Purpose The purpose of this retrospective cohort study was to identify the causes of requiring reoperative genioplasty and determine the factors associated with reoperation. Methods Medical records and radiographs of patients who underwent genioplasty were reviewed. The demographic data, characteristics of operation, and treatment outcomes were gathered to analyze the causes that required reoperation. Descriptive statistics and logistic regression analysis were computed to evaluate the study. Results Of the 157 patients included, there were 12 patients (7.6%) who needed reoperation after genioplasty. Age <= 25 years significantly decreased the likelihood for the need for reoperative genioplasty compared with age > 35 years. However, the need for reoperative genioplasty was not directly associated with gender, simultaneous orthognathic operation, direction and amount of movement, method of fixation, or bone graft interposition. Fixation failure, esthetic problems, residual obstructive sleep apnea, and palpable step at the inferior border of the mandible were the causes that required a second operation by reposition and re-fixation with rigid fixation, recontouring, or reoperation by genioplasty. Conclusion Genioplasty procedure provided a predictive result. A reoperative rate was only 7.6% and younger age decreased the risk of reoperative genioplasty.