Q: I had a chin reduction by bone burring 2 months ago. Not only do I see no change in the size of my chin, but I now have a witch’s chin/double chin due to the scar under my chin. I feel like I should wait to address this, but I am in a very public position and need to fix this as soon as possible. It is affecting my work and my self-esteem. Is it too soon to do a revision?
A: With the story of a recent chin reduction by burring, you almost certainly had an intraoral (inside the mouth) approach to your chin procedure. When this is attempted, two results happen after surgery. First, little to no change is ever seen in the amount of chin projection as just the very edge of bone has been work on which is inadequate. Secondly, and a much worse problem, is the chin ptosis or sagging that can occur due to the disinsertion of the mentalis muscle and the degloving of the chin soft tissues. The intraoral approach requires a very careful reapproximation and resuspension of the muscle if this is to be prevented.
The best time to correct a chin ptosis/witch’s chin is earlier rather than later. The more time that passes allows more scar tissue to form and can make a good correction more difficult. There are several different methods of correction depending upon the end goal and tolerance to an external scar. The chin soft tissues can be resuspended from an intraoral approach which will leave no visible scar but will not make for any chin reduction. The other approach for chin ptosis repair is from under the chin where both bone and soft tissues can be reduced, solving two problems, but leaving a submental skin scar.
Dr. Barry Eppley