How Can I Best Fix My Lower Lip Incompetence After Multiple Chin Bone Surgeries?

Q: Dr. Eppley,, I’m seeking your expert opinion on revising a complex aesthetic and soft tissue issue following multiple surgeries of the chin/jaw. Background: I have condylar hyperplasia — my right jaw joint grew longer than the left, causing my entire jaw and chin to be skewed to the left. The right side of my face is noticeably bigger than the left. To try to improve this asymmetry, I had my first genioplasty in my early 20s, However, by my early 30s my chin still sat too far to the left, so I had a revision genioplasty. Even after the revision, my jaw remained crooked, so I had orthodontic treatment (braces) in preparation for full double jaw surgery to properly realign everything. I underwent double jaw surgery at the end of 2022, and the surgeons reversed the previous genioplasty at that time. Unfortunately, I developed two infections after surgery, which required them to remove the lower plates — so my lower jaw has been cut into and operated on multiple times. Current concern: Since all these surgeries, I now have persistent lower lip incompetence: My bottom lip does not touch my top lip at rest. My bottom teeth are always visible, and the lower lip sits too low and slightly everted. This looks unnatural and really affects my confidence. I believe this is due to mentalis muscle detachment, soft tissue stretching, and scarring from multiple surgeries and infections. What I’m hoping for: Your expert assessment on what is causing this — mentalis detachment, scar contracture, tissue deficiency, or all three. Your advice on whether mentalis resuspension (possibly with vestibuloplasty and dermal-fat grafting) would be suitable and realistic for me, given my extensive surgical history. Examples of similar cases you have corrected (before/after photos, if possible).. I can provide detailed photos (frontal, profile, lips at rest and forced closed), plus all my surgical and orthodontic records if helpful. I’m open to a virtual consult and prepared to travel from Australia if you think I am a candidate. Thank you so much for your time and for considering my situation, I truly appreciate your expertise.

A: Thank you very your inquiry and detailing your a complex surgical history… although when it comes to lower lip incompetence this is not an unusual background. The problem is your prior genioplasty has been reversed, losing support to your soft tissue chin pad and lower lip. Well I do not know the dimensions of your prior genioplasty any loss of horizontal projection and having head multiple surgeries to do so is going to result inching pad contraction and lower lip incompetence.

That being said there are limited surgical options to try to improve it which, from my experience, means basically do everything that you know how to do and hope it provides adequate improvement. Thus, as you have mentioned, mentalis resuspension, dermal fat grafting and a shortening vestibuloplasty are all of the soft tissue procedures. How this applies to you I cannot say based upon a verbal description alone.

Dr. Barry Eppley

World-Renowned Plastic Surgeon