Will A Sliding Genioplasty Help Improve My Lip Incompetence?

Q: Dr. Eppley, I had a bimaxillary osteotomy in August 2002 although was not at all happy with the results due to a advanced upper jaw and the genioplasty height was too long. I had corrective surgery in February 2003 to correct the upper jaw and genioplasty as well. I have read that this forms scar tissue and if I underwent a third genioplasty to shorten the chin slightly and to advance the chin forward and then have the chin muscle reattached or stitched in a more favorable position to reduce the lip incompetence and improve lower lip symmetry is this likely to be risky due to two previous surgeries done 10 years ago? From this information can you tell me if I’d be a suitable candidate or not and explain possible risks?

A: Thank you for sending your pictures. My perception is that your chin is too vertically long which is very evident on your x-ray. (although it looks longer on the x-ray than it does in your pictures) This would also account for for lip incompetence/sag. In theory, a bony genioplasty that brings the chin forward and shortens it slightly should be beneficial for both aesthetic and functional issues. My only reservation is that you have had two prior genioplasties and at least the second one should have addressed both of these chin issues. I am curious as to why you think this second or revisional genioplasty was ‘unsuccessful’.

In regards to your jaw angles, your x-ray show a high jaw angle and a shape that often occurs after a sagittal split mandibular ramus osteotomy in which there can be some reshaping of the angle with accentuation of the antigonial notch. While on the x-ray jaw angle implants look like they would be helpful, I am a little concerned about that when doing the computer imaging of you. Your jaw angles are a little wide naturally and even just vertically dropping them down may make your face look too full or ‘bottom heavy’. That may be particularly so when bringing the chin forward and vertically shortening it.

I have done some computer imaging from three angles and on your x-ray to get your thoughts on these potential changes.

Dr. Barry Eppley

Indianapolis, Indiana