I've been doing osseous genioplasties (sliding and multidimensional) for 20 years, so my opinion is backed by experience.I must thank you for posting the Xrays, they are critical in all the cases and furthermore in revision cases like yours.I see your preop Xray and the only and right indication that comes to my mind is applying an overlapping technique of sliding genioplasty, aka "jumping genioplasty"; yuor chin was to short in depth and too long vertically, a pretty common combination in the office of genioplasty surgeons; did your surgeon detect this? probably... I can guess it from the technique he used, which was not a jumping genioplasty.To begin with, the standard sliding genioplasty needs a strictly horizontal cut at the chin or the closest possible to be horizontal, otherwise you will be producing paradoxical effects or unwanted ones; as is evident in your Xray your osteotomy (bone cut) was:-not horizontal but in a quite random angle which seems too vertical to me-asymmetrical, on one side the cut is different to the other, this explains the asymmetry noticeable in your frontal look-and, the most important to explain your muscular issues, too marginal, too cautious; the cut should have covered a larger chin area; in a sliding genioplasty the whole chin and part of the sides of the jaw are cut and mobilized (like a boomerang or horse shoe shaped piece of chin bone)In the overlapping genioplasty you perform a complete horizontal cut just below the mentalis nerves point of exit and through the whole chin and its side wings, the mobilize the cut fragment attached to the oral muscles, and finally overlap the fragment so that the back cortex of the chin jumps onto / makes contact with the anterior surface of the jaw; by means of this witty maneuver the chin is forwarded and at the same time vertically shortened, which is what you needed.In your case the surgeon did a too vertical cut of a too small fragment of the chin bone, then he has rotated this fragment and then applied screws to fix the fragment at a higher position; is this rotation of a too small fragment which includes partially the oral muscles the cause of your discomfort.Solution is complex now, to begin with it is essential to get a 3D reconstruction CT scan to assess the anatomical detail of the assembly and plan the future revision; hypothetically one solution might be reversing the fragment back and apply an interpositional graft so that the forwarding is achieved without such vertical tension.See the link below to find few cases of my own practice very similar to yours which I had the opportunity to operate successfully on, sharing a lot of common features with the technical problem you have posted.
