Your Questions

Q: Dr. Eppley, I am inquiring about a genioplasty revision.I originally had double jaw surgery and a genioplasty performed. The results of the jaw surgery were great and the genioplasty was not bad either however there was some asymmetry and the chin projected just a tad more then I preferred, so I had a revision on the chin to move it back very slightly, a total of 1.5mm back from the original 4mm that it was moved forward as well as correct the asymmetry. 

The results of the revision were not satisfactory, I developed chin ptosis and loose skin. 8 months later I decided to have another revision surgery to move the chin forward by 1mm, nearly back to it’s original position of 4mm and the mentalis muscle resuspended. After recovering from this surgery I have realized that the chin was not moved forward enough to support the mentalis muscle and the loose skin. There has been some improvement, I have a slightly droopy smile and I still have loose skin. I believe that the surgeon used a different type of plate and therefore the measurements were not as accurate as expected. 

My question to you is, what are my best options to correct this, I am okay with having a bigger chin at this point, so I am considering having a 4th genioplasty and utilizing my CBCT scans, images, etc to have it moved to exactly into the same position that it was in after the first surgery, but do you think that undergoing a 4th genioplasty would be okay to do? Also, if the chin is moved to the same position that it was prior to any revision and the mentalis muscle is suspended correctly, what do you think my chances are of achieving similar results of what I had prior to the revisions? 

I understand that some of these questions can’t be truly answered with out a full examination but if you can answer them based on experience that would be helpful, 

A: The short answer to your question is that approach would be the only viable option. Bony support has to be re-estabished to the soft tissue chin pad. Whether returning to its original advanced position is enough is unknown but it can only help. There certainly is no harm in doing a 4th genioplasty as the vascular quality of the tissues would not be impaired and the amount of scar tissue at this point is irrelevant.

Dr. Barry Eppley

Indianapolis, Indiana

Q: Dr. Eppley, I had a genioplasty with iliac bone grafting five years ago. The result was disastrous. I got a long and prominent chin and it was so completely different than I planned. After that, I had several revisions to get an imprrovement. For example the jaw bone had been suspended back and I also I had a chin reduction. This resulted in an unpleasant scar under my chin. Now the chin soft tissue is scarred and hanging down. If my mouth is closed I feel a strain on the chin muscle. During relaxation my lower lip hangs down showing my bottom teeth. The mentalis muscle shows a strong contraction.

I couldn´t find any surgeon who had enough knowledge in this specific area of genioplasty revision and chin ptosis. In various discussion forums about this topic I came across your name. I hope that your skills and experience in this special field could be helpful in my case. Is there any possibility to solve my problem and what could this be? What is the probability of improving my situation? Your help would be very much appreciated. I have attached some pictures for you to see my chin problems.

A: Your chin surgery history and outcome has certainly been that of a nightmare. What you currently have is chin ptosis with severe contracture. What need is an intraoral approach to  release the scarred chin tissues, mentalis muscle resuspension with suture anchors and a V-Y vestibular closure. Your submental scar should also be released and revised. The divot (indentation) in your chin would be treated by the placement of a small dermal-fat graft at the same time. All of these procedures would be done simultaneously address all of your current chin problems. My experience in doing these chin ptosis repair procedures is that improvement is always obtained, it is just a matter of the degree of improvement.

Dr. Barry Eppley

Indianapolis, Indiana