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The sliding genioplasty is a commonly performed and effective method for specific  types of chin augmentation. One of the risks of the surgery is lower lip tightening and contracture. (lip shortening) One of the primary causes of this postoperative problem is the bony step off caused by the advanced chin bone. This creates a dead space underneath the mentalis muscle on closure which sets up the opportunity for the soft tissues to be pulled down into it during healing. This postoperative risk is increased the larger the chin bone movements are or if multiple bony chin surgeries have been performed.

The classic findings of such intraoral contracture are the triad of a tight lower lip, a scarred and deepened vestibule and an inferior lip position or sag. Some or all of these may be present in varying degrees. Such contracture findings represent a fundamental pathology…a soft tissue deficiency. This will not be improved by removal of the fixation hardware, a common treatment approach that rarely provides any improvement nor would it be expected to do so.

In severe cases of lip contracture/tightness after a sliding genioplasty the comprehensive approach to the problem is release, graft and lift. A complete intraoral release is necessary but the mucosal incisions for the release must factor in the how the tissues will be lifted and closed. One helpful maneuver to help raise the lower lip is a mucosal V-Y advancement. This maneuver recruits tissue up onto the vermilion of the lower lip through an initial V mucosal incision into the depth of the vestibule. The other soft tissue procedure that can be helpful is to raise up the vestibule through an excisonal shortening procedure. This requires horizontal incisions through the vestibule from canine to canine.Once these incisions are made a full release is down to the plate/bony step off.

Such a release creates a large space into which a graft needs to be placed. A fat graft is what is needed and, while fat harvested from any site will do, the buccal fat pad provides a very convenient source. This large lobulated fat graft fits into the newly created dead space providing anew softy tissue that will revascularize fairly quickly.

With the fat graft in place closure is done in multiple layers. The depth of the vestibule is raised and the V-Y mucosal advancement completed. This combination of procedures releases and raises the lower lip. The lip and vestibular lifts are supported by the fat graft which prevents some or all of any recurrent contracture. 

Dr. Barry Eppley

World-Renowned Plastic Surgeon

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