Q: Dr. Eppley, I was thinking if I would be a good candidate for a custom implant? I had a chin implant done two years ago but had it removed six months later because it did not look and appeared unnatural and asymmetric. This time, I want the implant to address the asymmetry of my chin and also add length and width to my jawline while also lengthening my chin. I have attached pictures to try and show you what I’m looking at getting resolved. Also, are custom implants significantly more costly? My left side of the chin is about 3-4 mm shorter than my right side. Also when I feel where my chin transitions to my jawline, there is more of a “dip” in the bone on my left side. I would like a more smoother jawline transitioning to my chin and a more prominent jawline on both sides as well. I have outlined the area of jawline I am referring to and that I would like it both extended horizontally and vertically. I have attached the picture of my previous implant to show the increase in asymmetry that the implant caused. I think the asymmetry caused the implant to not fit snug and was also the reason why I was able to move the implant from side to side even months after. And finally I have re-attached the ideal chin and jawline. I think what i’m looking to fix would give me the desired look.
A: Based on your pictures and your good illustrations, the only way you would get that chin result is with a custom chin implant. There is no off-the-shelf chin implant that would have those exact dimensions and shape. Why your first chin implant resulted in that undesired look is not known to me because I don’t know what style and size of chin implant it was. It may have been inappropriate for your chin based on a variety of factor6s including style, size and technical placement of the implant.
That being said, there are three ways to go about getting a ‘custom chin implant’. They are different because of how they are done and their cost.
#1.The least expensive way, because it costs no more than a standard implant, is to select a certain chin implant style and size and custom carve it either before and during surgery based on the illustrations you have shown. The limitation is that it is an approximation of the underlying chin anatomy.
#2 The second way is to get a 3-D CT scan and have an exact mandibular model made. From that model, I can then take an off the-shelf implant and then carve it to shape by placing it on the model. This is better than #1 because we would know the exact chin anatomy. The limiting factor is how close existing chin implants are to your needs. Besides the cost of a 3-D CT scan of your mandible (which your insurance will likely cover) is the cost of having the model made. ($ 1100)
#3 The most ideal way to get a custom chin implant is to take the mandibular model and I will then hand-care out a completely custom implant which will then be sent out for formal implant manufacture. The total additional cost of this approach is $3500
As you can see there are multiple ways to get a custom chin implant. But when it comes to having a chin implant that blends smoothly back along the jawline, a true custom chin implant is the only way to get that result in most cases.
Dr. Barry Eppley