Can My Chin Deformity After A Sliding Genioplasty Be Fixed?
Q: Dr. Eppley, I am about two months after double jaw surgery and sliding genioplasty to correct an open bite and weak chin. Everything is healing nicely, however since day one of my genioplasty, I have noticed that when I raise my lower lip or close my mouth, there is a “shelf” that forms from the mentalis muscle pushing up. It looks like a very deep labiomental fold, however it protrudes enough for me to be able to literally grab onto the muscle that is sticking out. This has been causing me to be tremendously depressed to the point where I’ve gone back to my surgeon and requested a revearsal of the genioplasty. I’ve been hearing about ptosis problems associated with chin augmentations, however mine seems to be the opposite. It looks fine with my mouth is open, however when closed, the muscle seems to be contracted too much and pushing out of my face. All of the doctors I’ve seen at my surgeon’s office seem to think that it will resolve with time, and that the incisions need to mature before the muscles can fully relax. However, it hasn’t shown any improvement. I was told if it doesn’t resolve by April, then it can be addressed, although I hate to wait that long. What I want to know is, what exactly is causing this, what is it, and by which method can it be fixed?
A: In a sliding genioplasty, the chin bone is brought forward and brings with it all of the attached soft tissue. Depending upon the angle of the bone cut of the genioplasty, the amount of bony advancement, the shape of the chin soft tissue pad before surgery, and how the mentalis muscle was sewn back will all influence how the chin soft tissue pad now looks and moves. What you are describing and demonstrating in your picture is a dynamic muscular deformity of the chin pad. (a roll becomes present when smiling, OK at rest) What I would do is first have some Botox injections done into this chin roll to determine if this is aesthetically helpful. If it improves with Botox then it becomes a later question of a mentalis muscle release and repositioning. (this also buys you some time without having the chin pad deformity as well ) If it does not improve with Botox injections then the only improvement is going to come from undoing the genioplasty to some degree. The interesting question in this regards is how much did the chin bone move forward and as it vertically shortened at the same time. In larger sliding genioplasty movements, the chin bone may come forward but may also get vertically shorter. This may cause some soft tissue bunching when one smiles as there is now an ‘excess’ of tissue.
Dr. Barry Eppley