Q: Dr. Eppley, I had a chin implant put in and removed within a few months about 4 years ago. I have slight chin ptosis, and read about “routine” procedures to reattach/tighten/lift the chin pad, like what you discuss above, but when I google search, I find no one who does this . I have googled “raising the introral sulcus”, “correcting bottom tooth show”(no one seems to have any suggestions for this), “correcting chin ptosis”, “submental tuck up” (which you have also talked about) and get like 2 results. and those that do these procedures have like one photo on their website. I would also like projection higher up on my chin so that overhead light hits a small area on the chin, the rest in shadow. The implant I had before just extended the downward line of my jaw and increased the area that the overhead light would catch, making my chin look longer. I feel a feminine chin not only projects, but curves slightly upward at the end of the jaw. On your chin implant page, the 7th one down has a nice curve up, as do many of your patients, the 8th one down does not, nor does the one on the bottom of page 1–you just continued the downward direction of these jaws and I don’t think it looks right. How do you avoid that?? Thanks.
A: Correcting chin ptosis is anything but a routinue plastic surgery procedure. There is not much written about it because its correction is not easy and the results not always predictable. I have learned that the most predictable way to get sustained improvement is to do a lower periosteal/mentalis release, elevation of the chin pad by suture anchorage to a higher position on the bone, a V-Y lower lip mucosal advancement and a shortening vestibuloplasty. Combining all four maneuvers will always correct a some degree of a sustained chin pad repositioning and maybe some slight lower lip elevation.
Getting a chin pad that curves upward with implant augmentation depends on numerous factors including the presurgical shape of the chin pad, chin implant style and size (women usually do better with a central button style chin) and whether an intraoral or submental approach is used.
Dr. Barry Eppley