Sliding Genioplasty Reversal
Q: Dr. Eppley, I have had multiple chin bone surgeries (sliding genioplasty) and my mentalis muscle now droops and dimples badly upon lip closure. (which I never had initially. The first surgery lengthened my chin inadvertently which made my face more gaunt looking. A second surgery was done to reverse the sliding genioplasty but that was not really done. The chin bone was not pushed back anywhere near as much as needed and it was asymmetrical. It appears the surgeon actually burred down the chin rather than a true sliding genioplasty reversal. Now I have step-offs that are astronomically different in size. What would you suggest to fix this all?
A: As best as I can determine from your description, you initially had a sliding genioplasty and then had it reversed. Rather than a complete osteotomy reversal, the bone was burred down to create part or all of the ‘reversal’. This has left you with bony irregularities and a soft tissue chin sag with dimpling. Comparing your preop x-rays to now I would assume that your goal would be to vertically shorten the chin and get it back as close as possible to your original chin position. This still will require an osteotomy (true sliding genioplasty reversal) as your chin is vertically longer than before. The mentalis muscle/chin pad could be resuspended at the same time. The chin dimpling is a more vexing issue as this is a result of multiple surgeries and aberrant muscle movements due to scar contracture. I would probably inject a little fat into the mentalis muscle to try and soften some of the scar contracture which may or may not be effective.
Dr. Barry Eppley