Symphysis graft procedures are being performed in clinical practice more frequently than ever before. Convenient surgical access, proximity of donor and recipient sites, low morbidity, availability of larger quantities of bone over other donor sites, minimal resorption, no hospitalization, and minimal discomfort are some advantages of this procedure over other intraoral sites. Three types of horizontal incisions can be performed during this procedure: the sulcular, the marginal, and the alveolar mucosal. Most studies regarding the chin graft technique are more concerned with the bone graft aspect than soft tissue management. Moreover, the criteria for the selected flap design appear to be based primarily on clinical experience or the same surgical approach regardless of interfacing factors. The periodontal status, amount of bone loss, periodontal risk of root fenestration, amount of keratinized gingiva, restorations in the gingival margin, and local musculature are some of the clinical findings that should be assessed to indicate the best incision design. In this review article, the advantages, disadvantages, indications, and contraindications of each incision design will be discussed.