Q: Dr. Eppley, I am interested in two procedures, revision rhinoplasty and chin reduction surgery. I nave a over reduced bridge and nasal bone which resulted a polly-beak look and inverted-V. My tip was over rotated and appears shorter. What I am hoping to have done is to bring back the shape of my nasal bone prior to surgery so it has the “Y” shape between my eyes I once had. I did research and found that you use implants and I wanted to see if it was a possibility to use an implant in that area. I took a 3D CT scan right before surgery, so I have access to what my nasal bone was prior to surgery. The second surgery I would like is a chin reduction surgery. I had a sliding genioplasty and immediately had lip issues. I feel my chin appears too long and may have contributed to my lip issues. My lower lip seemed to have rolled into my mouth after surgery and also shows a lot of my lower teeth now. When I take my finger and push up on the skin of my lower chin, it literally resolves all my issues. When I push up several millimeters on my chin, my lower lip rolls back out of my mouth and also takes its shape prior to surgery and covers my lower teeth like before. I have pictures of multiple angles of my face showing my nose and chin. Also a picture of me pushing up on my chin showing the result.
A: Thank you for your inquiry and detailing your surgical history and secondary desires. From a revision rhinoplasty standpoint, restoration of the dorsum can be done with either cartilages grafts or an implant. While an implant would do well for the mid- and upper dorsum, particularly in recreating the Y shape, it can not be used to derotate the tip. Tip work always needs to be done by cartilage grafting to avoid a high rate of complications from the pressure of an implant on the nasal tip skin.
By your description of lip symptoms, reducing the projection of the chin (partial reverse sliding genioplasty) with soft tissue resuspension would offer a combined benefit. Pushing up on the soft tissue chin pad in these situations always improves the lip retraction issue but such a simulated result does not always translate completely into what surgery can achieve.
Please send me any pictures you have of your nose and chin issues.
Dr. Barry Eppley