Can My Chin Be Fixed?

Q: Dr. Eppley, I am writing to you in the hope of receiving your guidance regarding a previous chin surgery that has unfortunately resulted in deeply distressing and long-lasting complications. Years ago I underwent a chin reduction procedure which n hindsight, I have come to understand the following: My very prominent chin was partially a result of orthodontic treatment that, in retrospect, should have been handled differently. I had an underbite which was corrected solely through braces, when surgery in combination with orthodontics would likely have been the appropriate course of action. I had (and still have) an excess of soft tissue in the chin area, which was largely responsible for the visible protrusion—especially noticeable when I laughed, spoke, or smiled. Unfortunately, the outcome of the surgery was very poor, both aesthetically and functionally. Over the years, I’ve consulted multiple plastic surgeons, including facial specialists, but none have been able to offer any real help. Many have assessed the case as too complex and beyond their expertise. Some even consulted colleagues and returned with the same conclusion—that nothing could be done. This has left me feeling hopeless at times. Regrettably, I have never been in contact with a maxillofacial specialist before—something I now realize would have been essential from the beginning. Through extensive personal research, I now understand that my case would partially fall under the field of maxillofacial surgery. I would like to briefly describe my current issues and have attached some photographs for your reference.

Summary of current concerns: There is a clear asymmetry in my chin. The bone appears to have been improperly treated or fractured, resulting in an uneven shape and a protrusion on the left side. This becomes especially noticeable when I speak or contract the area, as the soft tissues seem to sit unevenly over the bone. I also suspect possible nerve damage in the region. The soft tissue has redistributed unnaturally since the procedure, leading to abnormal facial expressions during speech and movement. This includes unusual contractions and tensions, and I strongly suspect that a nerve may have been affected or injured. Liposuction was also performed under the chin, with an incision about 1 cm below the chin. This scar and intervention have altered the appearance of the area—especially in profile—and contribute further to the unnatural look. Altogether, I experience abnormal movement of the chin, accompanied by tension and deformations that affect both my appearance and my self-esteem. The deformities become even more visible when I speak. As a result, I struggle intensely with being filmed (to an abnormal degree) and avoid having my photo taken unless I’m fully prepared. I know that you are an expert in this are and I am wondering if you might be willing to review my case and assess whether there are any possibilities for correction or improvement.  I hope I didn’t bore you and I hope that i could receive some sort of answer from you. Thank you so much for taking the time to read this. I look forward to hearing from you.

A: Thank you for your inquiry detailing your surgical chin history and your present concerns. From my standpoint there is nothing mysterious for elusive about understanding the anatomy of your current chin problem. This is simply the long term effect of having too much soft tissue chin pad tissue for the bone support that it now has which is a direct result of reducing the chin bone and not factoring in at the initial surgery the ultimate soft tissue contracture that is going to occur. This is a common surgical oversight in my experience with chin reductions and I see such complications of differing magnitudes all the time. Surgical improvement can definitely be achieved which requires a soft tissue chin pad release, reduction, perhaps secondary bone smoothing as well as the introduction of some new healthy tissue via fat grafting. Well this approach may not make your chin have a perfectly smooth appearance like it did before the initial chin reduction it certainly is going to make a major improvement.

The reasons surgeons have told you that your chin problem is not improvable is for two reasons. First and foremost they probably have never seen this chin problem before and therefore have no idea how to properly treat it. Equally they may also understandably feel no need to take on a difficult problem that they themselves did not create. Thus their proper answer to your problem should have been that they either do not know how to treat it or do not desire to take on the assignment.

I would have no idea who in Europe has experience in treating secondary chin problems like yours. This does not mean that surgeons do not exist who are capable of helping you. It merely means I would not know who they would be.

Dr. Barry Eppley

World-Renowned Plastic Surgeon