Can A Mentalis Muscle Resuspension Be Done Without A Sliding Genioplasty?
Q: Dr. Eppley, I am writing regarding your expertise on mentalis resuspensions, chin fat pad resuspensions, interoral shortening vestibuloplasty & sliding genioplasties.
Two years ago I had a free gingival gum graft performed. The periodontist also did an extensive and complete mandibular vestibuloplasty as part of the gum graft that included the intentional detachment of my mentalis muscles and a full and deep blunt finger dissection of the vestibule from rear molar to rear molar.
I have now significant discomfort and dysfunction. My lower incisors, all show when I talk or open my mouth. I had immediate speech dysfunction and a pronounced lisp following the vestibular deepening. My lower lip does not close properly. I have to throw my lower lip up to get it to close to the upper lip. I drool constantly and have to suck it back in. The lips both have changed shape completely and sag down noticeably like a very old person in their 80’s, I am half that age. My lower lip has changed color to a darker hue and is very dry looking. I can’t keep food out of the sides of mouth and my tongue can’t clear it. My chin is a completely different shape. It’s flat and a lot tissue has gathered at either lower corner. It’s like my face was cut off and it just sags down.
Years earlier I had a chin implant put in extraorally from under the chin. I had it removed extraorally as well due to aesthetic concerns as it was far too big and the wrong contour to my face.
I am wondering what, if anything, I can do. In my research it seems I need a mentalis resuspension in combination with one or more other procedures including perhaps a fat pad resuspension, vestibule shortening & a sliding genioplasty, To be honest I would rather not do a sliding genioplasty if possible but most surgeons seem to recommend it to take up loose tissue. A question I do have is – Is it possible to do a mentalis resuspension without doing a sliding genioplasty?
Any advice would be appreciated.
A: Thank you for your inquiry and detailing your surgical history and current problems to which I can say the following:
1) On a conceptual basis you have to go back and look at the origin of the problem and then adapt a treatment that is focused on reversing it. As you have described with the deepening vestibuloplasty from molar to molar the tissues have indeed been released and lowered. So efforts along the line of a shortening vestibuloplasty would seem appropriate.
2) While it is true that any form of chin augmentation (implant or genioplasty) can help with the success of mentalis resuspension, I wold be cautious about that in your case. Your history would indicate that you should limit the variables in any corrective approach. You have already learned well that not everything always goes according to plan, despite the best intentions, and you certainly don’t need to develop any new complications from a procedure that you do not feel is essential. In other words, you do a chin augmentation IF it remains an unfulfilled aesthetic desire. I cannot pass judgment on that ‘need’ based on a single frontal picture.
3) A mentalis resuspension can be done without a sliding genioplasty and most of the time is done without it. It can be useful to apply a sheet of ePTFE on the front portion of the chin to give the tissues something to grab into to help hold it. But I would certainly not use a sliding genioplasty for that purpose unless that was already desired to be done anyway. (which has you have already stated it is not)
Dr. Barry Eppley
A detailed description and pictures of your concerns allows for the most informed response.