Q: Dr. Eppley, I am in need of a sliding genioplasty revision. I had sliding genioplasty done which left me with a defect on the right side. The surgeon who performed the initial operation was going to take bone from jaw to fill the defect, but I was thinking it would turn out badly considering how bad it looked directly after the procedure. That was more than 10 years ago. A second surgeon I consulted stated he would use artificial filler to patch the defect and a very small implant if I wanted a more triangular “pixie-like” look to the chin. I definitely don’t want my jaw any wider. In fact I’d like it symmetric and less squared off on the sides. I’m just looking into my options at this point. I had so much trouble after the first operation with permanent anesthesia of the lower gum and my lip being slightly crooked. Scared it might end up worse.
A: What is have is a rather classic sliding genioplasty revsion problem. When the chin bone is brought forward, it narrows the chin and can leave at the bony tails an indentation or step-off at the back edge of the genioplasty. Whether this occurs depends on how far the chin bone is brought forward and the angle of the bony cut. Sometimes this lower jaw edge defect can only be felt, in other cases it can be seen as in your case. The two approaches to treat it are to fill in the bony defects, often with hydroxyapatite granules, or with an overlying chin-prejowl implant. But either approach will tend to make your chin somewhat wider. The other approach is to narrow or remove the bony edge by making it more v-shaped or narrow. Such a chin reshaping procedure would not be associated with the issues you had during the initial sliding genioplasty since the bone is not being downfractured.
Dr. Barry Eppley
Q: Dr. Eppley, I did an upper and lower jaw surgery five months ago. Unfortunately a genioplasty with bone graft was also done. See before and after X-rays attached. I’m very happy with my upper and lower jaw surgery but not the genioplasty with bone graft because now I’m unable to close my lower lip without forcing the lips together. It looks like the lower lip is being pulled down.
Is it possible to redo the genioplasty so Im able to close my mouth more easily. The secondary problem is that my face also look too long now. I added some before and after X rays. Is it possible to recut the bone and slid it back upwards half the distance it was slid downwards?. Or is it better to remove the bone graft and make the chin as it was originally?
A: Given that it has been nearly six months from the original procedure, there is no concern at this point about revisiting the genioplasty site. You can simply redo the genioplasty and either remove entirely the length that was added by the bone graft or shorten to whatever vertical distance you want. It is just as straightforward to do it either way.
Dr. Barry Eppley