Can Vertical Chin Lengthening Be Used To Correct A Soft Tissue Chin Pad Protrusion?
Q: Dr. Eppley, Four years ago I had a soft tissue reduction performed on my soft tissue chin pad. It was an intraoral thinning reduction. I was unaware at the time and the doctor did not communicate to me the level of potential for soft tissue contour deformities. The soft tissue took a long time to heal with edema in the excision site for months. Unfortunately, the soft tissue pad is now quite uncontoured and has an irregular shape from the surgery, and it seems as though the chin pad is not attached very well to the bone as it is hyper mobile and bags at the middle section of the chin. It is possible that some mentalis muscle was removed in the excision, I am unsure. I now have soft tissue chin balling to some extent. I have shown in the photos how the soft tissue lifts off the bone if I tilt my head or push the tissue up.
I have been to multiple surgeons since in pursuit of soft tissue contouring or tightening and or chin reduction. From the x-rays, it is obvious that the bone is not the primary contributor to the horizontal projection, but I have a significant soft tissue excess. In the photos, I have tried to show how the bottom point of the chin is very steep and meets the mid point of the chin (most prominent area) at a very steep angle. It is more pronounced on the right side than the left as the right side seems to have a slight deficit of tissue or is just irregularly shaped now. When i grow out my beard the tissue on the top / middle projects significantly and is a constant nightmare.
I fear that it may be hard to perform a submental tuck up with the bone as the bone still sticks out and due to the steep angle at the bottom. Maybe somehow with bone repositioning or something the tissue could be draped over it and tightened to create a more contoured appearance. I imagine there would have to be some kind of muscle resuspension too to get the chin to stick down. I have tried to show you all the angles in the photos and have demonstrated pulling down from underneath. The tissue will not come down over the bone perfectly as it is. I also have a little bit of submental fullness or skin excess which may make a submental tuck hard to perform. I have been turned away by other surgeons obviously because any procedure to the bone will result in a horrible soft tissue outcome. I am quite unsure about it and whether anything can be done. It is obviously a highly risky and difficult surgery. The photos do not completely demonstrate how the tissue is mis-shaped.
A: Thank you for your inquiry and sending your pictures to which I can say the following:
1) Intraoral soft tissue excision is never a good approach for the exact reasons you have observed. But that is past history.
2) The only new piece of information I can provide you is that you have a very flat mandibular plane angle. (chin and jaw angles on same horizontal plane) People that have such flat plane angles often have a soft tissue chin pad protrusion because the chin is actually vertically short. From my perspective the better approach initially and even now is vertical bony chin lengthening. That will do more for the soft tissue chin pad by stretching it out (unfurling it) than any further attempts at soft tissue reduction/manipulation on its own.
Dr. Barry Eppley