Excess chin tissue hangs down when I smile - Is Genioplasty my only option? (Photos)

Question

there’s excess tissue where my chin pad is. If I smile it droops down and looks like a witches chin.. Can this excess tissue be removed? Or is my only solution a reducrion Genioplasty? I believe I have an overactive mentalis muscle

Jeffrey H. Spiegel, MD · Answer

We can go in and remove the extra chin tissue through a small incision under the chin by the neck.  That is assuming it is mostly soft tissue (which your pictures suggest).

Timothy Osborn, MD · Answer

Looking at your photos, the good news is that at rest your chin and lip relationship looks quite balanced — there's no dramatic structural problem jumping out. What's clearly happening is that your mentalis muscle is overactive specifically with movement and expression, which is what creates that drooping, bunched chin pad when you smile.
What's driving it
The mentalis doesn't hyperactivate randomly — it's almost always responding to something structural underneath. In your case, the vertical height and forward orientation of the chin bone are the most likely culprits. When the geometry isn't quite right, the muscle compensates, and over time that compensation becomes the default pattern.
Your lower lip also has some anterior fullness, which is worth noting — it could suggest your lower teeth have some retroclination (tilting inward), which causes the lip to strain forward and the chin muscles to grip harder in response. That said, from photos alone it's impossible to say that definitively, and a proper clinical exam with imaging would be needed before drawing firm conclusions about your jaw and dental relationship.
Where to start
Before jumping to surgery, try conservative neurotoxin (Botox) injected into the mentalis. A small, precise dose can calm the muscle's overactivity and reduce the bunching without eliminating function. This is a reasonable first step that will also tell you how much of what you're seeing is muscle versus bone.
If neurotoxin gives you improvement but not enough, a reduction genioplasty — which addresses the underlying bone position driving the muscle behavior — is your most reliable long-term solution.
What to avoid
Don't let anyone simply shave the chin down without a full assessment, and avoid surgical resection of the mentalis — it's unpredictable and can create problems worse than what you started with.

Excess chin tissue hangs down when I smile - Is Genioplasty my only option? (Photos)

Answers (2)

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