Simultaneous rhinoplasty and genioplasty may be the way to go for many facial plastic surgery patients, especially those with microgenia, a new study shows.

According to the findings, the nose-chin-neck relationship determines an “aesthetically proportionate” face, which is why someone having a successful rhinoplasty can still end up with an out-of-balance face.

Italian researchers followed 90 people who had their noses and chins reshaped simultaneously between January 2002 and January 2004. Almost half of those who had their chin reduced had no subsequent changes in the new chin during 3 years of follow-up, and fully 52% had a stable profile 3 years after chin extension surgery. The findings appear online in JAMA Facial Plastic Surgery.

Performing a rhinoplasty with a chin implant at the same time is often called profileplasty, says Plastic Surgery Practice editorial advisory board member Steven J. Pearlman, MD, a facial plastic surgeon in New York City. “A receding chin can exaggerate a large nose or may even make a nose that isn’t that large appear so by an imbalance in the overall facial profile.”

As many as one in eight of Pearlman’s rhinoplasty patients could be helped by simultaneous chin augmentation. “About half do it at the same time,” he says. “The rest either wait to see how their nose comes out, can’t afford the extra surgery, or aren’t interested. “

But doing both surgeries at the same time does cut down on cost.

American Academy of Facial Plastic and Reconstructive Surgery (AAFPRS) President Robert M. Kellman, MD, the professor and chair of otolaryngology and communication sciences at SUNY Upstate Medical University in Syracuse, NY, agrees with the study authors. “The conclusion as suggested by the authors that a ‘pleasing profile’ is best improved by assuring proper proportions of both the nose and the chin to the remainder of the face is well accepted by those who practice the art of facial plastic surgery,” he says. “A superb nasal repair alone will not make up for a large disproportion in the prominence of the chin, and, in fact, it is commonly accepted that the rhinoplasty result will be significantly enhanced by correcting poor chin projection.”