Sliding Genioplasty

Q: Dr. Eppley I had sliding genioplasty / buccal fat removal / jawline implants and cheek implants all done at once one week ago.mI understand I am very swollen and still healing but I am having severe issues with my smile mainly my lower lip and I would like a second opinion on it. My surgeon wants me to wait but from my reading I believe waiting could be a bad idea.

Before surgery, I loved my smile and it was my best feature. Now due to my sliding genioplasty my lower lip is tucked in too high and inwards to my lower teeth. Instead of a nice curve it is flat and tight. I can’t smile or talk properly. It almost feels like the surgeon placed the stitches too high and fixed the lip in a weird position. I would like your opinion on whether or not this should be reversed or if there is another option such as releasing the stitches from where they are placed.

My lower lip is continuing to tighten and cover up my upper teeth. Even tonight it has gotten worse. I can move the lower lip outward and inward but it will not move down at all and is covering more and more of my smile by the hour. If I could describe it, it feels like the stitches are placed too high on my chin/gum and it’s locking the lip into an unnatural position of laying flat/straight over my teeth. I feel like I jus want to get in there and snip the stitches to release it. My lower lip is laying flat across my teeth and ruining my smile. I can’t even physically move the lip down by pushing with my fingers to curve the way it did prior surgery due to how it’s secured in place. I can barely get a spoon into my mouth or talk because it’s locked into position so high and worsening. It very obviously has moved the resting position of the lip where it feels like it is being pushed up by an implant but I had sliding genio. It now curls in and tucks under my upper lip and sits much higher on my teeth making me look toothless on the bottom. It literally feels like there is just too much lip and it can’t move out of the way for my teeth.  I can feel it held into position with the stitches that aren’t letting it free. I don’t want to wait to see if it resolves I just want the stitches in the front/chin released so they can move freely and then to do rehab with my lip to regain mobility and a normal bottom lip curve.

A: Thank you for sending your pictures. I see nothing unusual, both visually and in the pictures, in your early sliding genioplasty results. That was clearly the correct procedure given your very severe horizontal chin shortness. It is important to understand that this procedure takes apart the chin muscle to be able to cut and move the bounce and then puts ti back together at the end. This combined with the stretch of the tissues from the bene advancement will make the lip feel very tight and your smile is not going to be normal for awhile. I have no knowledge of what preoperative education you were provided but what I tell all my patients is two things. 1) Surgery is not ‘instant oatmeal’. You are changing your natural tissue relationships and this is by very invasive trauma to those very tissues. This is going to cause a lot of distortion and it can be very psychologically disturbing in the early recovery process particularly in young patients. 2) Recovery is a process of months not weeks. It will take a full three months for recovery to be complete from the procedures you have had done.

That being said I would agree with your surgeon that staying the course and allowing the recovery process to unfold naturally would be the prudent course of action.

The only remote question I would even think about at this point is whether the chin may be advanced just little further than your chin/lower lip tissues ‘like’. That can cause a lot of chin and lip tightness in big advancements. But I don’t know the actual number of millimeters your chin was advanced.

Dr. Barry Eppley
Indianapolis, Indiana