Sliding Genioplasty

Q: Dr. Eppley, I have a question about mentalis resuspension and v-y inner lip plasty. I had a sliding genioplasty and no plate was used during my sliding genioplasty, just two screws which seem to have been placed quite low. Could this be part of why the mentalis muscle is not as high as it was? Thank you.

A: One of the methods in sliding genioplasty bone fixation is that of lag screws as opposed to a step fixation plate and screws. This is undoubtably the two low placed screws that you see. Placing lag screws does require more muscle and soft tissue stripped off of the chin to place them. But I do not think, based on this description alone, as to why you think the mentalis muscle is not as high as it once was. You are likely referring to the depth of the labiodental fold of which the mentalis muscle makes little contribution to it. The labiodental fold is a fixed structure that is an external indicator as to the depth of the vestibular sulcus intraorally. When the chin bone is advanced the depth of the labiomental fold will often appear deeper since its position did not change but the chin projection became greater. This is not usually a reflection of loss of mentalis muscle attachment, it is the natural deepening of the labiomental fold area which will occur despite having the mentalis muscle attached back into its original position. This deepening of the labiomental fold is a natural occurrence in many sliding genioplasty outcomes.

Dr. Barry Eppley
Indianapolis, Indiana