Q: I had a Lefort III osteotomy along with a genioplasty which was done 3 weeks ago to the day. My lower lip sticks out and sags to where I can see all of my lower teeth. My craniofacial surgeon says give it time, but from what I know he did not attach the mentalis muscle correctly.
Do you have experience fixing this deformity without removing any tissue, just relocating the muscle? Any help you could provide would be appreciated!
A: My first comment on your concerns are that you have just had major surgery just a few weeks ago. A LeFort III procedure is one of the most significant of all facial surgeries that can be done. There is going to be lots of swelling all over the face, including the chin area. When you combine a chin osteotomy with a LeFort III the amount of swelling will be extensive.
While I wouldn’t disagree with you that it is disconcerting to see your lower tooth exposure after a genioplasty, this does not necessarily mean it will stay that way completely. Certainly swelling accounts for some of the current visible problem and your mentalis muscles are not going to work properly for awhile. So it may look ‘bad’ now but there is a lot of time for improvement. I would work and be patient with your craniofacial surgeon as time and healing will more likely than not make his guidance correct.
For the sake of argument, however, let us suppose that is does not improve. Mentalis muscle repositioning can certainly be done as a method of correction. If that should be needed at some point, I am certain your craniofacial surgeon will know the right timing and method to get the lower lip problem resolved.
Dr. Barry Eppley