Sliding Genioplasty Revision

Q: Dr. Eppley, One year ago I had a sliding genioplasty with 5mm advancement. I previously had iposuction under the chin ten years before the sliding genioplasty. I still have fullness under the chin and lower jaw region and lack 4mm or 5mm in chin projection to meet the lower lip and possibly 2mm in length.

I would greatly appreciate your views on the ideal way forward in considering these options:

1. Sliding Genioplasty revision to further advance 5mm and lengthen 2mm. Concerns mentalis muscle drooping, narrowing of chin from frontal view. Possible advantages of stretching muscles/skin to reduce that under chin/jaw fullness.

2. Custom medpor chin implant of 5mm with wings to add more width to chin. Concern won’t reduce the fullness concerns.

3. Neck lift, incision under chin tightening and or removing/shaving digastric muscles and submandibular glands. Concerns would need further incisions around ears to pull skin tort.

Would option 1, 2 or 3 be optimal or option 1 or 2 with option 3?

Ideally I’m after more chin identity and less fullness around that lower third of jaw/chin.

I have also had a CT scan which shows no chin fat as a concern and the submandibular glands are not abnormally large. 

I have attached photo images and x-rays.

I would appreciate your opinion as to the most suitable surgical option to move forward and greatly appreciate your advice and time.

A: In looking at your pictures and video, the correct procedure for you is #1 and a modification of #3. A sliding genioplasty revision would be preferred over any form of an implant as it will stretch out the muscles and skin under the chin.  That will help under the jawline and chin fullness.

For under the chin liposuction is often not completely adequate. What you need now is a submentoplasty. This is a procedure where a small incision is made under the chin, fat directly removed above and below the platysmal muscle and the platysmal muscle tightened. You do not need a formal necklift nor modification of the digastric muscles or the submandibular glands. This will work well and be synergistic with a secondary sliding genioplasty.

Dr. Barry Eppley

Indianapolis, Indiana