How Can I Improve The Tightness In My Chin After A Sliding Genioplasty?

Q: Dr. Eppley, I had a forward sliding genoplasty almost 20 years ago. It was advanced an estimated 8-10 mm. I was left with a tightness in lower gum line. 3-4 years later after this procedure tightness still existed so the original Dr. did another procedure sliding back the bone half way, so as of now around 4-5 mm advancement forward. This helped the condition a little bit, but the tightness still remains just not as bad after second procedure.

I recently had the bracket removed from chin in May of 2021 hoping this might relieve more of the tightness but that didn’t help. I have no nerve damage. 

I have read many good things about you and I’m in need of an expert in this area. Your opinion would be very helpful as I’m running out of ideas. It would be great to live without this tightness !!  I have lived with it for so long now. 

If there are no other options I would consider moving chin back to its original position.

A:This is not a bone problem, it is a soft tissue problem. Always has been. When you slide out the bone significantly there becomes a relative soft tissue deficiency due to scarring and soft tissue thinning.  When the soft tissue is allowed to contract back into the bony stepoff created by the bone advancement (grafting is not done) this is what can happen.

While setting back the bone helps a bit and was the logical treatment to do, it can not fully solve the scarring/soft tissue deficiency. Taking out the plate never provides any real relief because it does not address the problem…the soft tissue and it just makes more scar. (it is just an easy but wrong target)

You solve a soft tissue deficiency in the chin just like you would anywhere else in the body….release and the placement of new interpositional soft tissue. (dermal-fat graft) It takes an additive not a reductive approach. Some may consider fat injections as the soft tissue additive procedure but that injection approach does not create a good release and the placement of injected fat into scar often does not end up where it needs to be.

Dr. Barry Eppley

World-Renowned Plastic Surgeon