Should I Have A Sliding Genioplasty With A Mentalis Muscle Resuspension?
Q: Dr. Eppley, I have chin ptosis after the removal of a large chin implant. So what needs to be primarily done should be a mentalis resuspension. I am considering sliding genioplasty despite the risks of bone osteotomy, longer surgery time, and longer recovery time, only if it helps the result of the mentalis resuspension procedure. If genioplasty would have any negative effect or no effect on the mentalis resuspension procedure (i.e. more bleeding, swelling, more complications than the resuspension procedure alone), I would not want to have it done.
My question is, first of all, regarding [mentalis resuspension alone] vs. [mentalis resuspension + sliding genioplasty], would there be any difference in the result concerning the ptotic chin and lower lip disturbance? If there should be no actual difference, then I probably wouldn’t want the sliding genioplasty done due to longer recovery time and more risks. But, if the genioplasty should give any positive effect, I should consider it be done along with the mentalis resuspension procedure.
Secondly, my implant insertion and removal were both done by intraoral approach. Should the mentalis resuspension procedure be performed by intraoral approach again?
Lastly, you have mentioned the disruption of the attachments of labiomental sulcus as the cause of lower lip eversion disturbance. By the “attachments of labiomental sulcus”, do you mean the mentalis muscle attachment to the bone? Or is there any other muscle involved in this area? Does labiomental sulcus muscle repair simply mean resuspension of the mentalis muscle? Are there any other muscles that should be repaired to fix the attachments of labiomental sulcus?
A: The mentalis muscle suspension is infinitely improved by the concomitant sliding genioplasty as this procedure addresses one anatomic element that intraoral suspension does not…excess skin and subcutaneous tissues. Bone-occupying volume expansion with muscle tightening addresses all the issues of the ptotic chin problem.
The intraoral approach has disrupted the superior attachements of the muscle and, if only the mentalis muscle resuspension was going to be done, then you would do an intraoral approach for repair.
Labiomental sulcus disruption means the complete loss of superior mentalis muscle attachments. That is addressed in the intraoral mentalis muscle suspension procedure through the use of bone anchors.
Dr. Barry Eppley