Is A Sliding Genioplasty The Best Way To Treat Chin Ptosis?
Q: Dr. Eppley, I had a chin implant inserted 8 months ago, which turned out to be too big. I was very unsatisfied with the result and it was removed 2 months after the initial surgery, which is 6 months ago from now. The problem is that chin ptosis has developed. I am suspecting that adequate mentalis reattachment was not performed after the implant removal. Moreover, the central part of my lower lip would not move downwards, even when I smile widely, always covering my lower incisors totally. This seems different from typical lower lip incompetence caused by mentalis muscle ptosis, since I believe that ptosis of mentalis muscle causes lower lip to drop downward with inability to close mouth properly. This lower lip issue is not a newly developed problem, since it was present immediately after the initial implant insertion surgery and never went back to normal. Also, my lower lip seems to have become shorter in vertical length. My labiomental sulcus area looks like the soft tissue is fixed to the bone making it look unnatural when i speak or smile. I am thinking a mentalis resuspension would help my problems but my question is why would my lower lip not move downwards? This sometimes interfere with my pronunciation when I speak which bothers me a lot. One more question is would sliding genioplasty combined with mentalis resuspension give a better result than mentalis resuspension alone? I want to know the best solution to correct my problems. I am looking forward to your answer. Thank you.
A: You are correct in that the lower lip may sag with chin ptosis in some cases, but not always. Many chin ptosis patients have a normal lower lip position and function. Rarely you will have a patient like you who has the opposite lower lip problem in which the lip will not evert. This can occur if the implant was inserted from below (submental incision) and the implant pocket was made up close to the mandibular vestibule. This disrupts the attachments of the labiomental sulcus and blocks lower lip eversion. Even when the implant is subsequently removed, the muscle fibers remain disrupted.
Since there was a reason you had the chin implant in the first place, it would make the most sense to consider a sliding genioplasty. In that way all three problems can be simultaneously treated. (chin deficiency, chin ptosis, labiomental sulcus muscle repair)
Dr. Barry Eppley