Will A Revision Genioplasty Help My Chin Feel Less Tight?

Q: Dr. Eppley, I am interested in learning more about I am interested in learning more about revision genioplasty. I had a 6mm silicone chin implant placed under the chin which I had for 18 months. It was uncomfortable and so stiff. I had this removed and replaced by a sliding genioplasty of 8mms. This is also very very tight and all my teeth and gums feel tight and I’m in constant discomfort. There is a heavy feeling in my chin and a real tightness which is made worse when I talk. I have had 3 steroid shots in to the scar and it has helped a bit. Can you add any thoughts as to what’s going on here and any possible treatment? I have attached pictures and x -rays. It’s been 9 months since the genioplasty.

A: Thank you for your inquiry and sending your pictures. Having persistent tightness regardless of whether one has had a chin implant or a bony genioplasty was done may speak to the possibility that any type of chin surgery in you will create the same effect. So it is possible that no revision genioplasty procedure may provide relief.

But the one observation I can make from your x-rays is that your bony genioplasty was positioned very high….much higher than normal. This makes the whole chin tissues vertically shortened and compressed. I think that happened because they wanted to place lag screw fixation and they unintentionally ended up having the downfractured chin segment moved way up to do so. (plate fixation would have avoided that positioning) In effect you have had an unintentional ‘jumping genioplasty’ technique done. I could easily see how that could make you chin tissues tight.

The revision I would see is to move that bony chin segment vertically down to create a more normal bony chin profile and relief the tension on the tissues. (keep most of the advancement but ‘re-lengthen’ the bone) This can be challenging given that lag screw fixation is often not easy to remove but it can be done.

But as I said originally, it is unknown whether any chin surgery will relieve your symptoms. But that is an unusual bone position for a sliding genioplasty.

Dr. Barry Eppley
Indianapolis, Indiana