Is this a step-off deformity? Is a revision necessary? (Photo)

Question

I had a sliding genioplasty and chin implant removal done 6 months ago. I'm wondering if this bump underneath my chin is a step-off deformity and if a revision to shave it down would be necessary.

Earl Stephenson, Jr., MD, DDS, MBA · Answer

Dear teenreb,

Thank you for your question and the image—it offers a helpful visual context. It’s completely reasonable to notice changes under your chin following a sliding genioplasty, especially when paired with chin implant removal. Let’s look at what may be causing the fullness and what your next steps might be.

What Could Be Causing This:

Residual Swelling:
At six months post-op, low-grade swelling—particularly in the submental area—is still possible. This can cause fullness or a subtle "bump" under the chin that gradually resolves.
Step-Off Deformity:
A "step-off" refers to a palpable or visible ridge where the advanced chin bone meets the remainder of the jaw. It’s a known possibility after genioplasty, especially when the transition isn’t perfectly smooth.
Submental Fullness from Soft Tissue or Fat:
In some cases, lingering fat or minor skin laxity can give the appearance of a bulge, even when the bone work is technically sound.

A thorough clinical evaluation by a board-certified plastic or maxillofacial surgeon is essential. They’ll assess whether the fullness is bony, fatty, or soft tissue-based—and imaging like a CT scan can help clarify whether a bony step-off exists.

Treatment Options:
Observation:
If the concern is swelling or soft tissue settling, continued healing over the next 3–6 months may result in natural improvement.
Surgical Revision (If Bone Is the Cause):
If a true bony step-off is confirmed and is significantly affecting your contour or confidence, surgical contouring to shave the excess bone may be considered. This is a targeted procedure and typically well-tolerated when needed.
Soft Tissue Solutions:
If the issue is soft tissue rather than bone, options like radiofrequency-based skin tightening (e.g., FaceTite, Morpheus8) may help. These treatments stimulate collagen production and improve skin contraction, leading to a smoother profile without surgery.

In your case, the result shown in your second photo is absolutely realistic—but identifying the source of the irregularity is key to achieving it. With the right evaluation and tailored treatment, refinement is possible without rushing into unnecessary or aggressive revisions.

All the best,
Earl Stephenson, Jr., MD, DDS, MBA
ESJ Aesthetics

Michael P. Morrissette, DDS, FACS · Answer

It is difficult to determine the cause of the bump beneath your chin. I would recommend a follow-up with your surgeon to investigate the cause of this contour deformity. A CT scan would be very helpful.

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