Your Questions

Q: Dr. Eppley, I have had multiple chin bone surgeries (sliding genioplasty) and my mentalis muscle now droops and dimples badly upon lip closure. (which I never had initially. The first surgery lengthened my chin inadvertently which made my face more gaunt looking. A second surgery was done to reverse the sliding genioplasty but that was not really done. The chin bone was not pushed back anywhere near as much as needed and it was asymmetrical. It appears the surgeon actually burred down the chin rather than a true sliding genioplasty reversal. Now I have step-offs that are astronomically different in size. What would you suggest to fix this all?

A: As best as I can determine from your description, you initially had a sliding genioplasty and then had it reversed. Rather than a complete osteotomy reversal, the bone was burred down to create part or all of the ‘reversal’. This has left you with bony irregularities and a soft tissue chin sag with dimpling. Comparing your preop x-rays to now I would assume that your goal would be to vertically shorten the chin and get it back as close as possible to your original chin position. This still will require an osteotomy (true sliding genioplasty reversal) as your chin is vertically longer than before. The mentalis muscle/chin pad could be resuspended at the same time. The chin dimpling is a more vexing issue as this is a result of multiple surgeries and aberrant muscle movements due to scar contracture. I would probably inject a little fat into the mentalis muscle to try and soften some of the scar contracture which may or may not be effective.

Dr. Barry Eppley

Indianapolis, Indiana

Q: Dr. Eppley, I am about three months post op sliding genioplasty to advance my chin forward 6mm. The surgery made my lower part of face more narrow with a clear step off in my jaw line which was not there before and I still have mentalis strain. Actually I like my face before and I didn’t want it to change in the frontal view, just wanted a little projection to improve my profile. My surgeon told me nothing will change in front but now I see dramatic changes. I’m thinking of reversing the surgery and I have questions regarding that option. In case of full reversal am I going to regain my old look and the step off will go away? Risk of skin sagging? And when I can use injectable after surgery? Thank you.

A: When the chin is moved forward by sliding genioplasty there are almost always two aesthetic ‘side effects’ of the procedure. It is not a question of whether they will be there but how much and how noticeable will they be to the patient. First, as the chin comes by bone movement the front end of the jawline will appear more narrow. This is a simple principle of a U-shape that is being extended, the U will become more like a V. Secondly, the back ends of the sliding genioplasty will leave some degree of step-off along the inferior border of the jaw. The bigger the bony chin advancement the bigger these step-offs may be.

In a sliding genioplasty reversal, it is important to recognize that you probably will never be 100% exactly like it was before. The bone may be perfectly repositioned back but how the soft tissues, which have been traumatized and stretched, will respond is unknown but to be 100% like you were before can not be guaranteed. If you are young there should be no residual chin soft tissue sagging and the bony step-off should be gone. Most of the time the issue will be how the lower lip responds with a two-time mentalis muscle disruption/repair.

Dr. Barry Eppley

Indianapolis, Indiana

Q: Dr. Eppley, I am interested in a sliding genioplasty reversal. I had a 6-7 mm sliding advancement genio a little over four months ago (no vertical change, just a straightforward Sagittal advancement secured with a single titanium bone plate). From the beginning, I hated it. Even as the swelling has gone down I think it makes me look masculine, old, and like I have gained weight. I regret it so much and cry every day. I know I can’t go on like this but I am worried that reversing the procedure completely will give me jowls, which I never had to begin with. I understand you have some experience with reversing the procedure and I’m wondering if you think I will ever look like I used to. Thanks and please write back as soon as possible, I am becoming extremely depressed.

A: Sliding genioplasty reversal surgery can be successfully done. I have done two such procedures just in the last month. I do not have a picture of what you looked like before to see if you can return to your previous look. But that issue aside, if you put the chin back form whence it came I see no reason why you wouldn’t return to your preop appearance. You are obviously young with good skin elasticity so you should return without a high risk of jowling. The way to hedge that risk of howling in a setback genioplasty is to just go back 4 or 5mms and end up with an overall 1 – 2mm advancement change from the original. There is some reason you had the genioplasty and this may be a good compromise approach.

Dr. Barry Eppley

Indianapolis, Indiana