How Can I Fix My Chin Ptosis After Subtotal Sliding Genioplasty Reversal?

Q: Dr. Eppley, Do you perform orthognathic surgery? I came across some very interesting comments from you on Realself posts. I started my orthodontic treatment over a year ag.. I refused to accept extractions and accepted IPR instead. Two orthognathic surgeons that I was recommended to by my orthodontist saw my case and called it “common” and “nothing to worry about.” They suggested a sliding genioplasty instead to aid with my lip incompetence, and assured me that jaw surgery was unnecessary. I accepted. I ended up undergoing two sliding genioplasties in one month. This is because the first time turned out to be a total mess. My chin had been advanced too much (8 mm), and that was after I had refused a 10mm advancement. The second one turned out better (5 mm), but now I have ended up with chin ptosis. My lip incompetence is worse than ever before. I drool without realizing it and have trouble sleeping at night. Recently I’ve been waking up at night, gasping for air. After paying closer attention to my x-rays, I noticed my airway is very narrow. Shouldn’t that have been taken into consideration? Wouldn’t jaw surgery help with my narrow airway? I had no idea what to look for before, but after doing research, I learned that a narrow airway may lead to sleep apnea. I fear that I may have sleep apnea. A part of me feels like I’ve been neglected multiple times by several professionals. I found hope in your responses to several posts on Realself regarding v-y lip advancement, mentalis resuspension, and jaw surgery. I hope you can help me. Thank you for your time. I appreciate it so much.

A: Thank you for your inquiry, sending your pictures and detailing your concerns to which I can say the following:

1) While I have only limited information (a few pictures and a lateral cephalometric x-ray) it would be imprudent for me to make any in-depth comments about your candidacy for orthognathic surgery. All I can see is that you have a very significant flare to the upper and lower incisors and did not wish to undergo extractions as part of your orthodontic therapy. Thus with your current occlusal state orthognathic surgery is not an option. Perhaps that may have been different had extraction therapy been done where bimaxillary surgery may have come into play. That is a question for the orthodontists to answer.

2) Obstructive sleep apnea is a multi factorial condition of which a single piece of information (narrow airway seen on a lateral cephalometric x-ray) is way inadequate to make an accurate diagnosis. A formal sleep study is needed to determine if you have sleep apnea, whether it is central or obstructive in nature and what the appropriate treatment might be for it. It is a big leap to go from looking at the lateral cephalometric x-ray to assuming one would benefit by upper and or lower jaw advancement surgery for presumed sleep apnea.

3) Just like changing a big chin implant to smaller one (or removing it completely), subtotal reversal of a sliding genioplasty can cause lower lip incompetence. (even though that was what it was done to treat) I have heard this postoperative development from numerous females that have had subtotal sliding genioplasty reversals when the amount of forward movement was excessive. With the soft tissue elevation from the bone to perform the osteotomy, this is not totally surprising when the bone is then partially setback. Such lower lip incompetence is evident in your pictures. The question is now is whether an intraoral chin resuspension would be an effective treatment for you. While it is not always a 100% successful procedure, it is always a procedure that does not make anything worse and usually provides some improvement.

Dr. Barry Eppley

Indianapolis, Indiana