Q: Dr. Eppley, Pursuant to my previous questions on a sliding genioplasty, I have come to the realization that horizontal chin advancement will probably not improve the aesthetics of my profile without concurrent movement of the lower lip and the mentolabial fold. On the face of it, a small BSSO seems like the best bet. However, I’m really reluctant to go ahead with the BSSO due to the issues with repositioning of my bite and the wearing of braces. I really feel at a loss as to what to do in reducing the retrusive appearance of my lower jaw without going ahead with the BSSO. I know that the mentolabial fold can be improved with an implant or fat grafting, and obviously the chin can be improved but I’ve made a morph of my profile with just those changes but I feel like my retrusive lower lip is still pretty glaring. Is there anything you can suggest at all in doing a full BSSO camouflage procedure involving the chin, lower lip and mentolabial fold? Is there any scope for an implant to push the lower lip forward like there is with the upper lip? Also, is there any way for a genioplasty to actually lessen the mentolabial fold if it’s done with that in mind? If there’s anything else that you can suggest, please do so.
A: The simple answer is that without a BSSO you are not going to improve the horizontal position of the lower lip. The horizontal position of the lip is largely based on tooth position. Thus only moving the teeth forward (as in a BSSO) will achieve the ideal morph you have shown. You are in a classic conundrum where you can not get what you want the way you want it. You will have to accept some compromise….get the ideal result with the surgery you would not prefer to go through or get the lesser surgery and accept a lesser result.
Dr. Barry Eppley