You are here:

Oral Surgery/Genioplasty Reversal / Ptosis

Advertisement


Question
Soft tissue Ptosis
Soft tissue Ptosis  
I had lower jaw surgery (for an open bite) and chin surgery several months ago. The chin was severely asymmetrical and elongated due to a gap left between the bone segments. The surgical plan was not followed and the original planned advancement was doubled to 8mm. A revision surgery to correct asymmetry, reset advancement back to original planned advancement only and to close the gap to shorten the chin was carried out a month later.
The chin looks shorter but still has the effect of elongating, masculinizing and narrowing an already long face (I have borderline maxillary excess). I'm a young female and this has ruined my looks from a frontal point of view. Additionally, my chin has soft tissue or muscle that sags beneath the chin bone. When I close my lips together, the muscle dimples when I never had any mentalis strain originally.
I want to completely reverse the chin bone to its original position and correct the ptosis. Why would the muscle become unattached from its origins or droop? Why was there a gap left between the bones (when I was told my face would look a bit shorter as a consequence instead)? What method would correct the ptosis? I hear mentalis reattachment is a procedure that tends to fail and I am terrified that I am permanently disfigured. How does wearing a chin strap for 2 weeks help prevent drooping? Please be as technical in your explanations as possible. Thank you so, so much.

Answer
Thank you for your question.
(Why would the muscle become unattached from its origins or droop?) When the chin is advanced, the mental is muscle is cut at its origin. When the tissue is closed after the attachment, the muscle is sutured back together and and chin strap is placed for about 10 to 14 days to allow healing so you don't get the ptosis.
(Why was there a gap left between the bones (when I was told my face would look a bit shorter as a consequence instead)?) There is a gap between the bones as a result of the anterior mandible being cut from its position and advanced. As you move the bone forward, a gap is created at the inferior portion of your mandible and there piece that is moved forward.
(What method would correct the ptosis?) To correct the ptosis, the area needs to be opened again and the mentalis muscle either reattached with sutures or if there is no origin anymore on the bone, a hole is drilled in the bone/mandible and the muscle is attached to the hole created in the bone at where the muscle should be attached to.
(I hear mentalis reattachment is a procedure that tends to fail and I am terrified that I am permanently disfigured. How does wearing a chin strap for 2 weeks help prevent drooping?)The chin strap helps keep the muscle still and keeps pressure at the area  of healing. To help in the healing, the muscle needs to be still without movement so it can reattach. Any movement at the origin or insertion will let the muscle pull off the area of healing and result in ptosis. The procedure does not tend to fail if done correctly. I hope that helps.

Oral Surgery

All Answers


Answers by Expert:


Ask Experts

Volunteer


James M. Ryan. DDS, MS; Board Certified Oral and Maxillofacial Surgeon

Expertise

Dr. Ryan's expertise is in the field of Oral and Maxillofacial Surgery. Specifically, Dr. Ryan is an expert in Orthognathic Surgery. He holds uniques experience as the former Assistant Program Director of the Oral and Maxillofacial Surgery Residency Training Program at Washington Hospital Center where he trained residents to perform these complicated surgical procedures. Additionally, Dr. Ryan also has a tremendous amount of experience in reconstruction of the maxillofacial skeleton related to trauma and tooth loss. Dr. Ryan is an expert in 3 dimensional treatment planning for Orthognathic Surgery, Dental Implant Surgery and Wisdom Teeth removal. To learn more about Dr. Ryan, his full profile can be seen at www.eosdds.com

Experience

Diplomate of the American Board of Oral and Maxillofacial Surgery with current hospital affiliations at: Washington Hospital Center Holy Cross Germantown Hospital National Institute of Health/NIDCR

Organizations
American Dental Association. American Association of Oral and Maxillofacial Surgeons. District of Columbia Society of Oral and Maxillofacial Surgeons. District of Columbia Dental Society. American Board of Oral and Maxillofacial Surgeons. Health Volunteers Overseas.

Publications
Journal of Oral and Maxillofacial Surgery Journal of The American Dental Association

Education/Credentials
S.U.N.Y @ Stony Brook- B.S. in Biochemistry, Stony Brook, NY. Northeastern University- M.S. in Perfusion Technology, Boston, MA. D.D.S.- New York University College of Dentistry, New York, NY. Certificate and Chief Resident- Washington Hospital Center, Washington, DC. Clinical Fellow- The Johns Hopkins Hospital, Baltimore, MD.

Awards and Honors
Dr. Ryan has received numerous awards including: 2006 American Association of Oral and Maxillofacial Surgeons Dental Student Award, Washington Hospital Center 2008 Nurses' Choice Physician Collaboration Award, 2009 Resident Research Summit Scholarship Award, and the 2011 Outstanding Surgical Attending in the Department of Oral & Maxillofacial Surgery at Washington Hospital Center. He has also authored/coauthored and published several journal articles and held several teaching positions,including assistant professor, while at NYUCD.

©2016 About.com. All rights reserved.