T-shaped Osteotomy - A Technical Note

Abstract Genioplasty remains a key procedure in facial aesthetic surgery, particularly regarding gender affirmation, due to the significant role of the chin in defining lower facial proportions and sexual dimorphism. While T-shaped osteotomy (TSO) has conventionally been used to narrow the chin in feminisation procedures, its ability to provide three-dimensional (3D) control of bone segments also enables vertical and transverse modifications, including widening when combined with anterior advancement and controlled rotation. The sequential protocol using a 3D plan and customised surgical guide for osteotomy and reposition has not been fully published. This paper aims to report the use of TSO for combined advancement, vertical reduction and proportional transverse remodelling in a male Class II patient undergoing orthognathic surgery. The patient presented with retrusive, narrow and elongated chin morphology associated with Class II skeletal deformity, and underwent orthognathic surgery complemented by TSO genioplasty. Virtual surgical planning and customised surgical guides were manufactured. The technique included controlled bone segment repositioning to achieve both projection and desired contour. TSO provides a versatile and biologically favourable approach for genioplasty in aesthetic facial surgery.