Q: Dr. Eppley, One month ago I had an intraoral chin reduction surgery. This consisted of bone burring on the sides because I have a round face and had a somehow wide chin. I like the results of the chin, but can’t realy enjoy it because I am left with an inverted bottom lip! My surgeon says it takes time for the muscles to get used to the new form of the chin, but for me is not a satisfying answer, as my chin muscles move completley fine and also my lip. Also, from my reasearch, inverted lip seems to happen with chin augmentation, not reduction! Chin does not sag so mentalis muscle seems ok. I do have a tight feeling in the chin, When hand pulling lip up it does not strech as it used to. Is this scar tissue issues? contracted mentalis muscle? Did it attached to low? From what I can appreciate the indentation under my lip is at the same height. It just feel like tightness is pulling everything down and my lip responds by going inside. Would steroids injections work? Ultrasound? D o I need a scar revision surgery ( inside mouth scar seem ok ). Is just the muscle still tighten after the trauma?I am very distresed as I had a beautiful mouth and smile and now it looks so tense and unatural. Please consider answering my questions.
A: Thank you for sending all of your pictures. Mentalis muscle dysfunction is very common after intraoral chin procedures as the muscle must be completely detached to do the procedure. Since the muscle is put back together by sutures, there can be a period of tightness/distortion based on how tight it was put back together. While you may think the mentalis muscle fine, that is the main tissue injured during an intraoral approach. Whether it will have a complete recovery on his own can not be predicted. But the protocol for your recovery is as follows:
1) Stretching/massaging the lip and chin is helpful as you have already demonstrated. Such maneuvers should continue for another month.
2) Do NOT inject steroids as they are a destructive chemical that has unpredictable effects in tissues like muscle and fat. It may ultimately cause a worse problem in the long run.
3) If some improvement continues over the next month, then let natural healing takes its course.
4) If there is little to no improvement in another month, fat grafting either by injection or a small dermal-fat graft into the tight area would be the proper treatment.
You have plenty of time to improve as total healing takes up to six months. You have to be patient with this process. Impatience makes people do things that may not be prudent.
Dr. Barry Eppley