Background: The excessively projecting chin is most commonly perceived as a bone problem. And while that can be true in some patients a soft tissue excess can potentially be created by bone reduction alone. This is particularly relevant when an excessive soft tissue problems exists initially.
This is most commonly seen when a stronger than desired horizontal chin protrusion exists with dynamic soft tissue chin pad ptosis. This is seen when the chin has too much projection at rest (bone problem) and the soft issue chin pad pulls down when smiling. (soft tissue problem) This is a sure setup that if only the bone its reduced the soft tissue problem will be come magnified.
The need for horizontal chin bone reduction with a soft tissue chin pad excess obviates the use of an intraoral sliding geniopalsty setback…as this does not solve the soft tissue problem. A submental approach is needed so that both bone and soft tissue excesses can be concurrently treated.
Case Study: This female was bothered by her large chin that has excessive projection and a dynamic chin pad ptosis. Under general anesthesia and through a submental incision a 5mm reduction of bony projection was reduced by a reciprocating saw. These were prominent mental tubercles which often appear in a triangular configuration which are more common in men than women but can appear in either gender.
Once the bone was reduced the soft tissue pad was released and pulled down over the reduced bone and sutured to its inferior border. This tucked the upper incisional edge under the fat layer of the lower submental incisional edge. The skin and fat from the submental side was excised and closed.
When the results were assessed three months later the chin projection was less with a less deep labiomental fold.
Equally importantly the chin pad ptosis when smiling was diminished.
Key Points
1) An excessively projecting chin can be the result of excessive bone, soft tissue chin pad or both.
2) The excessive horizontally projecting female chin can be reduced by bone reduction but will also need soft tissue chin pad reduction as well.
3) Hyperdynamic chin pad ptosis can be resolved by chin pad excision and an inferior border tuck.
Dr. Barry Eppley
World-Renowned Plastic Surgeon