Sliding Genioplasty Revision

Q: Dr. Eppley, I am interested in a sliding genioplasty revision. I am a young male who underwent a sliding genioplasty six months ago to fix some minor facial asymmetry. The idea was to move the chin 1to 2 mms upward and 3 to 4 mms forward. Unfortunately, this didn’t happen. Instead, the right side was moved according to plan, but the left side wasn’t causing it to be rotated outwards and downwards. My chin is now crooked with the left side being considerably fuller both laterally and anteriorly, but also vertically longer (aproximately 5 mm height difference).

I’ve met with a new surgeon in order to try to get this corrected. He suggested an intra-oral burring of the bigger side (left) in order to spare me a scar. He said he would be able to reduce the height too. I did some research and it seems to be quite tricky to do an intra-oral burring for vertical reduction? I know you prefer the submental approach, but I’d like to hear your views on doing this intra-orally. Can the inferior border really be reached? How many millimeters can usually be removed vertically using the intraoral approach? And what are the chances of tissue sagging?

A:You are correct in assuming that it can be both difficult and unpredictable attempting to make these modifications through an intraoral approach. It would be simpler, more predictable and have lower risks of tissue sagging if it was done from a small submental incision. Seems like a difficult approach that has limitations when you are trying to fine tune the chin bone shape. You have already learned the lesson that when doing minor aesthetic corrections it is easy to miss the mark and still have residual issues. Any further revisions should be done with the technique that would be most likely to reach your goal with a low risk of further aesthetic issues.

Dr. Barry Eppley
Indianapolis, Indiana