How Can The Tightness After A Sliding Genioplasty Be Impoved?
Q: Dr. Eppley, I was in contact with you a while back regarding issues after my sliding genioplasty. It has been 2 years now since the surgery and it’s still tight. The area under the lower lip is very tight, the scar feels very tight and when I move my mouth everything feels even tighter. My lower gums and lower teeth also feel tight and sticky. It’s a weird sensation.
You did advise that the bone position was high and the chin tissues may be compressed and this could cause the tightness. I also saw on your website that you can use a fat graft in the labiomental fold. I did see this and then try HA filler in the area which does seem to have improved things a little a bit, not significantly but it does help and it seems to help with my speech,
I don’t get as much of the pulling and tugging feelings when speaking like I did before. The filler is voluma so does feel quite hard. It might have been better with a softer filler. I’m not sure the nurse who injected understood my complaint fully too.
You are the only person in the world it seems who suggests this. I’m astonished that no other surgeons seem to know about this problem!!
With this in mind, how do you see my revision? If I came to you what would you do with my chin?
Would you move it down and back and place a fat graft? Is that the way you think it should go or leave the bone and just do the fat graft?
Here is my X Rays again to remind you and also a 3D scan.
I’ve been to a facial pain clinic at my local hospital today and they are telling me this is neuropathic pain as a result of the surgery. They said that this can sometimes, very rarely happen where the brain starts sending the wrong signals causing strange and uncomfortable feelings in the area. They said this is permanent and surgery can make worse and won’t make any better. My surgeon doesn’t agree.
Your help is so much appreciated.
A: If you are satisfied with the aesthetic result I would do an intraoral release and place a dermal fat graft. That seems to work really well in cases like yours. The observation that injection of HA produced some mild improvement in your symptoms supports this therapeutic approach.
Dr. Barry Eppley