Posts Tagged ‘chin ptosis repair’
Wednesday, February 8th, 2012
Q: Dr. Eppley, I had a sliding genioplasty two years ago and have suffered with iatrogenic chin ptosis since. I have read in your writings that there is the possibility to resuspend the mentalis muscle using bone anchors to a higher level. Also you have recommended a VY lengthening of the mucosa of the lower lip at the same time.What is very hard to find out is how the patients feel after this surgery concerning to the ability to move the lip sidewards and forward and the movement to evert the inferior lip. Is this type of lip movement uncomfortable afterwards? How is the patients’ sensation moving their lips after a mentalis resuspension? Does it continue to be uncomfortable because of the devascularing nature of the intraoral incision or the mentalis muscle turning it out into an atrophic scar? My concern is that my most important issue that I would really like to repair is functional and I would really like to correct the discomfort I have. Would really appreciate if could please write a few lines about how patients feel moving their lips after this procedure.
A: Chin ptosis after a chin osteotomy is very unusual as the bony movement forward (typical direction) picks up any loose tissue. But it is possible if the chin osteotomy is used to vertically shorten the chin and move it backwards (not a good idea), if the surgeon does not tighten the now excess soft tissues. In my experience with chin ptosis repair, complaints about difficulty with moving the lips or loss of feeling have not been voiced. This does not mean that they may not exist, but that they were not considered significant. I suspect I have have not heard of them because they do not turn out to be problems after surgery.
Dr. Barry Eppley
Indianapolis, Indiana
Tags: chin ptosis repair, dr barry eppley, indianapolis
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Wednesday, November 2nd, 2011
Q: Dr. Eppley, I had a genioplasty with iliac bone grafting five years ago. The result was disastrous. I got a long and prominent chin and it was so completely different than I planned. After that, I had several revisions to get an imprrovement. For example the jaw bone had been suspended back and I also I had a chin reduction. This resulted in an unpleasant scar under my chin. Now the chin soft tissue is scarred and hanging down. If my mouth is closed I feel a strain on the chin muscle. During relaxation my lower lip hangs down showing my bottom teeth. The mentalis muscle shows a strong contraction.
I couldn´t find any surgeon who had enough knowledge in this specific area of genioplasty revision and chin ptosis. In various discussion forums about this topic I came across your name. I hope that your skills and experience in this special field could be helpful in my case. Is there any possibility to solve my problem and what could this be? What is the probability of improving my situation? Your help would be very much appreciated. I have attached some pictures for you to see my chin problems.
A: Your chin surgery history and outcome has certainly been that of a nightmare. What you currently have is chin ptosis with severe contracture. What need is an intraoral approach to release the scarred chin tissues, mentalis muscle resuspension with suture anchors and a V-Y vestibular closure. Your submental scar should also be released and revised. The divot (indentation) in your chin would be treated by the placement of a small dermal-fat graft at the same time. All of these procedures would be done simultaneously address all of your current chin problems. My experience in doing these chin ptosis repair procedures is that improvement is always obtained, it is just a matter of the degree of improvement.
Dr. Barry Eppley
Indianapolis, Indiana
Tags: chin ptosis repair, dr barry eppley, genioplasty revision, indianapolis
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Friday, November 5th, 2010
Q: There seems to be a multitude of people out there with chin/lip problems arising from intraoral surgery who don’t know where to turn or what to rely on to remedy their situation. Mostly their problems are attributed to mentalis detachment/loosening and scar tissue, particularly in the labiomental fold region. Chin/lip deformity poses a significant quality of life issues and must be taken seriously. A case study of scar revision in this instance, with before and after photos and details of the surgery, would be of great assistance. Mentalis resuspension seems straight forward enough if its loosened or detached from its origins. The question in my mind with regards to scar tissue excision, is how much mentalis muscle in the labiomental fold or chin pad region, can be safely excised before the mentalis can no longer function properly?
A: Ptosis, or sagging, of the soft tissues of the chin can occur after any form of chin surgery done through an intraoral (inside the mouth) approach. When it occurs, one surgical method to put the soft tissues back onto the chin bone is mentalis resuspension. This is fairly way to do and the most important technique for the procedure is how the muscle is secured back to the bone.
Generally speaking, the only scar tissue that ever needs to be removed during any chin revisional surgery is the scar capsule around an existing chin implant. (if the implant is being removed) This needs to be removed because it will not allow the overlying muscle to heal back onto the bone.
Dr. Barry Eppley
Indianapolis Indiana
Tags: chin ptosis repair, dr barry eppley, indianapolis, mentalis muscle suspension, plastic surgery
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Thursday, September 9th, 2010
Q : I had a sliding genioplasty surgery with bone graft on my jaw angle on the 17th of august, before the surgery when i smile my chin tissue protudes downward (chin ptosis) the oral maxilofacila surgeon told me he can fix it during the sliding genioplasty surgery, its been 3 weeks now, and when i smile my chin tissue still protudes downward, i told him about it and he said my mental labial fold has not heal completely thats why it protrudes downward, i think is cos he didnt move my chin forward enough. i wan to send photo to you so you can see what i mean, i really want to get this fixed asap.
A: Generally, a sliding genioplasty will pick up loose chin tissues as it comes forward. Thus correcting a pre-existing chin ptosis. It is not so much that the bone is advanced, but the mentalis muscle and the chin skin are pulled back over a longer bone surface. This is essentially the reverse of what happens when the bony chin is set back (not a good idea) as there is too much chin soft tissue that has less bone surface to be suspended and it will then droop.
Why your chin ptosis did not at least get some correction with the advanced bony chin is not clear. The one possibility is that the mentalis muscle was not put back or resuspended as well as it could be, thus negating the effects of better bony support. This is easily corrected at this early point after surgery as little actual tissue healing has occurred. More time and having the swelling go down further will not likely show an improvement. I would recommend re-entry and better muscle suspension.
Dr. Barry Eppley
Indianapolis, Indiana
Tags: chin ptosis repair, dr barry eppley, indianapolis, plastic surgery, sliding chin osteotomy
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Monday, May 31st, 2010
Q: Where to start? I had a chin reduction at a hospital overseas in 1992. I have never been happy with it. I have always been so self conscious that it looks odd to people when they see me from certain angles. I also felt that it was too extreme and not what I had pictured the result would look like. I also have a metalplate in my chin and too much fatty tissue in the front chin area. Is it possible to have the chin operation redone so it looks better? Or is a chin implant the answer for me?
A: Chin reductions can create unhappy results if not done properly. When you reduce bony support, you have to account for the overlying soft tissue. Reducing bone requires stripping off all of the chin pad tissues, there must be a way to satisfactorily reattach it and reduce or tighten these soft tissues. If not done, the chin bag will sag down and look like a lump of fatty tissue. Doing a chin reduction without simultaneous soft tissue management is akin to doing a breast reduction but without reducing and tightening the loose overlying skin.
There are three approaches to managing a sagging or ptotic chin pad. They include an intraoral muscle resuspension, a submental chin tuck-up, and the placement of a chin implant. Which approach is best depends on how on much the chin pad sags and one’s facial profile and appearance. If one is happy with their profile (chin not deficient), then either a muscle suspension or a submental tuck-up will work. The difference between the two depends on much tissue there is to tighten and whether one can accept a scar under the chin. If one feels that their horizontal chin position is short, then a chin implant would be preferable.
Dr. Barry Eppley
Indianapolis, Indiana
Tags: chin implants, chin ptosis repair, chin reduction, dr barry eppley, indianapolis, plastic surgery
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