Chin muscle repair after genioplasty

[GJ]

—remember in additional to the external scar tissue, there could be INTERNAL scar tissue surrounding that area.

Yep.
This is what I meant above when I said "what's looming below".

[ODog]

I don’t know, man. I had the same stiffness on right side of my UPPER lip and have most surface sensation. I just think it was nerve trauma that my fat surgeon inflicted on me, which was simply too great to recover from and the stiff feeling is simply how it manifested itself. I mean some people have weird like touching the lip feels like touching the chin - the nerves recovered in a weird way. Get your dentist to inject anaesthetic. If your stiff feeling gets worse, it’s probably the nerve.

Thanks for the reply. I had anaesthetic applied to the lower gums a couple months ago to remove my surgical screws (should’ve been removed earlier) and my lower lip was extremely warbled and crooked when moving it during this time. Is that normal or is that what you get when you apply anaesthetic to a area with damaged nerves? I didn’t notice increased STIFFNESS though FWIW, which clearly originates in the orbicularis muscle for me, not the actual lip.

By the way this stiff feeling is not there only when I move my lower lip. I can feel it almost reverberating in the background at rest. I can feel it a lot when I purse the lower lip just a tad.

[ODog]

Yeah it's usually those butterfly plates that cause issues. Regarding scar tissue, he should just be able to look at the lower lip to get an idea of what's looming below...you can even look yourself. Is there a lot of scar tissue (white, weird looking) inside your lower lip? Scar tissue can cause the symptoms you're describing, so I'd rule that out before considering anything else.

Yes I do have excessive scarring Inside the lower lip. I PM’d you a pic.

[ODog]

I don’t know, man. I had the same stiffness on right side of my UPPER lip and have most surface sensation. I just think it was nerve trauma that my fat surgeon inflicted on me, which was simply too great to recover from and the stiff feeling is simply how it manifested itself. I mean some people have weird like touching the lip feels like touching the chin - the nerves recovered in a weird way. Get your dentist to inject anaesthetic. If your stiff feeling gets worse, it’s probably the nerve.

I get what you’re saying and I sorta believe it may be nerve damage too. But why does this surgeon say nerve damage won’t cause stiffness? Maybe It’s possible you also had muscle damage that simply recovered.

I should say that I DO often have a crooked lower lip when smiling .

[ODog]

I think this is more common than you think.  I have talked to several people with this problem. Before getting any procedure or revision in the area, I suggest getting an MRN, its an MRI of the nerves.  It can show nerve entrapment and muscle problems. I had this done, and the images are nothing short of amazing.  Also, there is EMG muscle testing where they can test facial muscles—they do this in stroke patients. I totally believe that the surgeon can diagnose muscle entrapment as it feels totally different than normal tissue, but i would want a nerve and muscle assessment if possible.  Since the facial nerves in the area innervate those muscles, I would want to know if part of it is due to nerve damage. An MRN would also show scar tissue—remember in additional to the external scar tissue, there could be INTERNAL scar tissue surrounding that area. John Zuninga in Dallas is one of the few  in the country that does this imaging and he also does nerve testing (including the block described by PloskoPlus) Having this information would give you a better idea if muscle repair would help. The link below involves the shoulder but it described the imaging.

https://www.sciencedirect.com/science/article/pii/S0378603X16300171

Alright I guess Zuniga is the guy have to see before making my decision. Any idea as to the cost of the imaging? I called to inquire but the receptionist said she’d get back to me but did not.

[DRIVVEN]

Alright I guess Zuniga is the guy have to see before making my decision. Any idea as to the cost of the imaging? I called to inquire but the receptionist said she’d get back to me but did not.

It was covered by insurance for me, 40 dollar co-pay.  I would imagine they have non insurance prices too.  I think if you got a referral directly to the office, it would speak things up from trying to make a direct appt, even if its your PCP.

[ODog]

Ok, the muscle is imprisoned by something. It could be stuck between the bone cut...then 'sandwiched muscles'...so maybe he pulls out the meat between the bread.

Well why can’t any surgeon here in Canada pull the meat out between the bread? Seems like a simple procedure, yet nobody even suggests it?

