What are Your Thoughts On Soft Tissue Chin Pad Reduction?

Q: Dr. Eppley, I have read your articles on mentoplasty with great interest. If it is not too much trouble, I would very much appreciate your advice pertaining to chin reduction surgery.

I would like to ask please:

(I) If undertaking a bony reduction of the chin by way of bone shave/bur, what is the maximal amount that is generally achievable, anteriorly (and vertically)? I appreciate that soft tissues resuspension is vital. 

(ii) What are your thoughts on mentalis or soft tissue pad reduction?

(iii) I am a young female that is requesting a downsize in my chin implant. The previous implant was placed by another surgeon overseas (~1yr ago) via a submental incision, and revised shortly after by the same surgeon. It unfortunately resulted in a pigmented and widened submental scar. Mysubmental tissues are somewhat firm. I want an intra-oral approach in light of this adverse scar outcome. My proposed new implant will only drop anterior projection by 1-2mm, so I do not anticipate a significant issue with chin pad ptosis/excess.  If proceeding with an intra-oral approach, do you do anything in addition to re-opposing the mentalis msucle? Ie Does one need to also anchor mentalis back to the mandible? And if so, do you use a screw and suture, or Micromitek?

Your expert advice is greatly appreciated.

A:In answer to your chin reduction questions:

1) When doing any form of shaving/burring for a bony chin reduction I never do that intraorally. That is only going to result in soft tissue chin pad ptosis no matter what suspension technique is used. I only do that through a submental approach where the soft tissue excess can be managed by an excisional tuck.

2) Soft tissue chin pad reduction, as mentioned above, can be effectively done through a submental approach.

3) If an existing submental scar exists, particularly if it is widened and pigmented, you have nothing to loss by cutting out that scar and performing the chin implant reduction inferiorly. There is a good chance you will make the scar better (and certainly no worse) and any concerns about soft tissue redundancy can be definitely managed. The only reason to ever go intraorally would be if a submental scar did not exist.

Dr. Barry Eppley

Indianapolis, Indiana