Chin Ptosis Correction

Q: Dr. Eppley, I am interested in chin ptosis correction by reduction of bone through burring or shaving (to reduce blunt and  long chin) and chin resection for removal of excess soft tissue to correct my chin ptosis. I had a sliding genioplasty and ever since I have always had a problem when I talk or smile. My chin pad or mentalis muscle drops below my chin bone. It’s a problem that I hate so much! I though the sliding genioplasty would ix the problem but it didn’t. It also made my chin look loner not shorter. 

As part of the chin reduction, I would want a prejowl chin implant, medium size by Implantech, secured with screws for forward chin projection.

A: A: In regards to your chin ptosis correction, I think you are spot on for what will solve your chin concerns. Only a submental resection of the overhanging chin pad will get rid of the ptosis that you have. Adding a chin implant will have a complementary effect in that regard as well as provide some forward chin projection. Horizontal chin augmentation is another method that can pick up or fill out a loose chin pad.

Dr. Barry Eppley

Indianapolis, Indiana

Chin Ptosis Correction

Q: Dr. Eppley, I am interested in chin ptosis correction. I originally had a chin implant ten years ago. Following an accident in nine years later the implant moved and it was changed with a new implant last year. This new chin implant was much too large for my face and was removed six months later. Following the removal of the implant I developed chin ptosis with too much lower teeth show when I opened my mouth.

I subsequently had a chin ptosis corrective surgery three months ago with bone anchors. The result from the chin ptosis surgery is substantially the same as before the surgery but now my lower lip goes in on the right side when I smile or I speak or when I open my mouth my lower teeth sees too much. When I talk I have trouble to articulating my words, maybe because of the new position of my mouth. I saw the surgeon again last month for this problem again and he did Artecoll to correct the irregularity of the chin and  offered me another surgery to remove the extra skin under the chin and to do Botox to correct the defect of the lower lip.

I did not accept these proposals because I want to have first your opinion and advice. The surgery to remove the extra skin under the chin makes me nervous because now when I open my mouth my lower teeth show too much and I fear that this problem will be accentuated with this surgery. Now I really need your advice and your help. I’m sure you could find a solution to restore my chin. I read your publications regarding chin ptosis and possible treatments could be a small implant or 2 or 3 mm osteotomy for support under the chin could help or neck lift. I have seen before and after pictures on your web site concerning this surgery in which you made all this women much more beautiful. Thank you very much for your answer. 

A: The first thing is I would not rush into any surgery immediately. It has just been three months and your tissues are still healing. If too much lower tooth show is the primary concern any type of submental tissue removal would not help in that regard. Given your history of multiple chin implants and now being ‘implantless’, it appears that an important part of getting your lip back up may be the placement of a new smaller implant to help drive the tissues upward or possibly even making the vertical length of the chin shorter. Lower lip sag is a very difficult problem that is not easily solved.

Dr. Barry Eppley

Indianapolis, Indiana

Chin Ptosis Repair

Q: Dr. Eppley, I am interested in chin ptosis correction. I originally had a chin implant ten years ago. Following an accident in nine years later the implant moved and it was changed with a new implant last year. This new chin implant was much too large for my face and was removed six months later. Following the removal of the implant I developed chin ptosis with too much lower teeth show when I opened my mouth.

I subsequently had a chin ptosis corrective surgery three months ago with bone anchors. The result from the chin ptosis surgery is substantially the same as before the surgery but now my lower lip goes in on the right side when I smile or I speak or when I open my mouth my lower teeth sees too much. When I talk I have trouble to articulating my words, maybe because of the new position of my mouth. I saw the surgeon again last month for this problem again and he did Artecoll to correct the irregularity of the chin and  offered me another surgery to remove the extra skin under the chin and to do Botox to correct the defect of the lower lip.

I did not accept these proposals because I want to have first your opinion and advice. The surgery to remove the extra skin under the chin makes me nervous because now when I open my mouth my lower teeth show too much and I fear that this problem will be accentuated with this surgery. Now I really need your advice and your help. I’m sure you could find a solution to restore my chin. I read your publications regarding chin ptosis and possible treatments could be a small implant or 2 or 3 mm osteotomy for support under the chin could help or neck lift. I have seen before and after pictures on your web site concerning this surgery in which you made all this women much more beautiful. Thank you very much for your answer. 

