Should My Sliding Genioplasty Be Reversed?
Q: Dr. Eppley, I recently had a bilateral sagittal split ramus mandibular osteotomy with a sliding genioplasty. My bottom lip (and perhaps top) have thinned considerably. It seems the bottom lip flips in somewhat. It was always very full and pouty. Can something be done? In addition, my jaw angles used to be much more prominent and I had a longer ramus. What can be done? Will reversing the genioplasty help?
A: Reversing the genioplasty is not the solution for an inward inversion of the lower lip after the procedure. That is caused by disruption of the origin of the mentalis muscle on the bone and it being resutured back together. This can be a source of lower lip tightness, lower lip thinning, and some inward inversion/contracture of the lower lip. Unless you terribly dislike the position of the chin, moving the chin back is not going to solve these soft tissue problems. Rather some soft tissue augmentation is a better approach. This could include the placement of a dermal-fat graft below the vestibule in the lower lip after it is released. (all done through your existing intraoral incision) Fat injections can also be done at the same time into the lips. The take of fat injections is variable but that of the dermal-fat graft assured.
Many BSSO procedures change the shape of the jaw angles, often losing their distinct shape. They often appear less pronounced and higher afterwards when the bone has healed. In some patients, jaw angle implants can restore a more distinct shape and the addition of a little angular width as well.
Dr. Barry Eppley