Q: Dr. Eppley, I found your website, and I was wondering if you could offer a suggestion in my case. I had jaw surgery twice several years ago. First, a 2-piece Lefort I, IVRO, and a jumping genioplasty was done. (I was a skeletal Class II with anterior open bite.) The surgery, in every aspect, was poorly done and I had a re-do Lefort I six months later. Again, the outcome was not good, and I underwent re-do 2-piece Lefort I, BSSO, and re-do chin osteotomy about 10 weeks ago (with a different surgeon). In this final surgery, bite correction was achieved, and in most respects, it was a success. But I am still unhappy with the appearance of my chin. I have significant step-offs from the first genioplasty. In the re-do, my surgeon shaved down the bone (no cuts) in the front, but did not address the step-offs. From the ceph x-ray, it seems the bony part of the chin is in the right place, but I have significant soft-tissue protrusion that I am very unhappy with. I believe the success of the re-do was compromised by the technique used by the first surgeon (not sure why he didn’t do a sliding genioplasty, as my chin was not terribly receded in relation to my jaw). I am concerned that a third procedure to “correct” the chin may cause more harm than good, but I am not sure. I am also not sure how much swelling I still have in that area. I did not have this amount of soft tissue in the front of the chin area before the first surgery. It appeared after the first surgery, and only increased with the most recent surgery. The step-offs are clearly visible from the front and side, in addition to my being able to feel them. Thank you for your time.
A: I am very sorry to hear of your very complex orthognathic surgery history. From a chin standpoint you had a jumping genioplasty (I have never liked this chin osteotomy technique) which has it own lateral step-off issues. Then the last genioplasty procedure burred down the front edge of the bone which is guaranteed to create a soft tissue excess issue. All of these genioplasty techniques understandably have left you with step-offs and some degree of soft tissue ptosis/sag. While you aren’t quite three months from the last surgery, I see no reason that your chin issues will improve with time. The best way in my experience to address these chin problems are from a submental approach for your genioplasty revision for chin reshaping. The step-off chin defects can be filled in and the chin sag removed with a submental tuck technique.
Dr. Barry Eppley