Will A Second Sliding Genioplasty Help Me?

Q: Dr. Eppley, Back in 2017, a surgeon convinced me to get a chin implant alongside a rhinoplasty to give me a better profile and to relax my strained mentalis muscle.
The implant felt tight and worsened my strain, giving me a pebble chin so I had it removed in 2019.

My chin sagged in the worst way and I couldn’t close my mouth naturally without forcing and making my chin ball up.

Another surgeon told me that it was scar tissue and advised me not to touch just massage and let it heal by its own, but I didn’t listen to him and went to another surgeon who performed a sliding genioplasty on my chins months ago (9mm horizontal advancement and 2mm vertical) to stretch the tissues.

It semi worked as it reduced the ptosis and I’m now able to close my mouth more naturally, but as you can see on the pictures, the ptosis is still there and not totally fixed.
I still feel like I have to force my lips together a bit and I sleep with my mouth open. I also get spasms and random contraction around my mouth. It’s like the muscles are trying to move by their own.

Do you think that you can help me? I’m very depressed.

A: Thank you for the additional information. Your case is a tough one as having had two prior surgeries you really don’t want to have a third…unless there is great assurance that it will actually make you better. With your still very short chin and having gotten some improvement from the prior sliding genioplasty (not sure why any vertical was ever added as you need to drive the chin forward as much as possible) it is certainly tempting to think that doubling your forward chin projection (out to 16 to18mms) would help even further. But to know if that is even possible would require either a lateral cephalometric x-ray (maybe your surgeon did it after surgery) or a cone beam scan of your chin.

Dr. Barry Eppley

Indianapolis, Indiana