Will Hardware Removal After A Sliding Genioplasty Release My Deep Labiomental Fold?

Q: Dr. Eppley, I have a few questions about sliding genioplasty surgery.

1. I had a sliding (osseous) genioplasty last summer, but I still have a decent labiomental crease. I am not experiencing tightness unless I really pull by lower chin down, but it’s not bothersome. My surgeon is suggesting hardware removal (since he says it’s pulling the skin in, and scar tissue accumulates there), some bone shaving, and fat grafting. Hardware removal doesn’t seem promising, and bone shaving seems counterintuitive. Do you think these suggestions will help reduce the fold?

2. Does hardware add any projection, and will removal reduce projection?

3. Does cutting into the mentalis muscle and soft tissue again increase the chance of nerve damage? (Luckily I had no permanent numbness from the first procedure.)

4. Unrelatedly, I’m considering jawline implants, but I am fearful of bone resorption. (This is why I avoided chin implants.) Is this a risk of jawline implants?

Thanks so much!

A: A deeper labiomental fold is not going to be improved by hardware removal or bone shaving after a sliding genioplasty. That is a failure to appreciate the anatomic basis of the problem. This is the resilt of a change in the shape of the chin bone which now has a deeper concavity or stepoff beneath the labiomental fold. This bone area needs to be built up on top of the plate for which a dermal-fat graft works well for this problem.

Numbness comes from injury to the mental nerves which lies way to the sides of the mentalis muscles.

The best way to avoid the remote risk of bone resorption with jaw implants is to not do them.

Dr. Barry Eppley

World-Renowned Plastic Surgeon