A cohort of 676 patients who had undergone 712 genioplasties by the senior author over a 30 year period was examined. From this group were culled 18 patients who were deemed not to have had a satisfactory final outcome after multiple previous operations, including removal of residual alloplastic implants, one or more osseous genioplasties, and cervico-mental soft tissue revisions.

In 17 of these individuals, patient satisfaction was obtained after use of a costal cartilage graft, carved into an "autogenous implant" and placed through a submental approach. No infections, displacement, or erosion into bone were noted, and there seemed to be little if any resorption of the cartilage graft.

In one patient who had had 23 previous operations on her chin, the 4mm symphysis did not lend itself to a genioplasty, and the condition of the soft tissues did not seem a promising cover for a cartilage graft. A satisfactory outcome was obtained with an osteocutaneous iliac free flap.

Conclusion: In the patient who has one or more genioplasties and still is considered to have a deficient chin, a costal cartilage graft may provide a satisfactory final result.