Sliding Genioplasty Revision
Q: Dr. Eppley, I am interested in a sliding genioplasty revision. I have previously had a sliding genioplasty with 5mm advancement and liposuction to the neck. I still have fullness under the chin that I feel could be improved through further chin or a jaw advancement to enhance my side profile and align the chin with the bottom lip. I feel an additional 5mm would suffice.
The first option I am considering is a sliding genioplasty revision that would provide the desired 5mm projection for better alignment. This would also assist by making the muscles and skin more taut to decrease the fullness in the neck region. Is there any structural risks advancing another 5mm in performing another genioplasty. Is my chin bone thick enough to support another 5mm?
The second option; braces to the lower teeth to shift the teeth back 5mm and then performing lower jaw surgery and advancing the jaw by 5mm.
The third option; platysma plication to tighten the muscles and/or shaving the digastric muscles, submandibular glands or lifting the glands up via suture support.
I have attached a photo highlighting the area of concern and an x-ray; you will see my teeth are already fairly aligned and bite is fairly good.
I have also had a CT scan which shows no chin fat as a concern and the submandibular glands are not abnormally large.
I would greatly appreciate your opinion as to the most suitable surgical option to move forward with. Also, based on aesthetics alone; is a lower jaw advancement compared to a genioplasty more pleasing to the eye? Do they bring forward the same muscles?
I look forward to your opinion and greatly appreciate your thoughts and time.
A: Thank your for sending your facial pictures and images. In answer to your questions:
1) You have enough bone to allow for another 5mm increase and 2-3 mms vertically down for your sliding genioplasty revision. Your chin still remains dimensionally short, 5mms was an inadequate movement from an aesthetic standpoint.
2) Your submental fullness can be further improved by direct supraplatysmal defatting (liposuction always leaves behind more than one thinks), direct subplatysmal defatting, platysmal muscle plication and partial resection of the anterior bellies of the digastric muscles. Collectively this is known as a submentoplasty procedure. In my experience the common use of just neck liposuction is often inadequate for many men as it only addresses what lies above the muscle which is often just half or less of the anatomic reason the submental fullness exists. The thicker tissues of men usually require a more aggressive approach.
3) Your outline of what can be achieved by a more thorough neck contouring approach is not realistic. The back half of your drawing is on the jawline and not on the neck. I have provided a more accurate representation of the actual zone of submental/neck improvement.
Dr. Barry Eppley