Q: It’s been 9 months since I underwent a sliding genioplasty (to move my chin forward and decrease vertical height). It seems like the bony portion of my chin is symmetrical but the soft tissue is not. My lip line is uneven at rest and looks more pronounced when I smile. This is very bothersome to me since my smile and lip line were even before the surgery. My doctor repositioned my mentalis muscles to help with lip incompetence and it seems like the right side is higher than the left. I think the muscles are working properly, it just seems that their origins or insertions are just not even. It has not gotten any better with time. I have an awkward dimpling on the right side of my chin also (the right side definately feels abnormal compared to the left). Wondering if the soft tissue can be corrected to give me an even lip line and smile. I’m not interested in redoing the osteotomy but really would like your opinion on the soft tissue aspect. I’m very uncomfortable with how I look right now which is really making me regret having the genioplasty done in the first place. Thank you for you time Dr. Eppley!
A: While the bone in chin osteotomies understandably gets the most attention, there is also associated soft tissues that are carried with it. Since these soft tissues, particularly the mentalis muscle, must be cut through to perform the procedure it must be put back together in the final phase of the wound closure after the osteotomy is completed. While it is not common to have mentalis muscle problems, they can happen.
The most common mentalis muscle problem relates to how it was resuspended. Inadequate suspension or suspension that has loosened during the healing phase can cause lip and chin asymmetries, dimpling in the chin, and an uneven lower lip during smiling. When these occur, they can be corrected but one must have a very clear understanding as to the location and type of muscle problem. Sometimes it may just be a matter of soft tissue release and the interposition of a fat graft. Other times it may require muscle tightening or shortening. Careful analysis of at rest and smiling photographs in front and side views will help make the correct diagnosis.
Dr. Barry Eppley