[ben from UK]

Surgery after the age of about 35 increases the risk of nerve injury or other complications. Also, multiple procedures increase the risk.

[ODog]

Surgery after the age of about 35 increases the risk of nerve injury or other complications. Also, multiple procedures increase the risk.

I’m way under 35

[InvisalignOnly]

Sorry to hear about what happened to you - you are certainly not alone with this problem, one of the many reasons I was reluctant to undergo this surgery when I was younger was the fact that I read about speech problems as a possible complication and surgeons I spoke to confirmed this is a possibility.

My two cents (a lot of people will not like me for this but I'm trying to help): USD 3,000.- and upwards is a serious amount of money in India - even if I was determined to have this surgery there, I would negotiate the cost as they are most certainly giving you a higher price than what other people would pay. The fact that someone sounds confident about something does not mean anything, is certainly does not mean they're right. If you have never been to India, you'll get a massive culture shock first. I have spent part of my life in India and have family connections there but would not go there for serious, invasive surgery. If you're planning to do a surgery like this while it's your first time in India... well, good luck. I suggest you go to India for a holiday, not surgery, at least not the very first time you visit. It's an amazing country but it can take some time getting used to.

[kavan]

Well why can’t any surgeon here in Canada pull the meat out between the bread? Seems like a simple procedure, yet nobody even suggests it?

To address your question of 'then, why don't the NA doctors pull meat from sandwich', it's because a 'COULD BE' isn't a diagnosis of what it is. They would have to diagnose what ever med condition or name of it was something where the muscle somehow got trapped somewhere in vicinity of bone cut OR was just put somewhere where now the muscle has less FREEDOM than prior. This 'incarceration' relates to SOMETHING. It's just that it doesn't relate to a type of usage of that term with your NE doctors

I'm just trying to help 'brain storm' what this could be given the term 'muscle incarceration'. So, it could be muscle kind of 'stuck' between the bone cut. But within a 'could be' scenario, there is always a 'couldn't be'.

Another 'could be' that wouldn't be nerve damage would have to do with re-attaching everything back (muscle, ligament, tendon connections, whatever) after they detach when making dissection inside mouth to move the chin. So, do they re-attach exactly where they were before they detached or do they have to change where they attach to somewhere else due to chin being moved somewhere else than prior? I don't know.

So, we (well not me) don't know exactly what this is. Only what it could be. However, we DO know that through the incision inside the mouth below your lip, things were detached and later had to be attached somewhere. Also, when patients complain of lower tooth show subsequent to getting a chin implant where the incision is through inside of mouth, a PS (who does not put them in via inside mouth) does an operation to re-attach to a better place.

Again, IDK exactly what it is other than to suggest you engage your Canadian docs about the possibility of IF the structures they DETACHED and attached or re-attached after the surgery have something to do with your complaint. So, 'incarceration' could have something to do with the muscles not having the FREEDOM of function they used to have subsequent to their being put somewhere where they lost it. But your NE docs are not going to 'relate' to the
incarceration term because it's probably not in their med lingo to use it the way the Indian doctor is.

I would also suggest you ask the Indian doctor if his operation will involve DETACHING the muscle connections from where they were attached during your surgery and re-attaching elsewhere for better function.

[ODog]

M
My two cents (a lot of people will not like me for this but I'm trying to help): USD 3,000.- and upwards is a serious amount of money in India - even if I was determined to have this surgery there, I would negotiate the cost as they are most certainly giving you a higher price than what other people would pay.

You got that right. A consultation with him is literally 10x less than my consult with Cameniti in Canada. So you’re right he’s probably jacking up the surgical price. I’m sure I can negotiate somewhat. Even so, $5000 is not a lot of money to be speaking normally again.

 The fact that someone sounds confident about something does not mean anything, is certainly does not mean they're right. If you have never been to India, you'll get a massive culture shock first. I have spent part of my life in India and have family connections there but would not go there for serious, invasive surgery. If you're planning to do a surgery like this while it's your first time in India... well, good luck. I suggest you go to India for a holiday, not surgery, at least not the very first time you visit. It's an amazing country but it can take some time getting used to.

