How Can A Crooked Sliding Genioplasty Be Fixed?

Q: Dr. Eppley, I have a crooked chin after genioplasty 6 weeks ago. After the swelling went down, the shape veers to the left. It looks lower than the right. My chin originally is very small and after this procedure it looks more sharp and just goes to the left. before surgery, i had slight asymmetry from an implant but the surgeon said he would improve it with genioplasty. What are my options?

A:At six weeks after a sliding genioplasty most of the swelling is usually gone. Residual swelling and bony remodeling will continue to evolve and, for these reasons, I always use the end point of three months to pout the final critical assessment of any facial bone procedure such as a sliding genioplasty. Whether what you are seeing now will be present in another six weeks cannot be predicted at this point. But for the sake of discussion let us assume that it does.

A crooked sliding genioplasty is the result of either an asymmetric bone cut or a bone segment that has rotated. Because most genioplasties have a central point of bone fixation (plate and screws), it is possible that the down fractured bone segment is rotated with the left side being slightly out more than the right. This is the most likely reason for what you are seeing now. There are two approaches to its improvement. One option is to adjust the bone fixation to reposition the chin bone segment. That is usually only possible in the first three months after surgery without having to recut the bone. The other option is to simply burr down the longer bone segment.