Will My Chin Need A Revision After A Vertical Reduction Genioplasty?
Q: Dr. Eppley, I’ve just recently had upper and lower jaw surgery to correct an underbite. I also had a sliding genioplasty (4 mm vertical reduction). All of this was just done 5 weeks ago, so I realize I need to give it more time before know what the final results will be; it seems I still have some swelling. My questions/issues: 1) I’m wondering if the chin should have been reduced more. 2) I’m wondering if a have a bit of ptosis. I don’t notice it so much normally, but when I smile big, my chin gets flatter and seems to project out more. There seems to be a little loose/excess skin. The bottom half of my chin (maybe my chin pad?) seems a bit puffy and fatty, but maybe some of this is swelling. I’m not sure if a lipo of the chin area would fix this, or if the mentalis needs to be resuspended, etc. Or maybe it’s just in my head and it’s normal. Or maybe it’s swelling. I should note though that in 2002, I had a chin reduction that was done with a burr, and I’ve since learned that that can cause soft tissue issues. 3) The right side of my chin is a little longer than the left side, so it kind of makes my chin look a little slanted and the right side looks a little pointy. I’d prefer for the bottom of the chin to just be straight across (square-ish jaw line maybe?)
A: The first thing I would say, of which you already know, is that it is way too early to judge the final results of your recent bimaxillary jaw surgery even in the chin area. Quite frankly, you still have an ‘orthognathic’ facial appearance which means there is still swelling and the tissues havge not settled over the new skeletal base. I would not critique the results until a minimum of 3 months and preferably 6 months after the date of your orthognathic surgery. When the tissues feel soft, move normally, and most of the feeling has returned, then you can focus on the aesthetic outcome.
For the sake of discussion, if all of these chin asymmetry/shape issues persist, they can be further improved by a chin revision. Whether this is done by a submental or intraoral approach remains to be seen based on exactly what the issues are. The key is what the overlying soft tissues do and how they settle out.
Dr. Barry Eppley