Q: Ever since my chin osteotomy was done over a year ago, the muscle in my chin does not seem to be working right. It feels tighter on the right side and dimples in when I smile or make a pout or blowfish face. It feels tight all the time and twitches often. Can muscle work be done on the chin without having to do anything with the chin bone? I do not want to go through another chin osteotomy. I have attached some photographs, at rest and in animation, for your review.
A: Thank you for sending those very illustrative photographs. I couldn’t have asked or instructed you to take those animated views any better. The one observation that seems to be consistent is that there is mentalis muscle asymmetry, both at rest and in animation. With your history and photographs this suggests to me that the right mentalis muscle has been tightened, lifted more or otherwise sewn donw tighter to the bone. This would explain why the right side has better lip competence (elevation at rest) but moves and feels abnormal.
Given that you are over one year months from surgery, I would expect to see no improvements or changes. You certainly could have some muscle done on that side. That would require no bone work or secondary chin osteotomy. Your chin bone position and overall facial appearance look very good to me, very balanced. That is a very simple procedure that could be done under local anesthesia or IV sedation. It is nothing like what you have experienced with the original chin osteotomy. I would go intraoral on that side and release part of the mentalis muscle in the area where the greatest dimpling is/loss of labiomental fold. I would then place a small dermal graft so the muscle in that area stays released.
I couldn’t guarantee that that would be a complete cure but there is no downside (can’t make it worse) and it is fairly simple to do with no real recovery.
Dr. Barry Eppley