Should I Have A Revision Sliding Genioplasty For A Result That Appears Excessive For A Female?
Q: Dr. Eppley, I had a sliding genioplasty six weeks ago in order to correct my microgenia. My main concern was that I always got a double chin when I put my head down slightly (I am not overweight), and the fact that I did not have a lot of definition in my chin/jaw line area (my chin and neck sort of blended together). My chin was advanced forward 7mm and down 4mm. The surgeon also moved my chin to the right 2mm and down 1mm to correct some asymmetry. I have healed nicely, except for some numbness in my gums under my lower 6 front teeth. I just am not happy with the results aesthetically. I think my chin looks too long/big and the procedure has changed my smile for the worse. My lower lip looks very flat and sunken in when I smile. It’s not as full as before. I also have some tightness and a scar at the incision site that I can feel with my tongue. I spoke to the surgeon about all of this, hoping he would say I was still swollen or that once the tightness inside my lower lip goes away that my smile would return to normal. He did say that the tightness would go away in about 6 months but that my smile would not change. He offered to do a revision or a complete reversal, or he said that I could consult another surgeon. He recommended that I not wait until 6 months (when the tightness goes away) and that I do the revision as soon as possible. He said that he could bring my chin up, but no more than 2mm because then my mentolabial fold would start to get too deep. Will that be enough to get my lip to roll back out again or should he (or another surgeon) reduce the horizontal projection as well? Or is there another option that I have not mentioned? I am not looking forward to doing another surgery and going through the recovery process again. I am afraid that I will have more nerve damage/numbness or that I will still be unhappy with the results. I wanted to know what you would advise that I do. What options do I have in order to bring my smile back to normal and to make my face look less masculine? Any help or advice would be appreciated. Thank you.
A:Thank you for your inquiry and sending your before and after surgery pictures. If I just looked at the pictures and knew nothing of your current postoperative concerns, I would say that not only was that the correct surgery for your anatomy but that the postoperative result was excellent and a major improvement. In other words everything was done ideally and the dimensional changes appropriate and certainly not overdone. I have looked and done many sliding genioplasties and that is a textbook example of a good aesthetic result.
That being said I have seen more than one female patient who has a similar story as yours. Very good results aesthetically but the patient simply can not adjust to their new look despite how good it may appears to others. This may seem strange to most surgeons but not to me as a sliding genioplasty falls into the category of facial reshaping surgery, which constitutes much of my practice and experience, which carries with it its own unique patient psychology to it. For some facial reshaping patients, no matter how much the preoperative plan made sense and looked good, they have a hard time adjusting to their new face. It looks overdone and just doesn’t ‘fit their face’. When you combine that with the many common postoperative symptoms from surgery that take a a lot of time to full resolve (stiffness, some numbness and smile alterations), the patient feels compelled to make a change. Whether this is some form of subtotal or complete reversal will vary with the patient and the facial procedure done. In theory and what I advise all of my patients is that no one should consider any change for at least 3 to 4 months after surgery until they are in more of the benefits phase where many of the early uncomfortable symptoms have improved and they have ‘worn the result for a awhile’. For some such patients they do develop more comfort with the result while others never do and proceed with a revisional surgery. I can not tell you which direction you may head if you wait…no one can. But all you can do, now or months later, is some degree of subtotal setback. As a general rule there is a reason you had the surgery so I always split the difference from where they started to where they are now dimensionally.
Dr. Barry Eppley