How much do you think my chin was moved forward? (Photos)

Question

I had sliding genioplasty 4 years ago. I wanted only a slight advancement, like 5-6mm. My surgeon said he moved it 6-7mm. I am still mostly numb in my lip and chin and have a lot of tightness. Do you think my chin was moved forward more than 6mm? The farther the chin is advanced, is there more damage to nerves and soft tissue. I am just trying to understand what when wrong.

Sanchaita Kohli, MDS · Answer

Hi Catdreamer. 
The chin segment appears to have been moved both forward and downward. So even if the forward movement was around 6 mm, the effective change would be greater because there was a shift downward as well. 
Bony healing appears to be satisfactory. But there are a few points to note here regarding your query:
1. It is unfortunate to learn about the lack of your sensory recovery. However, long lasting damage to the nerves depends more on the precision of the bony cut and surgical nerve dissection and preservation than on the amount of chin advancement. We have performed several chin advancements greater than 10 mm safely while preserving the integrity of the nerves and sensation over the lip and chin region.
Modern technologies like ultrasonic bone surgery prevent injury to the nerves and advanced 3D virtual surgical planning techniques ensure great precision while operating. This alleviates the risk of permanent mental nerve injury.
2. We can achieve far greater predictability with the results these days with modern tools like custom cutting guides and custom titanium fixation plates. There are 3D plates available in standard sizes like 4mm, 6 mm, 8 mm that ensure that your advancement is exactly the same as that planned.
Hope this helps.

Barry L. Eppley, MD, DMD · Answer

There is little if any aesthetic difference between 5-6 to 6-7mms of chin advancement. A greater amount does not increase the risk of nerve injury or soft tissue tightness. It is all about where the level of the bone cut is relative to the inferior alveolar nerve both in its intrabony course as well as its exit from the bone. Soft tissue tightness frequently results from contracture of the soft tissues into the bony step off of the advanced chin bone.

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