Q: Dr. Eppley, I am inquiring about a genioplasty revision.I originally had double jaw surgery and a genioplasty performed. The results of the jaw surgery were great and the genioplasty was not bad either however there was some asymmetry and the chin projected just a tad more then I preferred, so I had a revision on the chin to move it back very slightly, a total of 1.5mm back from the original 4mm that it was moved forward as well as correct the asymmetry.
The results of the revision were not satisfactory, I developed chin ptosis and loose skin. 8 months later I decided to have another revision surgery to move the chin forward by 1mm, nearly back to it’s original position of 4mm and the mentalis muscle resuspended. After recovering from this surgery I have realized that the chin was not moved forward enough to support the mentalis muscle and the loose skin. There has been some improvement, I have a slightly droopy smile and I still have loose skin. I believe that the surgeon used a different type of plate and therefore the measurements were not as accurate as expected.
My question to you is, what are my best options to correct this, I am okay with having a bigger chin at this point, so I am considering having a 4th genioplasty and utilizing my CBCT scans, images, etc to have it moved to exactly into the same position that it was in after the first surgery, but do you think that undergoing a 4th genioplasty would be okay to do? Also, if the chin is moved to the same position that it was prior to any revision and the mentalis muscle is suspended correctly, what do you think my chances are of achieving similar results of what I had prior to the revisions?
I understand that some of these questions can’t be truly answered with out a full examination but if you can answer them based on experience that would be helpful,
A: The short answer to your question is that approach would be the only viable option. Bony support has to be re-estabished to the soft tissue chin pad. Whether returning to its original advanced position is enough is unknown but it can only help. There certainly is no harm in doing a 4th genioplasty as the vascular quality of the tissues would not be impaired and the amount of scar tissue at this point is irrelevant.
Dr. Barry Eppley