Mentalis Muscle Sagging: A Side Effect of Facial Contouring Surgery (Mentalis Resuspension, Mentalis Muscle Lift, Chin Ptosis Correction)
ptotic chin / chin ptosis
Cause
Chin bone reduction (reduction osseous genioplasty, intraoral osseous burring), chin implant removal
Anatomical mechanism: displacement and sagging of the chin muscle, atrophy of the chin fat tissue, capsular contracture
This refers to a condition in which, after chin bone contouring surgery, the origin of the chin's soft tissue, particularly the muscle (mentalis muscle),
becomes detached (displacement), causing the chin to sag.
Treatment
Thread lift, muscle plication, laser treatment, liposuction, Accu injections, V-Shurink, Ultherapy --- X
Mentalis resuspension + chin bone advancement (bony projection) + submental flap surgery --- O
Some clinics and doctors recommend thread lifts, laser treatment, liposuction, Accu injections, chin advancement, V-Shurink,
Ultherapy, and the like as treatments for sagging under the chin, but these have almost no effect.
The reason is that the bulging under the chin caused by a ptotic chin does not result from
fat suddenly accumulating under the chin after chin bone reduction or setback surgery; rather, the submental length has shortened, and the tension of the muscle and soft tissue
has become slack.
The solution, therefore, is to use, depending on the patient's condition, mentalis resuspension +
chin bone advancement (bony projection) + submental flap surgery as appropriate for each individual.
Among the side effects that are not uncommon after chin contouring surgery is the “witch’s chin,” or “ptotic chin.”
Feature 1: The tip of the chin sags downward, and the crease under the chin (submental crease) becomes pronounced.
Feature 2: The lip drops downward, so effort is needed to close the mouth.
Feature 3: The lower teeth show.
Feature 4: Pebbled dimpling appears when the mouth is closed.
When an intraoral incision is made for chin surgery,
the mucosa and the chin muscle are incised about 1cm above the groove at the gums (sulcus),
and the chin muscle is then dissected off the bone.
After this dissection, once the bone surgery is finished, the incision is sutured, but
i) Too little muscle is left at the origin (bone) when the muscle is incised.
ii) Too much muscle is excised, creating a gap.
iii) After extensive dissection, the bone is moved (set back) a great deal, so the origin of the chin muscle
cannot be sutured back to its original position (reapproximation),
and the chin muscle sags as if a rubber band had snapped.
ⅳ) Displacement (shift) of the origin of the chin muscle (mentalis muscle).
ⅴ) Long downward sagging.
ⅵ) Reduced muscle thickness and volume.
As a result,
1) With no muscle padding beneath the mucosal layer, there is a tight, stiff feeling.
2) The lip sags and does not close.
3) The lower teeth are exposed.
4) The sulcus deepens as the origin moves downward.
5) The chin muscle bunches up, or pebbled dimpling appears.
6) A witch’s chin, in which the area under the chin sags downward, and similar changes appear.
1. When the bone of a long, protruding chin is cut to shorten it or pushed back
(Reduction Osseous Genioplasty)
2. When protruding chin bone is ground down through an intraoral incision
(Intraoral Ossepus Burring)
3. When an implant was placed through an intraoral incision to correct a receding chin and later removed
(Removal of Chin Implant)
4. When chin surgery has been repeated
The angle between the neck and the underside of the chin (cervicomental angle) increases, and the area bulges.
This surgical method involves extensive dissection of the chin muscle and soft tissue,
and as the projection of the chin tip decreases, the chin muscle sags as a whole.
The muscle at the chin tip therefore sags most often and most severely, and the sagging of the chin tip looks worse when smiling.
Prevention
To prevent chin sagging, it is effective to combine setback osteotomy with
mentalis resuspension.
Treatment Method
Mentalis resuspension + chin bone advancement
*Chin Advancement
After osseous advancement genioplasty,
sagging under the chin and of the chin itself rarely appears.
This is because the soft tissue under the chin, such as the muscle and fat layer, is lengthened,
which raises its tension, so the soft tissue does not sag easily.
1. Mentalis Resuspension
2. Chin bone advancement (bony projection)
3. Submental flap surgery
Carefully examining each person's condition and applying the 3 methods above appropriately according to that condition
is the optimal solution.
* Academic Basis for the Treatment and Prevention of Ptotic Chin After Chin Surgery*
Cutting the bone and moving it forward (jumping osteotomy) + mentalis resuspension
The submental crease was eliminated by flap surgery.
History
- 13 years ago: “two-jaw surgery”
- 12 years ago: “inverted V-shaped chin osteotomy”
- 10 years ago: chin fat grafting 1 time, filler 2 times
- 3 years ago: facelift
Symptoms
- Lower teeth exposed.
- Muscle sagging.
- Looks long.
- The mouth closes only with effort.
- Heaviness.
- Chin tip asymmetry.
Surgery
Mentalis Muscle Lift
The degree of tooth exposure when the mouth is open was completely resolved.
The chin was also considerably shortened, and the symmetry of the sagging improved.
The everted lip was also resolved, as was the pointed, sagging chin tip.
The jawline has become gentler and the lip has moved upward, giving a relaxed appearance.
PH
1. Three years ago, Mandibular body augmentation with prosthesis(Hydroxyapatite of chemical bone) &
zygoma reduction
=> infection, Lt. side mandibular body
=> Irrigation and Antibiotics
2. Two years ago, chin augmentation with silicone implant
=> infection
=> removed 1 month later
3. 1 year ago, scar excision and chin lift operation at other country
Five times of operation for the chin during 3 years,
Before surgery, you can see that the lips were parted and the lower teeth were exposed.
After surgery, the lip moved upward into a natural position.
The lip is directed upward, and the sagging chin tip and lip have been raised.
The muscle contraction at the chin tip when the mouth is closed has disappeared.
You can see that the area under the chin has straightened and the everted lower lip has been raised.
After surgery, there is no strain on the chin, and the jawline is smooth.
PH
1st surgery: 12 years ago, Gore-Tex was placed to correct a receding chin.
2nd surgery: 4 months before the visit, philtrum reduction => the mouth did not close well.
3rd surgery: 2 months before the visit, the Gore-Tex was replaced with an 8mm silicone implant => the mouth closed even less.
4th surgery: 2 weeks after the 3rd surgery (2 and a half months before the visit), the silicone implant was replaced with a 5mm one.
5th surgery: 2 weeks after the 4th surgery (2 months before the visit), the silicone implant was removed.
6th surgery: 7 weeks after the 5th surgery (1 week before the visit), lip filler.
(Gore-Tex => silicone => replaced with smaller silicone => silicone removed)
CC
The mouth does not close. The patient desperately wants to be able to close the lips. Food and saliva often spill.
P/E
The soft tissue of the chin and the upper and lower lips was stiff, with almost no movement.
Plan
Wait while massaging the chin and lips so that the soft tissue softens.
It was decided to determine the timing of chin reconstruction surgery through regular checkups and examinations.
Although it has been only 1 month since surgery, the chin has shortened,
and the mouth can now be closed comfortably without effort.
After surgery, you can see that no walnut-like chin dimpling forms, because no effort is needed to close the mouth.
With the lips relaxed, all of the lower teeth were exposed before surgery,
but after chin ptosis correction the lower teeth are not visible and the appearance is natural.
The contrast is also clear in the three-quarter view. You can see that the chin has become much shorter.
There is a marked difference in the degree of lower tooth exposure.
In the side view, after surgery, the lips look relaxed and natural,
and you can see that the chin has also shortened.