Q: Dr. Eppley, I had a sliding genioplasty about 14-months ago. The procedure left me with lower lip incompetence and a pulling down tightness of the lip. I tried to have the surgeon reverse my genioplasty in the hopes of relieving my symptoms but he was fearful the bone would split/crack with the removal of the plate screws. So, instead he shaved the bottom portion of my chin bone to release some soft tissue tension. Though the surgery did relieve some tension, I still have all the same issues and now the muscle that runs the front length of my chin now protrudes, as if it is not attached to the bone. When I push down on this muscle with my finger, it releases the tension in my lower lip, but when I remove my finger from pressing down on the muscle, the muscle flexes and immediately pulls down my lip. So, I have two questions; can this muscle be reattached to the bone and keep it from protruding/flexing, and my second question is, how many mm of bone can be safely shaved from the bottom of my chin? The surgeon who shaved my bone said 3-4 mm was removed and I am wondering if more can be taken? Thank you in advance Dr. Eppley.
A: Thank you for your inquiry an detailing your sliding genioplasty history. Why your chin was subsequently shaved instead of the whole bone being move back (sliding geneoplasty reversal) is baffling. It makes no surgical sense at all that the bone would fracture if it is recut and move back. I have done that many times and have never seen it to be a problem. The problem with shaving is actually what you are experiencing….lax soft tissues. You should have had the sliding genioplasty reversal procedure and not shaving. Shaving and a sliding genioplasty reversal does not have the same soft tissue effects.
Whether you should just have the bone cut and moved back depends on how much your chin was initially advanced and what your chin bone looks like now in a lateral cephalometric x-ray. Either way the soft tissues appear to need resuspension.
Dr. Barry Eppley