Can I Correct Lower Lip Ptosis and Soft Tissue Chin Pad Excess At The Same Time?

Q: Dr. Eppley, I have read many of your articles and I am impressed with your ability and skill to help many patients that other surgeons cannot seem to.

I have issues with my chin after surgery in the same way as some of your case studies suggest.

I had bimaxillary jaw surgery in 2007, in which the surgeon performed a sliding genioplasty that left me with a chin that was too horizontally and vertically large, as well as far too projected past my lip. In 2010 I had the lower jaw screws removed, as they were creating visible lumps on my jaw. This was via an intraoral incision.

In 2018 I finally had a chin reduction, I think by burring, and via an intraoral incision. The surgeon also performed a mid-facelift to help with tightening the skin after reduction- although I would have thought it should have been a lower. Not enough was taken off the chin, however, and in 2019 I had it revised via another intraoral incision. It was flattened projection-wise, but not narrowed or shortened enough, leaving a rather wide, and vertically long (mainly when I smile) chin still, but with excess soft tissue that now is unsightly and causes me problems including lip ptosis.

My lips no longer sit together when relaxed, and talking is very uncomfortable- some times more than others, as I have to stretch my top lip down to pronounce certain words, and my mouth feels very tight when doing this. (I also have a long mid-face, which may contribute to this). I also have a very dimply/scrunchy chin unless I get Botox/Dysport in it, which doesn’t entirely fix it.

I also embarrassingly find myself dribbling sometimes if I am not consciously holding my lips together, which is uncomfortable to do all the time.

I have since tried to do some research and realised that the intraoral approach can create lip/chin ptosis. Especially since I have had it four times for the varying reasons. I am looking for someone to help me tighten the chin area with soft tissue excision, correct the lip ptosis, and even further vertical and horizontal chin reduction. I am aware it would likely require an external incision approach and I am happy to undergo that to fix the problem. I live in Sydney, Australia, and first would sincerely appreciate if you knew of a good surgeon in Australia (preferably NSW), who could surgically address my concerns. Otherwise, if I could get some advice or have a consultation with yourself about the steps I need to take to fix it.

Thank you so much for your help, and kindest regards,

A:Thank you for sending your pictures and detailing your surgical history and current lip-chin problems. In summary you have a redundant soft tissue chin pad with some lower lip incompetence. These are very diametric problems as soft tissue chin pad excess is treating by the removal of tissue (submental excision) while lip incompetence is treated by the addition of tissue.  (intraoral vestibular shortening and dermal-fat grafting) But the soft tissue removed from the submental excision could be used as the tissue graft for the vestibular release. So while there are diagnostically diametric they are procedurally synergestic.

Dr. Barry Eppley

World-Renowned Plastic Surgeon