Q: Dr. Eppley, I’ve just recently had upper and lower jaw surgery to correct an underbite. I also had a sliding genioplasty (4 mm vertical reduction). All of this was just done 5 weeks ago, so I realize I need to give it more time before know what the final results will be; it seems I still have some swelling. My questions/issues: 1) I’m wondering if the chin should have been reduced more. 2) I’m wondering if a have a bit of ptosis. I don’t notice it so much normally, but when I smile big, my chin gets flatter and seems to project out more. There seems to be a little loose/excess skin. The bottom half of my chin (maybe my chin pad?) seems a bit puffy and fatty, but maybe some of this is swelling. I’m not sure if a lipo of the chin area would fix this, or if the mentalis needs to be resuspended, etc. Or maybe it’s just in my head and it’s normal. Or maybe it’s swelling. I should note though that in 2002, I had a chin reduction that was done with a burr, and I’ve since learned that that can cause soft tissue issues. 3) The right side of my chin is a little longer than the left side, so it kind of makes my chin look a little slanted and the right side looks a little pointy. I’d prefer for the bottom of the chin to just be straight across (square-ish jaw line maybe?)
A: The first thing I would say, of which you already know, is that it is way too early to judge the final results of your recent bimaxillary jaw surgery even in the chin area. Quite frankly, you still have an ‘orthognathic’ facial appearance which means there is still swelling and the tissues havge not settled over the new skeletal base. I would not critique the results until a minimum of 3 months and preferably 6 months after the date of your orthognathic surgery. When the tissues feel soft, move normally, and most of the feeling has returned, then you can focus on the aesthetic outcome.
For the sake of discussion, if all of these chin asymmetry/shape issues persist, they can be further improved by a chin revision. Whether this is done by a submental or intraoral approach remains to be seen based on exactly what the issues are. The key is what the overlying soft tissues do and how they settle out.
Dr. Barry Eppley
Q: I would like to know if there is any procedure that can be done to reshape or reduce the muscle on the tip of my chin. I had a sliding genioplasty in 2005 but I still have this round fleshy muscle on the end. I know the muscle is functional but can it be reduced at all or reshaped? I can send pictures if you would like. Thanks so much.
A: What you are referring to is the size or thickness of the mentalis muscle. That certainly makes up some of the chin thickness but there is also some contribution by fat also. Some debulking of the mentalis muscle can be done but you have to be careful not to take too much. That can cause scar tissue and lead to irregulrities and muscular fasciculations when the chin moves. But it may benefit by some debulking and repositioning on the chin bone since you have had a prior sliding genioplasty. I would have to see some pictures to have a better idea as to whether that is a reasonable option.
Dr. Barry Eppley
Q: Ever since my chin osteotomy was done over a year ago, the muscle in my chin does not seem to be working right. It feels tighter on the right side and dimples in when I smile or make a pout or blowfish face. It feels tight all the time and twitches often. Can muscle work be done on the chin without having to do anything with the chin bone? I do not want to go through another chin osteotomy. I have attached some photographs, at rest and in animation, for your review.
A: Thank you for sending those very illustrative photographs. I couldn’t have asked or instructed you to take those animated views any better. The one observation that seems to be consistent is that there is mentalis muscle asymmetry, both at rest and in animation. With your history and photographs this suggests to me that the right mentalis muscle has been tightened, lifted more or otherwise sewn donw tighter to the bone. This would explain why the right side has better lip competence (elevation at rest) but moves and feels abnormal.
Given that you are over one year months from surgery, I would expect to see no improvements or changes. You certainly could have some muscle done on that side. That would require no bone work or secondary chin osteotomy. Your chin bone position and overall facial appearance look very good to me, very balanced. That is a very simple procedure that could be done under local anesthesia or IV sedation. It is nothing like what you have experienced with the original chin osteotomy. I would go intraoral on that side and release part of the mentalis muscle in the area where the greatest dimpling is/loss of labiomental fold. I would then place a small dermal graft so the muscle in that area stays released.
I couldn’t guarantee that that would be a complete cure but there is no downside (can’t make it worse) and it is fairly simple to do with no real recovery.
Dr. Barry Eppley