A: The first thing is I would not rush into any surgery immediately. It has just been three months and your tissues are still healing. It would be helpful to see pictures from different angles for a more complete assessment. If too much lower tooth show is the primary concern any type of submental tissue removal would not help in that regard. Given your history of multiple chin implants and now being ‘implantless’, it appears that an important part of getting your lip back up may be the placement of a new smaller implant to help drive the tissues upward. Soft tissue suspension alone appears to have been inadequate.

Dr. Barry Eppley

Indianapolis, Indiana

Will Vertical Wedge Excision for Chin Ptosis Correction Work

Q: Dr. Eppley, I am interested in chin ptosis correction.  I had two prior jaw surgeries (one orthognathic with sliding genioplasty). My mentalis muscle has been weakened and my lower third (chin particularly) looks bulkier because of this. There is some excess soft tissue around my chin as well (skin, maybe some fat). I’ve been thinking about mentalis muscle re-suspension, when I stumbled across this article which explains an alternative of Vertical Wedge Excision of Chin Ptosis.
This seems to me like a minimally invasive procedure with dramatic results that comprehensively addresses all laxity (muscle and skin). I wanted to ask you for your opinion on this, since I am worried about the longevity of the result when no sutures are used to resuspend the mentalis muscle. Perhaps a combination of both would be the way to go? Would you be able to perform this procedure preferably under sedation rather than general anesthesia as it involves no bone work? Also, since I am not from the States and would like to travel only once, would you be able to give me an indication of the approximate cost? I have attached here a picture for your reference – my problem seems to be largely excess soft tissue around the chin which makes it longer, bulkier horizontally and vertically and even asymmetrical, similarly to the pictures shown in the article that I linked above.

Thank you for your advice in advance.

A: Chin ptosis is a multifactoral problem that has different anatomic variants. Thus there is no one single best chin ptosis correction procedure. The first important classification is whether the chin ptosis is associated with a lower lip sag or not. If there is no lower lip sag there is no benefit to mentalis muscle resuspension or trying to move the chin tissues back upon the bone.

The next important chin ptosis classification is whether there is excessive chin tissues or whether there is a normal amount of tissue volume. If the overhanging chin tissues are normal in volume, and their resection may be associated with causing a lower lip sag, then resuspension should be done. When the ptosis is caused by excessive chin tissues then resection would be the appropriate approach.

When it comes to resection of the chin pad, it can be done horizontally (under the chin), vertically (as shown in the article) or through a combined vertical and horizontal technique. (inverted T) There is no question that adding a vertical direction to the chin pad excision provides an additional element of chin pad reduction that is helpful, it is just a question of the scar that can result from it. Once you go vertical, the scar is going to be noticeable since it is above the submental region. Whether the scar would be aacceptable depends on the magnitude of the excessive chin pad and the patient’s skin type. This article, which does not really describe a novel technique in my experience, shows a single case done on a Caucasian female. The resultant scar can be quite different in men of certain ethnicities.

But regardless of technique, any soft tissue chin work can be done under local/IV sedation.

Dr. Barry Eppley

Indianapolis, Indiana

Will Removing A Chin Implant Cause Ptosis (Witch's Chin Deformity)?

Q: Dr. Eppley, I am ready to get my infected chin implan removed but since it is my face I want to make sure I’m getting the most qualified person to do it. If you were in my place are there any particular questions or concerns that I should make sure my surgeon has dealt with to reduce risk of nerve damage, ptosis since it is a pretty large implant? The implant was placed through the mouth. Also have you ever used hyperbaric oxygen therapy? Could it help reduce post operation healing time? How many

work days would I need to take off to be able to return to work? Would you use any head dress?

A: In theory , any surgeon that places chin implants should be able to remove them. The issue that you need to be aware of, particularly since this is a big implant and you are removing it from inside the mouth and are not replacing it, is the high likelihood that chin ptosis will result. (sagging of chin tissues off of the bone since that are now stretched)You will likely need a simultaneous muscle resuspension done at the same time to avoid this potential aesthetic problem. There is no benefit to hyperbaric oxygen (HBO) therapy in surgical removing an infected chin implant. HBO has benefit in irradiated tissues where the native blood supply is compromised. If the muscle is resuspended to the bone, there is no need for a chin dressing afterwards. A chin dressing is not going to prevent chin soft tissue sagging anyway.

Dr. Barry Eppley

Indianapolis, Indiana

How Can I Fix My Low Hanging Lip And Gum Show After Chin Implant Removal?

