Q: Dr. Eppley, I have never had any work done to the chin area although years ago I did have a submental incision at the crease where skin and tissue was removed and lipo done. Here are my concerns:
1) Chin Ptosis/witches chin is potentially causing:
a) A deep submental crease causing an unsightly irregularity between the point of the chin and throat. The excessive tissue that I can feel that has drooped down from the point of the chin seems to be part of the problem (chin ptosis). The skin and tissue around the chin is very thick and dense. The bone on the tip of the chin does not appear to be excessive but a profile x-ray would be needed to confirm this. maybe.
b) A very deep labiomental crease seems to have been caused by excessive mental muscle contraction. The crease has worsened as I have gotten older. I would like to have a smooth transition from the neck area to the tip of the chin.
Hope you have some positive things to say about you being able to help me with my profile.
A: Thank you for sending all of your pictures and detailing your concerns. In regards to the potential witch’s chin, that is not what you actually have. A witch’s chin deformity is when the normal chin tissues have slid off the bone for a variety of reasons. This chin soft tissue malposition creates an overhang off the end of the bone which also leads to a deepened submental crease an undesireable chin-neck profile. What you have is a normal bony chin and the chin soft tissues in proper position on the pogonion point of the chin but with a deepened submental crease. The deepening of the submental crease has been exacerbated by the prior facelift both anatomically and visibly.
The difference between a witch’s chin and what you have is anatomically different and requires a diametrically different approach to effectively treat. A witch’s chin is treated by the excision/removal of tissue and resuspension because there is a relative excess of soft tissues that are malpositioned. A deep submental crease with normal chin tissues after a facelift has to be treated by addition and not subtraction. Your chin and neck tissues are likely too tight to be able to simply remove and tighten them and end up with a smooth transition on the underside of the chin into the neck. Conversely the submental indentation needs to be released and augmented. Whether this is done by a dermal-fat graft or an implant onto the bone can be debated, each with their own advantages and disadvantages.
As for the labiomental crease, that is a very difficult problem to improve without some potential aesthetic liabilities. It is very deep and is an inverted skin fold. Nothing simply placed under it (injections of any kind) will push it out. The dermal attachments of the crease have to be released through an incisional approach and a fat graft placed under it. This places a scar in the crease line. While admittedly your labiomental crease line is like a scar anyway, this is an aesthetic issue of which to be aware.
Dr. Barry Eppley