Q: I was wondering if an intraoral chin reduction could be successful if I don’t have much soft tissue. I know if the mentalis muscle is disturbed it can cause sagging but if it is properly tightened back together could this still happen? What is the likelihood?
A: When the chin bone is shortened from inside the mouth, the muscle is not only detached but now an excess amount of soft tissue results. In other words, there is too much soft tissue for the amount of bone left. That is what creates a chin soft tissue sag or witch’s chin. While tightening up the muscle back to the bone is effective for very small chin reductions (that aren’t noticeable), such muscle tightening will not work for more visible chin bone reductions. The extra amount of soft tissue must be shortened (removed) as well as tightened. So the answer to your question is that intraoral chin reduction is usually a bad idea no matter how well the muscle is retightened. Only a submental (under the chin) approach can adequately remove and tighten the loose soft tissue that is created from chin bone reduction.
Dr. Barry Eppley
Q:I am looking at having a revision surgery on my chin for what I believe is a partial non-attachment of the soft tissue to the hydroxyapatite implant. Some of my chin hang independently from the rest and looks aged. My surgery was two years ago. I am contacting you because I see you have specific knowledge of the intricacies of chin surgery. Could you give me some information about what I should do now and whether you have dealt with this problem before?
A: Thank you for your inquiry. Before I can answer your questions specifically, let me get some details as to your chin surgery from two years ago. You refer to having a hydroxyapatite implant placed. Since there are no off-the-shelf hydroxypatite implants of which I am aware, I assume that this was an intraoperatively carved one that was done from a block of material. Furthermore, I am assuming that it was placed intraorally (through the mouth) as opposed to under the chin through the skin.
Your description of your concern’s sounds like what is known as a ‘witch’s chin deformity’, otherwise known as soft tissue chin ptosis. There is where the chin soft tissues sag off of the end of the bone/implant. Because any type of chin implant augmentation must detach the muscles, there is that risk after surgery although it almost exclusively occurs from an intraoral approach.
Please send me some photos of your chin and provide answers to my questions, then I will be able to confirm this diagnosis. I have seen this numerous times and the appropriate correction (implant notwithstanding) in most cases is a mentalis muscle resuspension procedure.
Dr. Barry Eppley
Q: Over a year ago, I had a medium-sized chin implant placed from inside my mouth and I HATED it. Last month I finally had it removed but I don’t look the same. My chin seems to droop a bit. I am going CRAZY over this! Please tell me what I can do!
A: To understand the problem and how to fix it, you must appreciate what any implant in the body does that changes the size of an area. Like a breast implant, a chin implant pushes off of the underlying bone stretching out the overlying soft tissues. As a result, you are gaining more soft tissue which the area needs to look bigger.
This soft tissue expansion can really be appreciated when and if the implant ever comes out. Without the implant’s support, the now extra soft tissue sags creating a classic chin ptosis condition. Some refer to it as a ‘witch’s chin’ deformity. There now is too much soft tissue for the amount of bone or underlying soft tissue support. Furthermore, the mentalis muscle has been detached from the chin bone and likely was not resuspended at the time of implant removal. This muscle problem can particularly arise when chin implants are placed from inside the mouth where the superior muscular attachments are completely separated.
Correction of chin ptosis can be done by two different approaches, based on the severity of the soft tissue sag. If the laxity is mild, then an intramural approach with muscle resuspension using bone anchors works very nicely. If the soft tissue sag is more severe, then an approach from the underside of the chin known as a submental tuck-up can be done for soft tissue removal and reattachment back to the bone.
Another option would be to replace the chin implant with another one (even if it is smaller), but that doesn’t sound like an option in your case.
Dr. Barry Eppley