Well that’s really the point of this thread. I really wanted to know if anyone’s heard of NA surgeons performing this kind of revision. I don’t want to go to India. I also don’t want to live with this tugging feeling in my lower lip.

[Post bimax]

You got that right. A consultation with him is literally 10x less than my consult with Cameniti in Canada. So you’re right he’s probably jacking up the surgical price. I’m sure I can negotiate somewhat. Even so, $5000 is not a lot of money to be speaking normally again.

Well that’s really the point of this thread. I really wanted to know if anyone’s heard of NA surgeons performing this kind of revision. I don’t want to go to India. I also don’t want to live with this tugging feeling in my lower lip.

I think if anyone had heard of it they would have probably posted it.  The NA price would probably be even higher if you could find a Dr that does it.  Sounds like it's worth pursuing with the Indian doc IMO.  Going to India for a few days is a small price to pay for life changing result assuming it works out.

[ODog]

To address your question of 'then, why don't the NA doctors pull meat from sandwich', it's because a 'COULD BE' isn't a diagnosis of what it is. They would have to diagnose what ever med condition or name of it was something where the muscle somehow got trapped somewhere in vicinity of bone cut OR was just put somewhere where now the muscle has less FREEDOM than prior. This 'incarceration' relates to SOMETHING. It's just that it doesn't relate to a type of usage of that term with your NE doctors

I understand that, my concern is that nobody’s had any interest in diagnosing the problem, only Richardson. He sent me a voice message on Instagram basically saying that speech issues 7 months post-op indicates there is something very wrong. He says he sees more cases like this as more and more surgeons are doing genioplastys. But the surgeons here don’t even think speech problems post-op is indicative of anything. It’s Frustrating. Like it’s not taken seriously. [/quote]

I'm just trying to help 'brain storm' what this could be given the term 'muscle incarceration'. So, it could be muscle kind of 'stuck' between the bone cut. But within a 'could be' scenario, there is always a 'couldn't be'.

Another 'could be' that wouldn't be nerve damage would have to do with re-attaching everything back (muscle, ligament, tendon connections, whatever) after they detach when making dissection inside mouth to move the chin. So, do they re-attach exactly where they were before they detached or do they have to change where they attach to somewhere else due to chin being moved somewhere else than prior? I don't know.

So, we (well not me) don't know exactly what this is. Only what it could be. However, we DO know that through the incision inside the mouth below your lip, things were detached and later had to be attached somewhere. Also, when patients complain of lower tooth show subsequent to getting a chin implant where the incision is through inside of mouth, a PS (who does not put them in via inside mouth) does an operation to re-attach to a better place.

Again, IDK exactly what it is other than to suggest you engage your Canadian docs about the possibility of IF the structures they DETACHED and attached or re-attached after the surgery have something to do with your complaint. So, 'incarceration' could have something to do with the muscles not having the FREEDOM of function they used to have subsequent to their being put somewhere where they lost it. But your NE docs are not going to 'relate' to the
incarceration term because it's probably not in their med lingo to use it the way the Indian doctor is.

I would also suggest you ask the Indian doctor if his operation will involve DETACHING the muscle connections from where they were attached during your surgery and re-attaching elsewhere for better function.

Caminiti said patients often come him to complaining of feeling like they were “sewn up too tight.” This would be in line with what you are saying about not re-attaching the muscles properly, but Caminiti said this is not the case and if just FEELS that way. Well, it FEELS that way to me too. So it’s either he’s right or he just hasn’t come to realize that this may be a real problem. Regardless, how can I ask him
To re-stitch me if he’s not even confident that it’s the source of the problem?

I guess I’m just surprised that the best surgeon in Canada is offering me NO solution.

Richardson wouldn’t divulge too much info on what he would do precisely, probably because he knew I would take his plan to a surgeon here. I don’t know.

[ODog]

I think if anyone had heard of it they would have probably posted it.  The NA price would probably be even higher if you could find a Dr that does it.  Sounds like it's worth pursuing with the Indian doc IMO.  Going to India for a few days is a small price to pay for life changing result assuming it works out.

I’d probably get it close to free in Canada tbh, since it’s a complication of my surgery.