Q: Dr. Eppley, I really appreciate you for trying to help me out at this miserable situation. I had chin implant removal surgery 16 days ago. Dr. took out my Medpore implant from inside my mouth. Fortunately the look of my chin has not changed dramatically but the problem is when I talk you can see my lower gum which is a disaster to me and hurting my confidence badly. I saw my surgeon one week after the surgery and he said I should wait for six weeks, but now after more than two weeks the problem looks getting worse. My question is if this problem gonna improve? if not is there any fixation in the future for this problem or not?

A: What you are experiencing is a soft tissue chin ptosis problem. When implants are removed from an intraoral approach, it is important to resuspend the mentalis muscles and soft tissues of the chin. Remember that they have been stretched out from the implant and then cut through for the removal of the implant. If not tightened and resuspended to the bone, they will both fall and contract downward, exposing increased tooth and gum and even creating lower lip incompetence. I doubt that the tissues will magically move upward as they heal. But I would wait three months after surgery and make a decision then. I suspect you will need a soft tissue/mentalis muscle suspension for correction of this problem.

Dr. Barry Eppley

Indianapolis, Indiana

Is A Sliding Genioplasty The Best Way To Treat Chin Ptosis?

Q: Dr. Eppley, I had a chin implant inserted 8 months ago, which turned out to be too big. I was very unsatisfied with the result and it was removed 2 months after the initial surgery, which is 6 months ago from now. The problem is that chin ptosis has developed. I am suspecting that adequate mentalis reattachment was not performed after the implant removal. Moreover, the central part of my lower lip would not move downwards, even when I smile widely, always covering my lower incisors totally. This seems different from typical lower lip incompetence caused by mentalis muscle ptosis, since I believe that ptosis of mentalis muscle causes lower lip to drop downward with inability to close mouth properly. This lower lip issue is not a newly developed problem, since it was present immediately after the initial implant insertion surgery and never went back to normal. Also, my lower lip seems to have become shorter in vertical length. My labiomental sulcus area looks like the soft tissue is fixed to the bone making it look unnatural when i speak or smile. I am thinking a mentalis resuspension would help my problems but my question is why would my lower lip not move downwards? This sometimes interfere with my pronunciation when I speak which bothers me a lot. One more question is would sliding genioplasty combined with mentalis resuspension give a better result than mentalis resuspension alone? I want to know the best solution to correct my problems. I am looking forward to your answer. Thank you.

A: You are correct in that the lower lip may sag with chin ptosis in some cases, but not always. Many chin ptosis patients have a normal lower lip position and function. Rarely you will have a patient like you who has the opposite lower lip problem in which the lip will not evert. This can occur if the implant was inserted from below (submental incision) and the implant pocket was made up close to the mandibular vestibule. This disrupts the attachments of the labiomental sulcus and blocks lower lip eversion. Even when the implant is subsequently removed, the muscle fibers remain disrupted.

Since there was a reason you had the chin implant in the first place, it would make the most sense to consider a sliding genioplasty. In that way all three problems can be simultaneously treated. (chin deficiency, chin ptosis, labiomental sulcus muscle repair)

Dr. Barry Eppley

Indianapolis, Indiana

 

Can The Sag Of My Chin Be Fixed After A Chin Reduction?

Q:  I had a chin reduction a couple of years ago and although I am happy with the new shape of the bone, I now have hanging soft tissue. Needless to say I am not happy with these results. I have visited five plastic surgeons and none of them wanted to fix this problem saying that it was dangerous to cut or reattach the muscles and the ending results could be worse. I am very dissapointed and have attached some before and after pictures for your review. I hope you can help.

A: Your pictures show quite clearly some soft tissue sag or ptosis off of the chin bone. It is most pronounced centrally which is what one would expect given that your chin reduction was most likely an intraoral burring approach done to the central button.  To improve this problem there are two approaches, intraoral muscle resuspension or a submental tuckup. The intraoral approach uses a suture anchor to the bone to reattach the muscle and tighten it back done. This is a scarless approach. The submental tuckup  uses an incision under the chin where the loose skin and muscle is removed and tucked or tightened to the bone. Each has its own advantages and disadvantages. The intraoral approach avoids a scar under the chin but the submental tuckup is a more reliable method.

There is no danger to performing this procedure and there is no chance of making the problem worse. Whoever has said has either never treated the problem or is completely unaware that such surgical correction exists.

Dr. Barry Eppley

Indianapolis Indiana