Q: Dr. Eppley, I was wondering what my options are in order to completely reshape my chin. When I smile it wrinkles up and I have as deep crease on my chin with a thick lower chin. I want to smooth it out completely to have no crease or dimple. would this be possible?
A: Let me first separate chin dimpling (which is a stippling through the chin pad with muscle moment) from a chin dimple/cleft. (a permanent indentation or groove in the chin pad which is present when the muscle is not moving.
Chin pad wrinkling/dimpling is a difficult problem for which the options include Botox injections, fat injections or mentalis muscle disinsertion/resuspension. Botox can be temporarily effective because it partially paralyzes the muscle and stops the animation deformities. Fat injections work by adding volume to the chin indentation to help fill them up to a smoother level. Mentalis muscle manipulation works by creating a new attachment level for the muscle which changes its length of contractile excursion and hopefully lessens the dimpling action.
Chin dimples/clefts are treated by adding volume for which fat injections remains the simplest way to accomplish that effect.
As you can see fat injections is the only method that can treat chin dimpling and dimples but does so at the expense of making the chin somewhat bigger. (which may not be desirable)
Dr. Barry Eppley
Q: It’s been 9 months since I underwent a sliding genioplasty (to move my chin forward and decrease vertical height). It seems like the bony portion of my chin is symmetrical but the soft tissue is not. My lip line is uneven at rest and looks more pronounced when I smile. This is very bothersome to me since my smile and lip line were even before the surgery. My doctor repositioned my mentalis muscles to help with lip incompetence and it seems like the right side is higher than the left. I think the muscles are working properly, it just seems that their origins or insertions are just not even. It has not gotten any better with time. I have an awkward dimpling on the right side of my chin also (the right side definately feels abnormal compared to the left). Wondering if the soft tissue can be corrected to give me an even lip line and smile. I’m not interested in redoing the osteotomy but really would like your opinion on the soft tissue aspect. I’m very uncomfortable with how I look right now which is really making me regret having the genioplasty done in the first place. Thank you for you time Dr. Eppley!
A: While the bone in chin osteotomies understandably gets the most attention, there is also associated soft tissues that are carried with it. Since these soft tissues, particularly the mentalis muscle, must be cut through to perform the procedure it must be put back together in the final phase of the wound closure after the osteotomy is completed. While it is not common to have mentalis muscle problems, they can happen.
The most common mentalis muscle problem relates to how it was resuspended. Inadequate suspension or suspension that has loosened during the healing phase can cause lip and chin asymmetries, dimpling in the chin, and an uneven lower lip during smiling. When these occur, they can be corrected but one must have a very clear understanding as to the location and type of muscle problem. Sometimes it may just be a matter of soft tissue release and the interposition of a fat graft. Other times it may require muscle tightening or shortening. Careful analysis of at rest and smiling photographs in front and side views will help make the correct diagnosis.
Dr. Barry Eppley