INTRODUCTION: Along with the nose, the chin is arguably the most important aesthetic feature of a face in profile. Patients with extreme protrusion of the chin may seek treatment for this rare condition, but as of yet there is no consensus as to what the optimal surgical management is. We describe our experience with a new adjunct to the traditional reverse sliding genioplasty. METHODS/MATERIALS: In the previous four patients with this problem, a reverse sliding genioplasty was performed, with rotation of the osteotomy segment in a posteroinferior direction in the vertical plane. RESULTS/CONCLUSIONS: Historically, protrusion of the chin has been a difficult aesthetic problem to treat. Burring and cutting of the protruding chin was done in the past, with disastrous soft tissue consequences resulting in witches chin deformity. Reverse sliding genioplasty has provided an improvement, but it results in slack in the genioglossus, geniohyoid, and mylohyoid muscles. We have described a modification to the reverse sliding genioplasty in which the osteotomy segment is rotated to give more vertical dimension to the chin, and to maintain the normal tension of the soft tissue. We believe this gives superior results to previously described techniques.