How Can My Big Chin Be Reshaped And Made More Sculpted?

Q: Dr. Eppley, I had chin reduction done when I was 13 (intraoral approach), however, there are still problems with it and it never has looked exactly right.  I think it may be soft tissue issues?  It still has a bulbous shape, and ever since the surgery, has this odd-looking submental fullness.  The underneath side of my chin sags and looks very unnatural and strange from the side; it has looked like this every since I had the surgery.  I don’t understand why this is…. is this fat or muscle or why doesn’t it look exactly right?  

Also, my bottom lip positioning is incorrect.  My bottom lip needs to come down and out (more everted), because when i smile my bottom lip goes in over my bottom teeth.  What I am wanting is a more normal-looking profile, less of a labiomental fold with a bottom lip that everts (instead of inverts) like normal, and a more sculpted chin (less fleshy and bulbous on the end and a more smooth profile without all the submental fullness.  

I talked to you before about soft tissue reduction of the chin, but I now have x-rays which might be more helpful.  I have attached my digital pics and the x-rays of my mandible (DICOM files).  Would only a soft tissue reduction/augmentation be able to address my problems?  Or do you think I need something done to the bone?  Another ostectomy or bone burring?  I want to get rid of this fullness underneath and get a more sculpted, normal-looking chin, instead of a bulbous one.  What type of procedure or procedures do I need to fix these problems and improve my profile? Thank you 🙂

A: Good to hear from you and I remember your case quite well. Let me dissect all your issues one by one. First the submental fullness is a soft tissue isseu of too much fat and loose skin, which often  happens from an intraoral approach to horizontal chin reduction particulalry if done by an osteotomy. Just that alone could be corrected by a submentoplasty procedure to flatten out the submental fullness and tuck the tissues under the chin. Secondly, the files of the x-rays you sent me were text and not the images and I have no way of opening them in an imaged format. You will have to send me the x-rays  actual jpeg files. But even without the x-rays I believe you need further chin bone reduction/reshaping to have a more sculpted chin shape. The value of the x-rays for me is to know whether there is any hardware in there and what the bone shape looks like. Thirdly, no chin procedure is going to change the depth of the labiomental fold. That has to be addressed directly by either fat injections or a subcutaneous implant to soften its depth. Lastly, the lip position and how it moves is not something that can be reliably changed by surgery. The only option is to do a v-y internal mucosal advancement to create more eversion but this will not in the long-run move the lip position lower.

Dr. Barry Eppley

Indianapolis, Indiana