Will the facial skin become loose after a 7mm genioplasty reversal? (Photo)

Question

I’m a 28-year-old man. Six months ago, I had a 7 mm horizontal sliding genioplasty. The surgeon did a great job, but I preferred the way my face looked before the surgery, so he’s going to move my chin back to its original position. However, I’m worried that if my chin is moved back by 7 mm, the skin on my face and under my chin will become looser or more saggy than it was before the genioplasty. Should I be concerned about this?

Alejandro Nogueira, MD · Answer

First of all, yes the skin, the muscles and all facial soft tissues are going to shrink back satisfactorily, however there are nuances here.

Make absolutely sure your surgeon has in mind, for the reversion procedure, to REATTACH the mentalis muscle tendon back onto the surface of the jaw; viewing the Xray you posted it is clear he'll have to fully dettach it to perform the reversal, normal and routinary, same normal and routinary than reattaching the mentalis; do discuss this thoroughly with him; should the mentalis muscle float free you'd get double chin, dislocation when expressing and lower lip incompetence, plus expression deformities; so not a trivial issue.

Second, you did NOT get a sliding genioplasty, it was a technique with major shortcomings, the surgeon did a very conservative forwarding (which is essential what a sliding thing does), and instead of doing a sliding he angled down the chin fragment, living a tiny hair-thick line of contact between jaw and chin fragment, in what I believe was an intent to increase the vertical height... or just a mistake... did you request from him vertical increase of your chin? If the vertical increase was a feature and not a bug, this is not the method accepted, instead a osseous grafting taken from iliac bone is the correct method, because this linear contact between jaw and chin fragment are non sufficient to obtain good ossification and bone healing, leaving you with a glass jaw prone to break with minor impacts (no, the titanium plate does not prevent this, ludicrous to pretend so).

I recommend you have a serious discussion with your surgeon and the real intentions he had when he angled down the chin fragment, which probably is the reason for your insatisfaction, was this an error or an intentional design? if intentional... why he did not supply bone grafting to create a solid assembly? if an error... maybe you need better hands and re-do the sliding.

Mats Hagstrom, MD (license on probation) · Answer

Most likely you have enough elasticity in your skin to not have a skin laxity after reversing the procedure repaired, and
That said, reversing the procedure may not give you exactly the same appearance you had before.
Everything has now healed with different anatomic relationships.
There may be some changes in both bone and soft tissue from having had the procedure.
If you’re unhappy with the result and want to go back to your original appearance, then you should let the surgeon do that.
If there are secondary issues, then you’ll need to deal with those later.
Best,
Mats Hagstrom MD

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Will the facial skin become loose after a 7mm genioplasty reversal? (Photo)

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