How Can I Fix Mentalis Muscle Spasms After A Sliding Genioplasty?

Q: Dr. Eppley, I had a sliding genioplasty 4 years ago and I am still struggling my chin is in pain and has complete spasms I get Botox but it’s not lasting more than 7 weeks I don’t know what else can be done my surgeon just sent me to a neurologist they done scans ect and can’t find anything in them My surgeon just says he hasn’t seen this. Before I am desperate is there anything else I can do.

A: This is certainly a very unusual problem after a sliding genioplasty. Given that the procedure requires cutting through and then putting back together the mentalis muscle right at its origin, and then requiring the reattached muscle to be stretched over a longer bone distance (assuming that the chin was lengthened) one can see that is a theoretical source for muscle dysfunction. (although this is done routinuely and the problem of muscle spasm is rarely seen) 

While Botox appears to provide some good temporary relief any longer term benefit will require surgical intervention. Surgical options include: 1) reducing the amount of horizontal chin advancement that was done (giving the muscle less length on which two contract) and 2) releasing the muscle introrally and  placing an interpositional fat graft. Given the rarity of the problem I can not say which one may be more effective or whether either one would provide assured muscle spasm relief. But anatomically these are surgical remedies that make sense.

Dr. Barry Eppley

World-Renowned Plastic Surgeon