Q: Dear Dr Eppley, I underwent a chin reduction with a jaw contouring operation about one year ago. As for the result, have always found that it looked odd. My chin was reduced by 1cm and now my mouth does not close properly at rest and there is a ‘balling’ shape to the muscle and a wrinkled look. I recently had a MACS lift as my jaw muscles also looked slack after the op. However my chin is unchanged and still feels loose, unattached and ‘balled up’. I have come across your writing online and think your expertise may help resolve this. What do you suggest?
A: If your chin reduction was done through an intraoral vertical osteotomy reduction technique, then you would likely end up with soft tissue excess over the chin area when a large amount (1 cm) is vertically reduced.. (mentalis muscle and skin) These excess soft tissues could very well end up looking like a ‘ball’ over the chin area. This could really be predicted beforehand as where is all of the soft tissue that covered the 1 cm that was removed supposed to go?
No form of a facelift would solve the excess tissue problems in the chin area nor should it be expected to. A MACS lift, like any form of a limited facelift, is a lateral or side of the face operation based on soft tissue pull. So it will tighten up any loose skin over the side of the jaw/jaw angle area/jowls, but will do nothing for the chin area. The chin area excess is a central problem that requires direct excision and tightening, most commonly done through a submental incisional technique.
Dr. Barry Eppley
Q: I had a facelift last year but am unhappy with some ‘dogears’ in my scar under my chin. Can this be improved by extending the scar?
A: Most full or more complete facelifts involve an incision under the chin. (submental incision) This is done to access the central neck area for fat removal and neck muscle tightening. Usually this is a very small incision and does not involve the removal of skin. It is simply a point of access. It is closed and there is very rarely any scar issues with it. Dog ears, a redundancy or bunching of skin at the ends of a scar, do not usually occur with this submental incision as no skin is removed. In short, this inicision is not there to do some sort of ‘neck tuck-up’.
There is a neck procedure done known as a submental tuck-up which is done for chin ptosis or sagging. But this is not done to create a neck lift. That is a fundamentally flawed approach as the neck can not really be lifted by this limited incision. To do so would require a much longer incision which would usually be cosmetically unacceptable. I have seen a few patients over the years who have had this type of procedure done elsewhere and the results have not been good for this very reason. You can not lift and remove enough neck skin with a cosmetically acceptable submental incision.
If you have dogears in your submental scar, I am wondering if this might be the operation that you had. The dogears can be removed but it will require extending the scar length as you have surmised.
Dr. Barry Eppley