Deep Labiomental Sulcus
Q: Dr. Eppley, I had orthognathic surgery ten years ago to correct a class II malocclusion. I had a LeFort I osteotomy, sagittal split mandibular osteotomies and a sliding genioplasty. I am very happy with my bite. My teeth meet and my quality of life has been greatly improved. There are a few things that I am unhappy about that have gotten worse as I have aged and my face is getting thinner. The deep mentolabial sulcus I have that makes me look like I have a tiny stuck on chin, my high angle jaws, and my super long philtrum. I’d love to resolve all three of these issues but, if I were to pick the most important to me they would be my chin and my long philtrum. I am not looking to transform into a new person. I want to continue looking like myself but, with some improvement.
Please tell me if I am off base with my assessment of my deficiencies. I’d love to have your professional opinion.
A: I would agree completely with your assessment from the concerns of a deep labiomental sulcus, the long philtrum and the high jaw angles.
Your chin shows a classic long-term sliding genioplasty outcome in which the labiomental sulcus has gotten deeper in the step of the bone cut. This can be improved by a dual approach of placing a labiomental implant on the bone and possible fat grafting at a more superficial level. (although filling in the step of the bone usually suffices) The long philtrum can be treated by either a subnasal lip lift or a more complete upper lip vermilion advancement. That choice depends on how you want to see the lip change. The high jaw angles can be treated by small vertical jaw angle implants.
Dr. Barry Eppley