Postop Sliding Genioplasty Concerns

Q: Dr. Eppley, we communicated a few months ago and I wanted to give more time to heal from my sliding genioplasty that I had last year which was advanced 7mms.  I still have substantial numbness on the right side of my chin/lip, though feeling seems to slowly be coming back.  I’ve attached pictures to in attempt to illustrate my dislike of the results.  

I am happy with the advancement,  but feel I need some soft tissue repair.  My chin drops below the bone when I smile, and feels tight at the incision.  I have asymmetry with my bottom lip, left side lower, and lost volume.  Lip feels stuck to gums,  and mental labial fold too deep.  All these issue also cause my chin to be too wide and round, and vertically long. I only had an advancement, no lengthening.

A: Thank you for sending all of your pictures. Your list of chin symptoms are the following:

Tight deeper labiomental fold
Incisional tightness
Lower lip asymmetry and less volume

Chin ptosis
Vertically long and rounder chin

I list these symptoms this way because some can be predicted for a sliding genioplasty and some can not.

All of the incisional and lower lip issues are not rare from an intraoral incision where the chin bone has been advanced and mechanically makes sense.

But when the chin bone is advanced the frontal appearance of the chin usually looks more narrow not more wide. It can become vertically longer if the bone was moved that way or can appear so because the chin is more narrow. Only a postop x-ray can determine the exact chin movement that was done.

I have never heard of or seen chin ptosis developing from a bony chin advancement because the chin tissues have never been detached from bottom of the bony chin and it is being advanced as well. I don’t think what you have is ptosis, just that with the chin bone being more prominent the soft tissues of the chin stick out more but they are not falling off of the bone so to speak.

Dr. Barry Eppley
Indianapolis, Indiana