Q: Dr. Eppley, I have had two chin reductions, a sliding genioplasty and bone burring and a chin lipectomy. Now my chin has collapsed, please help me to know what to do for a chin reduction revision?
A: Based on your history of two intraoral bony chin reductions, the overlying soft tissue appears to have ‘collapsed’ or become completely balled up over the chin. This is what can happen when intraoral approaches are done for horizontal chin excess. Intraoral bony chin reduction relies on the excess soft tissue chin pad to somehow shrink down and become less over a reduced bony chin prominence. While that may work for a very small horizontal chin excess, larger reductions result in the chin soft tissues just contracting down into a mass of distorted and indented soft tissue. This is why a submental approach which reduces bony and soft tissue is the better choice as it prevents what appears to have happened in your case by reducing the soft tissue as well as the bone.
The question is how best to release the contracted chin tissues and restore their volume. There are two basic approaches. First, if one is happy with the horizontal chin projection fat injections can be done to expand out the soft tissue a bit and try to soften it. The second approach is if one can tolerate a little more horizontal chin projection, the soft tissues can be released through a submental approach and a small chin implant can be used possibly with a little bit of fat injections.
Dr. Barry Eppley