Q:  Dr. Eppley, I would like to change the shape of my chin. It seems too wide. Several years ago I went to a doctor for a rhinoplasty and came out with a rhinoplasty and a chin implant.   I went in with no desire for a chin implant but in the consultation he suggested  I had a recessed/ weak jaw and that a chin implant would correct it. So as a young naive first timer to plastic surgery I said ok and every doctor I’ve seen since can not understand why that first doctor recommended that.

I’ve had x-rays done of it and showed them to other doctors, one has said it is minor and not causing much protrusion at all. This he thought it best to leave in as removing it could cause a gap or “witches droop” as he called it .

Another doctor said it can easily be removed, and should be,  so as usual Im confused. But I am erring on the side of caution and not touching it due to potential resulting problems. (i.e. its been there 15 years so I assume all the nerves/ muscles would have grown around it, thus to a non- medical mind as myself the removal of it seems complex) And by the way, that nose job was  a failure too. Its the nose job where I pay $10,000 and come out looking exactly the same except with a round bulky nose.

A: Your chin implant information is very relevant, as while the chin implant may not have provided much horizontal projection, it often adds width. So it could be making a contribution to your chin width issue. This would depend on what type of chin implant it is, but most used today are of the extended or winged type which always adds width. That is usually fine for men but I almost never use them in women because of that issue. Women look better with a more angular or tapered chin.

A chin implant removal is actually very straightforward and not complex at all. The key is to make sure the mentalis muscle is adequately resuspended if done intraorally or a submental tuck-up is done if removed from below.

Dr. Barry Eppley

Indianapolis, Indiana

Q:  Dr. Eppley, I am currently looking to having my Goretex chin implant removed after five years. I have always been unhappy with it as it is simply too big for my face. Can you please let me know how it is removed, any issues I should know and what the process to do it involves.

A:  Thank you for your inquiry. When it comes to removing a chin implant, it is often necessary to tighten the mentalis muscle/chin tissues at the same time to prevent chin ptosis or sagging afterwards. This is particularly relevant if it is a large implant and produced a significant stretch of the chin tissues. Much like a breast implant, what happens to the overlying expanded soft tissues on removal? The approach used for chin implant removal, intraoral vs. submental incision, would depend on how it was originally placed and how much loose chin tissues are expected to result. This could mean an intraoral mentalis muscle resuspension or a submental tuckup from underneath. There are, of course, some cases where simple implant removal is all that is needed…but these are only a minority of cases.

Regardless of what needs to be done, this is an outpatient done under sedation or general anesthesia. There is minimal recovery and discomfort afterwards. There are no restrictions after such surgery.

Dr. Barry Eppley

Indianapolis, Indiana

Q:  Dr. Eppley, I had a medpor chin implant placed in me about 18 months ago.  I would like this removed and replaced with a smaller implant for several reasons (mechanical problems and aesthetic reasons).  Can you remove the implant given the time frame I have had it? Thank you for your time.

A: Despite the fact that the Medpor material does allow for some superficial tissue ingrowth, it is by no means impossible or even that difficult to remove. The material gets the reputation for being difficult to remove as it is compared to silicone, which has a smooth and slippery surface which slides in and out of tissue pockets quite easily. But Medpor facial implants can be removed, it just requires a little more surgical effort and sometimes removing the old implant in pieces. The chin implant being in place 18 months does not impact the removal process anymore than if it was there 18 weeks or 18 years. Tissue ingrowth into the material occurs rapidly and very early after implantation. It does not get worse with longer times of implantation and, contrary to many opinions, does not get any bony ingrowth into it either. Since the tissue ingrowth just occurs into the outer layers of material, it does not get deeper or penetrate further beyojd a certain point.

Dr. Barry Eppley

Indianapolis, Indiana

Q: I just had a large chin implant placed two weeks ago with neck liposuction. I didn’t really feel I needed the implant in tyhe first place as I had a good chin. The implant is way too large and I don’t like how it feels. I am going to have it removed and I understand there can be sagging skin or nerve damage. Please please give me your advice as to what I can do to correct the sagging skin or rippling in the event that it does occur.

A: The first thing that I can say is it is only two weeks after surgery so there is still swelling, so it is hard to say yet that it may be too large. Also, it is very common to have a chin that feels stiff and wooden for weeks after surgery. This is a very unnatural feeling but it will eventually pass by six to eight weeks after surgery. So whether your feelings about the chin implant would be the same two months from as they are today is hard to say. Since I have no pictures of you, either before and after surgery, it is impossible for me to comment on whether the chin implant should or should not be removed.

That being said, if you are convinced that the chin implant needs to be removed then the sooner the better. The less time the chin soft tissues are stretched out the better. I would have no concern about nerve damage as removal does not cause that problem. It is all about whether the tissues will shrink back down without developing a sag. This problem can usually be averted by doing some soft tissue suspension during the implant removal.

Dr. Barry Eppley

Indianapolis Indiana