Q: Dr. Eppley, I am interested in a sliding genioplasty revision.I had a sliding genioplasty in Feb 2014 moving my chin forward around 8.5mm. From the start it looked like the result was asymmetrical. 2 years later this is definitely the case. From my attached photos you can see that the left side is sticking out of the face slightly when viewed from the front and there is also a step off when viewing from the side. I’d like to know what my options are.
A: Most asymmetries after a sliding genioplasty comes from differences in the angle and length of the bone cuts on the two sides. Even subtle differences become really apparent when the horizontal movement become bigger. This creates asymmetry from the appearance that the chin is rotated (which it may well be) but often it is just two different lengths of the bone cuts.
In correction of your chin asymmetry, the first piece of information that would be very helpful is to know exactly what the bone looks like. This is where a 3D CT scan can be enormously helpful in understanding your existing chin shape as well as planning what to do about. Fundamentally it comes down to either reduction of prominent bone wings or augmentation of bone wing deficiencies…or some combination there of. You appear to need this exact combination by both your picture and your description of the chin asymmetry.
Dr. Barry Eppley
Q: Dr. Eppley, I am interested in a sliding genioplasty revision. I am a young male who underwent a sliding genioplasty six months ago to fix some minor facial asymmetry. The idea was to move the chin 1to 2 mms upward and 3 to 4 mms forward. Unfortunately, this didn’t happen. Instead, the right side was moved according to plan, but the left side wasn’t causing it to be rotated outwards and downwards. My chin is now crooked with the left side being considerably fuller both laterally and anteriorly, but also vertically longer (aproximately 5 mm height difference).
I’ve met with a new surgeon in order to try to get this corrected. He suggested an intra-oral burring of the bigger side (left) in order to spare me a scar. He said he would be able to reduce the height too. I did some research and it seems to be quite tricky to do an intra-oral burring for vertical reduction? I know you prefer the submental approach, but I’d like to hear your views on doing this intra-orally. Can the inferior border really be reached? How many millimeters can usually be removed vertically using the intraoral approach? And what are the chances of tissue sagging?
A:You are correct in assuming that it can be both difficult and unpredictable attempting to make these modifications through an intraoral approach. It would be simpler, more predictable and have lower risks of tissue sagging if it was done from a small submental incision. Seems like a difficult approach that has limitations when you are trying to fine tune the chin bone shape. You have already learned the lesson that when doing minor aesthetic corrections it is easy to miss the mark and still have residual issues. Any further revisions should be done with the technique that would be most likely to reach your goal with a low risk of further aesthetic issues.
Dr. Barry Eppley
Q: Dr. Eppley, I am seeking a sliding genioplasty or chin reduction revision. After a sliding genioplasty 18 months ago and two bone burring operations to reverse it (6 and 12 months after the original surgery) there are still areas of bone, on either side of my chin, that were not shaved back to create my original narrow shape. I am left with a wide bulky chin, the excess skin and tissue have sagged from over the past year. Now, after my most recent operation, I have even more tissue. I am always advised to go back to the trio of surgeons who did it but after this I really do not want to. There is a huge miscommunication and when they discuss things in Spanish, in front of me, I no longer trust them. I just want to have my normal looking chin back. Do you perform this type of revision and reconstruction surgery? How often?
A: While you did not state exactly the method by which your two chin revisional procedures were done, I suspect they were by an intraoral bone burring method. While you should have had the sliding genioplasty reversed by redoing the osteotomy and setting back where it once was, intraoral bone burring was destined to create exactly what you have now…a broader flat chin with soft tissue excess. The proper solution now is a submental chin reduction technique where the chin bone can be narrowed and the excessive chin soft tissue removed.
This is a sliding genioplasty and chin reduction problem that I see and treat regularly. It would be helpful to see some picture of your chin and to know the exact details of all three of your prior surgery.
Dr. Barry Eppley
Q: Dr. Eppley, I had a sliding genioplasty to narrow my chin. I told the doctor that them when I smile, my face looks big at the side of the chin so he mentioned that he’s gonna cut or reshape the bone there and remove some muscles. I’ve attached the photo of the before and after surgery. Because after I did this, every time I smile or not even smiling, I see my line around my chin area looking like someone took a bite out of it and the bone there’s gone. Also I feel like my chin is more narrow not like before. I really don’t mind if it’s making my chin comes forward, but not like before. It is possible to reshape the chin bone in any way. Or just simply just cut the middle and then put the bone in front?
A: Based on your pictures and the x-rays, what you had done was a sliding genioplasty that brought your chin forward and up a bit as well as had a central wedge taken from it to narrow it. This is clearly evident in the x-rays and by the plate fixation used. What this has done, and is not uncommon, is to narrow the chin but there is a step off at the back part of the osteotomy cuts. I see where no other bone has been removed…and certainly no muscle or soft tissue has been removed. This has left you with a chin that is now too narrow for the rest of your jawline…hence your interpretation that it looks like a bite has been taken out of the jawline behind the chin. (hollow part)
You have two options to consider for your sliding genioplasty revision. Probably rather than moving the bone back, which can be done, you could simply fill in the bone defects left along the jawline. (provided you are satisfied with the way the front part of the chin looks)
Dr. Barry Eppley
Q: I had a sliding genioplasty just one month ago in January 2011. It was advanced 8mm and I feel it was too much. I do not like how my chin looks. It is not a natural look. I also lost almost 2/3 of my lower lip which make the chin even bigger. It really has changed me a lot. I was wondering what can be done to recover the fullness of my lip. I am even considering a reverse genioplasty to bring it back to 5mm even though the cephalometric analysis says that I am short 9 mms. How long should I wait for a revision and any further interventions?
A: Now that you are roughly 6 weeks out from your initial chin surgery, most (but not all) of the swelling should have subsided. While there is some final swelling and stiffness of the chin that needs to go away in the next few months, that will only change the chin projection by maybe 1 to 1.5mms. Therefore if you feel the chin is too strong at this point, then it is and your decision to set it back some more is reasonable. A change from 8mm to 5mm is reasonable since it takes at 2 to 3mms to really see any difference. The time to make that change is NOW. The bone is not yet healed and it is a relatively easy plate and screw exchange to do the revision.
When you say you have lost ‘2/3s of my lower lip’, I am assuming you mean that you have a drooping lower lip otherwise known as lip incompetence or sag. Unlike chin swelling where time will make some of it go away, time will not lift up a sagging lower lip. This is a function of the mentalis muscle position/resuspension on the chin bone. To imrpove that situation, the muscle need to be lifted up higher in the bone and secured. This will help the lower lip get back to a more normal position. The sooner this is done the better as muscle scarring is occurring. So again, NOW is the time to revisit this with your surgeon and have these discussions.
Reversing/revising the effects of a sliding genioplasty are best done early before complete bone and soft tissue healing has occurred.
Dr. Barry Eppley