Q: Dr. Eppley, I am interested in a sliding genioplasty revision. Four weeks ago I had a sliding geniplasty but I now think it was moved too far forward. It is easier to change the chin bone now or wait until it heals. Will the chin bone become harder to correct with time? I was not aware as I thought the soft tissues should be healed as to not disrupt muscles etc (this apparently takes 12 weeks), and I still have numb areas on the right side of my chin. Weighing up the pros and cons overall, when is the best time to perform the operation to achieve a better chin result?
Also, I had a rhinoplasty two years ago but have never been happy with my tip. It is still bulbous, maybe even bigger than it was before. Should the revision be done open or closed?
A: A revision of a sliding genioplasty can really be done at any time whether the bone is completely healed or not. The time to do revisional surgery on your chin is based on two considerations, when you are certain that the result you have is aesthetically unacceptable and the state of the bony union of the osteotomy. On the one hand, you would ideally like to change the chin before the bone has completely healed. (6 to 8 weeks) On the other hand, you never want to do a revision before the final result is seen so the patient has time to both adjust to the new look and is certain that a change is needed. You can see how both of these concepts must mesh to pick the ideal time for a revision. The state of the soft tissues (muscles) has really nothing to do with it.
In regards to the nose, the best chance for an improved outcome is an open approach where the needed and desired tip changes can be done under direct vision.
Dr. Barry Eppley