Will Vertical Wedge Excision for Chin Ptosis Correction Work
Q: Dr. Eppley, I am interested in chin ptosis correction. I had two prior jaw surgeries (one orthognathic with sliding genioplasty). My mentalis muscle has been weakened and my lower third (chin particularly) looks bulkier because of this. There is some excess soft tissue around my chin as well (skin, maybe some fat). I’ve been thinking about mentalis muscle re-suspension, when I stumbled across this article which explains an alternative of Vertical Wedge Excision of Chin Ptosis.
This seems to me like a minimally invasive procedure with dramatic results that comprehensively addresses all laxity (muscle and skin). I wanted to ask you for your opinion on this, since I am worried about the longevity of the result when no sutures are used to resuspend the mentalis muscle. Perhaps a combination of both would be the way to go? Would you be able to perform this procedure preferably under sedation rather than general anesthesia as it involves no bone work? Also, since I am not from the States and would like to travel only once, would you be able to give me an indication of the approximate cost? I have attached here a picture for your reference – my problem seems to be largely excess soft tissue around the chin which makes it longer, bulkier horizontally and vertically and even asymmetrical, similarly to the pictures shown in the article that I linked above.
Thank you for your advice in advance.
A: Chin ptosis is a multifactoral problem that has different anatomic variants. Thus there is no one single best chin ptosis correction procedure. The first important classification is whether the chin ptosis is associated with a lower lip sag or not. If there is no lower lip sag there is no benefit to mentalis muscle resuspension or trying to move the chin tissues back upon the bone.
The next important chin ptosis classification is whether there is excessive chin tissues or whether there is a normal amount of tissue volume. If the overhanging chin tissues are normal in volume, and their resection may be associated with causing a lower lip sag, then resuspension should be done. When the ptosis is caused by excessive chin tissues then resection would be the appropriate approach.
When it comes to resection of the chin pad, it can be done horizontally (under the chin), vertically (as shown in the article) or through a combined vertical and horizontal technique. (inverted T) There is no question that adding a vertical direction to the chin pad excision provides an additional element of chin pad reduction that is helpful, it is just a question of the scar that can result from it. Once you go vertical, the scar is going to be noticeable since it is above the submental region. Whether the scar would be aacceptable depends on the magnitude of the excessive chin pad and the patient’s skin type. This article, which does not really describe a novel technique in my experience, shows a single case done on a Caucasian female. The resultant scar can be quite different in men of certain ethnicities.
But regardless of technique, any soft tissue chin work can be done under local/IV sedation.
Dr. Barry Eppley