How Can I Improve Lip Seal and Increase Chin Projection After A Prior Sliding Genioplasty?

Q: Dr. Eppley, Thank you for your time. I hope this message will not be too long. 

Almost one year ago I underwent a sliding genioplasty with the aim of improving facial aesthetics and gaining a better lip seal. While there was some aesthetic improvement, the advancement has been quite small and I am left feeling dissatisfied. More importantly, my lip competence has actually increased slightly as I now feel tightness/pulling around the chin, which from what I have gathered is likely related to scar tissue of the mentalis complex. Probably there is more lower incisor show than before, but I do not have good images to compare. I am coming to you as your extensive resources provided online are one of the few touching upon this issue, and if further treatment is advised, which to be honest I hope it is as I am quite bothered with the situation, I would like nothing more than to come to you for this. Unfortunately I do not have access to an after x-ray picture, but have included normal photographs (they are not perfect before/afters but I have done my best). 

My goals are to improve the lip seal, increase chin projection (and potentially reduce height), and if possible reduce the tightness, or at least aim to not make it worse. Given the limited information I have been able to provide, do you think there is anything that can be done? If you prefer to discuss this in a video consultation, rather than via written messages, I would be happy to. 

A: Thank you for your inquiry and sending your pictures. As best as I tell from the pictures your chin advancement was very slight yet your symptoms are fairly significant for the amount of bone movement. It would be very helpful to see an after surgery x-ray to see the actual dimensions of bone movement.

But that issue aside the options are either to leave the chin position alone and do a scar release/interpositional graft (dermal fat graft) to improve your symptoms or to do a secondary genioplasty for further chin advancement and the use of allogeneic corticocancellous bone chips to fill in the step off and eliminate the bony dead space. I would estimate it needs to go at least to the new position as shown in the attachment image.

Dr. Barry Eppley

Indianapolis, Indiana